|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.98
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health SBD |
$30.38
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.60
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$10.08
|
| Rate for Payer: Priority Health SBD |
$30.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCN Commercial |
$12.17
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.74
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health Narrow Network |
$10.99
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.74
|
| Rate for Payer: UHC Medicare Advantage |
$13.74
|
| Rate for Payer: UHCCP Medicaid |
$7.74
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health SBD |
$24.89
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$194.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.66
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS Trust/PPO |
$184.71
|
| Rate for Payer: BCN Commercial |
$184.71
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$272.10
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health SBD |
$244.89
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health SBD |
$111.00
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.48 |
| Max. Negotiated Rate |
$265.55 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$88.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.52
|
| Rate for Payer: BCBS Complete |
$70.48
|
| Rate for Payer: BCBS Trust/PPO |
$265.55
|
| Rate for Payer: BCN Commercial |
$265.55
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.97
|
| Rate for Payer: Priority Health Narrow Network |
$88.78
|
| Rate for Payer: Priority Health SBD |
$111.00
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$174.78 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$38.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$174.78
|
| Rate for Payer: BCN Commercial |
$174.78
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.84
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$53.67
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health SBD |
$48.30
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.58 |
| Max. Negotiated Rate |
$425.47 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna Medicare |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: BCBS Trust/PPO |
$425.47
|
| Rate for Payer: BCN Commercial |
$425.47
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.11
|
| Rate for Payer: Priority Health Narrow Network |
$136.89
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna Medicare |
$85.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: BCBS Complete |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$67.60
|
| Rate for Payer: BCN Commercial |
$67.60
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$107.21 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.61
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$119.12
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health SBD |
$107.21
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$387.56 |
| Max. Negotiated Rate |
$25,485.33 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna Medicare |
$8,432.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,135.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,135.80
|
| Rate for Payer: BCBS Complete |
$4,563.54
|
| Rate for Payer: BCBS MAPPO |
$8,108.64
|
| Rate for Payer: BCBS Trust/PPO |
$4,882.79
|
| Rate for Payer: BCN Commercial |
$4,882.79
|
| Rate for Payer: BCN Medicare Advantage |
$8,108.64
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Commercial |
$8,897.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,108.64
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Mclaren Medicaid |
$4,346.23
|
| Rate for Payer: Mclaren Medicare |
$8,108.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,514.07
|
| Rate for Payer: Meridian Medicaid |
$4,563.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,324.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: Nomi Health Commercial |
$17,028.14
|
| Rate for Payer: PACE Medicare |
$7,703.21
|
| Rate for Payer: PACE SWMI |
$8,108.64
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: PHP Medicare Advantage |
$8,108.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,346.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,485.33
|
| Rate for Payer: Priority Health Medicare |
$8,108.64
|
| Rate for Payer: Priority Health Narrow Network |
$20,388.26
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,108.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.56
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,108.64
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,108.64
|
| Rate for Payer: UHCCP Medicaid |
$4,565.16
|
| Rate for Payer: VA VA |
$8,108.64
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,007.52 |
| Max. Negotiated Rate |
$11,439.32 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,261.73
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Cofinity Commercial |
$8,897.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,897.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health SBD |
$8,007.52
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,759.91 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna Medicare |
$2,199.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: BCBS Complete |
$1,759.91
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,399.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,771.86 |
| Max. Negotiated Rate |
$3,959.79 |
| Rate for Payer: Aetna Commercial |
$3,739.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,859.85
|
| Rate for Payer: Cash Price |
$3,519.82
|
| Rate for Payer: Cofinity Commercial |
$3,079.84
|
| Rate for Payer: Cofinity Commercial |
$3,783.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,079.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,519.82
|
| Rate for Payer: Healthscope Commercial |
$3,959.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,739.80
|
| Rate for Payer: PHP Commercial |
$3,739.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,859.85
|
| Rate for Payer: Priority Health SBD |
$2,771.86
|
|
