|
HC FECAL OCCULT BLOOD IMMUNOASSAY
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
30100123
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.47
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.68
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Medicaid |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$13.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PACE Medicare |
$4.16
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$4.38
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Priority Health Tiered Network |
$3.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.57
|
| Rate for Payer: UHC Core |
$6.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.38
|
| Rate for Payer: UHC Exchange |
$6.57
|
| Rate for Payer: UHC Medicaid |
$2.29
|
| Rate for Payer: UHCCP Medicaid |
$2.29
|
| Rate for Payer: VA VA |
$4.38
|
|
|
HC FECAL OCCULT BLOOD PEROXIDASE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82270
|
| Hospital Charge Code |
30100121
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Advantage |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.41
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC FECAL PH
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$5.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health Tiered Network |
$2.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.37
|
| Rate for Payer: UHC Core |
$5.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.58
|
| Rate for Payer: UHC Exchange |
$5.37
|
| Rate for Payer: UHC Medicaid |
$1.87
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC FECAL PH
|
Facility
|
IP
|
$24.41
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$21.97 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.53
|
| Rate for Payer: Healthscope Commercial |
$21.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.31
|
| Rate for Payer: PHP Commercial |
$20.75
|
| Rate for Payer: Priority Health SBD |
$15.38
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
|
|
HC FECAL REDUCING SUBSTANCE
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
30100427
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$2.88
|
| Rate for Payer: Mclaren Medicare |
$5.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$8.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.50
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: Priority Health Tiered Network |
$4.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.25
|
| Rate for Payer: UHC Core |
$8.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.50
|
| Rate for Payer: UHC Exchange |
$8.25
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.50
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
IP
|
$76.84
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.41 |
| Max. Negotiated Rate |
$69.16 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.95
|
| Rate for Payer: Cash Price |
$61.47
|
| Rate for Payer: Cofinity Advantage |
$53.79
|
| Rate for Payer: Cofinity Commercial |
$66.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.47
|
| Rate for Payer: Healthscope Commercial |
$69.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.63
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.41
|
|
|
HC FECAL WBC LACTOFERRIN
|
Facility
|
OP
|
$76.84
|
|
|
Service Code
|
CPT 83630
|
| Hospital Charge Code |
30100273
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$69.16 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$20.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS MAPPO |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.01
|
| Rate for Payer: BCN Commercial |
$21.01
|
| Rate for Payer: BCN Medicare Advantage |
$19.70
|
| Rate for Payer: Cash Price |
$61.47
|
| Rate for Payer: Cash Price |
$61.47
|
| Rate for Payer: Cofinity Advantage |
$53.79
|
| Rate for Payer: Cofinity Commercial |
$66.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.70
|
| Rate for Payer: Healthscope Commercial |
$69.16
|
| Rate for Payer: Mclaren Medicaid |
$10.30
|
| Rate for Payer: Mclaren Medicare |
$19.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.68
|
| Rate for Payer: Meridian Medicaid |
$20.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Nomi Health Commercial |
$29.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.63
|
| Rate for Payer: PACE Medicare |
$18.71
|
| Rate for Payer: PACE SWMI |
$19.70
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: PHP Medicare Advantage |
$19.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.70
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health SBD |
$48.41
|
| Rate for Payer: Priority Health Tiered Network |
$15.76
|
| Rate for Payer: Railroad Medicare Medicare |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.55
|
| Rate for Payer: UHC Core |
$29.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.70
|
| Rate for Payer: UHC Exchange |
$29.55
|
| Rate for Payer: UHC Medicaid |
$10.30
|
| Rate for Payer: UHCCP Medicaid |
$10.30
|
| Rate for Payer: VA VA |
$19.70
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC FELBAMATE (FELBATOL)
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| 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 |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$489.41
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$440.47 |
| Rate for Payer: Aetna Commercial |
$416.00
|
| Rate for Payer: Aetna Medicare |
$244.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.12
|
| Rate for Payer: BCBS Complete |
$195.76
|
| Rate for Payer: Cash Price |
$391.53
|
| Rate for Payer: Cofinity Advantage |
$342.59
|
| Rate for Payer: Cofinity Commercial |
$420.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.53
|
| Rate for Payer: Healthscope Commercial |
$440.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$391.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.06
|
| Rate for Payer: PHP Commercial |
$416.00
|
