|
HC METHADONE SCRN URN
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| 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 |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC METHADONE SCRN URN
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
|
|
HC METHADONE SERUM LVL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100575
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UHC Core |
$26.66
|
|
|
HC METHADONE URN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
|
|
HC METHADONE URN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100576
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: UHC Core |
$26.66
|
|
|
HC METHANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UHC Core |
$28.22
|
|
|
HC METHANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
|
|
HC METHEMOGLOBIN
|
Facility
|
OP
|
$46.10
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$41.49 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.25
|
| Rate for Payer: BCBS Complete |
$4.71
|
| Rate for Payer: BCBS MAPPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$39.65
|
| Rate for Payer: Cofinity Commercial |
$32.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$41.49
|
| Rate for Payer: Mclaren Medicaid |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$8.20
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.18
|
| Rate for Payer: PACE Medicare |
$7.79
|
| Rate for Payer: PACE SWMI |
$8.20
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: PHP Medicare Advantage |
$8.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.27
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health SBD |
$29.04
|
| Rate for Payer: Railroad Medicare Medicare |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.84
|
| Rate for Payer: UHC Core |
$12.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.20
|
| Rate for Payer: UHC Exchange |
$8.20
|
| Rate for Payer: UHC Medicare Advantage |
$8.45
|
| Rate for Payer: VA VA |
$8.20
|
|
|
HC METHEMOGLOBIN
|
Facility
|
IP
|
$46.10
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$41.49 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.96
|
| Rate for Payer: Cash Price |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$32.27
|
| Rate for Payer: Cofinity Commercial |
$39.65
|
| Rate for Payer: Healthscope Commercial |
$41.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.18
|
| Rate for Payer: PHP Commercial |
$39.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.27
|
| Rate for Payer: Priority Health SBD |
$29.04
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
OP
|
$173.50
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$121.45
|
| Rate for Payer: Cofinity Commercial |
$149.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$156.15
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$109.30
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
IP
|
$173.50
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.30 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$149.21
|
| Rate for Payer: Cofinity Commercial |
$121.45
|
| Rate for Payer: Healthscope Commercial |
$156.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: Priority Health SBD |
$109.30
|
|
|
HC METHYLMALONIC ACID
|
Facility
|
OP
|
$61.11
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
30100373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$22.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.51
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$21.21
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$21.21
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.21
|
| Rate for Payer: Healthscope Commercial |
$55.00
|
| Rate for Payer: Mclaren Medicaid |
$11.60
|
| Rate for Payer: Mclaren Medicare |
$21.21
|
| Rate for Payer: Meridian Medicaid |
$12.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: PACE Medicare |
$20.15
|
| Rate for Payer: PACE SWMI |
$21.21
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: PHP Medicare Advantage |
$21.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.78
|
| Rate for Payer: Priority Health Medicare |
$21.21
|
| Rate for Payer: Priority Health SBD |
$38.50
|
| Rate for Payer: Railroad Medicare Medicare |
$21.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.45
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.21
|
| Rate for Payer: UHC Exchange |
$21.21
|
| Rate for Payer: UHC Medicare Advantage |
$21.85
|
| Rate for Payer: VA VA |
$21.21
|
|
|
HC METHYLMALONIC ACID
|
Facility
|
IP
|
$61.11
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
30100373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$55.00 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.89
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Healthscope Commercial |
$55.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.78
|
| Rate for Payer: Priority Health SBD |
$38.50
|
|
|
HC MFM CORDOCENTESIS
|
Facility
|
OP
|
$429.05
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
36100262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.91 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$150.91
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Priority Health SBD |
$270.30
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.91
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$198.10
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
HC MFM CORDOCENTESIS
|
Facility
|
IP
|
$429.05
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
36100262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.30 |
| Max. Negotiated Rate |
$386.14 |
| Rate for Payer: Aetna Commercial |
$364.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.88
|
| Rate for Payer: Cash Price |
$343.24
|
| Rate for Payer: Cofinity Commercial |
$300.34
|
| Rate for Payer: Cofinity Commercial |
$368.98
|
| Rate for Payer: Healthscope Commercial |
$386.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.69
|
| Rate for Payer: PHP Commercial |
$364.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.34
|
| Rate for Payer: Priority Health SBD |
$270.30
|
|
|
HC MG EVALUATION WITH MUSK REFLEX, S
|
Facility
|
OP
|
$81.83
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$73.65 |
| Rate for Payer: Aetna Commercial |
$69.56
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$73.65
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.56
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$69.56
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.28
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$51.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC MG EVALUATION WITH MUSK REFLEX, S
|
Facility
|
IP
|
$81.83
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$73.65 |
| Rate for Payer: Aetna Commercial |
$69.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.19
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Healthscope Commercial |
$73.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.56
|
| Rate for Payer: PHP Commercial |
$69.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.28
|
| Rate for Payer: Priority Health SBD |
$51.55
|
|
|
HC MG EVALUATION W REFLEX
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health SBD |
$50.12
|
|
|
HC MG EVALUATION W REFLEX
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.63
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.69
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$50.12
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC MGLUR1 AB CBA, S
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200464
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health SBD |
$157.50
|
|
|
HC MGLUR1 AB CBA, S
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200464
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Cofinity Commercial |
$175.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$157.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MGLUR1 AB IFA, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200465
|
|
Hospital Revenue Code
|
302
|
| 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: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC MGLUR1 AB IFA, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200465
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MGLUR1 AB IFA TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