| Rate for Payer: Priority Health SBD |
$308.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.12
|
| Rate for Payer: UHC Core |
$254.98
|
| Rate for Payer: UHC Exchange |
$192.34
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$489.41
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.33 |
| Max. Negotiated Rate |
$440.47 |
| Rate for Payer: Aetna Commercial |
$416.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.12
|
| Rate for Payer: Cash Price |
$391.53
|
| Rate for Payer: Cofinity Advantage |
$342.59
|
| Rate for Payer: Cofinity Commercial |
$420.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$391.53
|
| Rate for Payer: Healthscope Commercial |
$440.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.06
|
| Rate for Payer: PHP Commercial |
$416.00
|
| Rate for Payer: Priority Health SBD |
$308.33
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$363.63
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$327.27 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$49.22
|
| Rate for Payer: BCN Commercial |
$49.22
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Advantage |
$254.54
|
| Rate for Payer: Cofinity Commercial |
$312.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$327.27
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$309.09
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$229.09
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.36
|
| Rate for Payer: UHC Core |
$189.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$142.91
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$363.63
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$327.27 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.36
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Advantage |
$254.54
|
| Rate for Payer: Cofinity Commercial |
$312.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Healthscope Commercial |
$327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PHP Commercial |
$309.09
|
| Rate for Payer: Priority Health SBD |
$229.09
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$363.63
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$327.27 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.36
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Advantage |
$254.54
|
| Rate for Payer: Cofinity Commercial |
$312.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Healthscope Commercial |
$327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PHP Commercial |
$309.09
|
| Rate for Payer: Priority Health SBD |
$229.09
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$363.63
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$327.27 |
| Rate for Payer: Aetna Commercial |
$309.09
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$61.33
|
| Rate for Payer: BCN Commercial |
$61.33
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cash Price |
$290.90
|
| Rate for Payer: Cofinity Advantage |
$254.54
|
| Rate for Payer: Cofinity Commercial |
$312.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$327.27
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.72
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$309.09
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$229.09
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.36
|
| Rate for Payer: UHC Core |
$189.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$142.91
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$207.04
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$130.44 |
| Max. Negotiated Rate |
$186.34 |
| Rate for Payer: Aetna Commercial |
$175.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.58
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cofinity Advantage |
$144.93
|
| Rate for Payer: Cofinity Commercial |
$178.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.63
|
| Rate for Payer: Healthscope Commercial |
$186.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.28
|
| Rate for Payer: PHP Commercial |
$175.98
|
| Rate for Payer: Priority Health SBD |
$130.44
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$207.04
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.82 |
| Max. Negotiated Rate |
$186.34 |
| Rate for Payer: Aetna Commercial |
$175.98
|
| Rate for Payer: Aetna Medicare |
$103.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.58
|
| Rate for Payer: BCBS Complete |
$82.82
|
| Rate for Payer: Cash Price |
$165.63
|
| Rate for Payer: Cofinity Advantage |
$144.93
|
| Rate for Payer: Cofinity Commercial |
$178.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.63
|
| Rate for Payer: Healthscope Commercial |
$186.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.28
|
| Rate for Payer: PHP Commercial |
$175.98
|
| Rate for Payer: Priority Health SBD |
$130.44
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$239.29
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$215.36 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Medicare |
$119.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.54
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Advantage |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$205.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$215.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.47
|
| Rate for Payer: PHP Commercial |
$203.40
|
| Rate for Payer: Priority Health SBD |
$150.75
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$239.29
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$215.36 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.54
|
| Rate for Payer: Cash Price |
$191.43
|
| Rate for Payer: Cofinity Advantage |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$205.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.43
|
| Rate for Payer: Healthscope Commercial |
$215.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.47
|
| Rate for Payer: PHP Commercial |
$203.40
|
| Rate for Payer: Priority Health SBD |
$150.75
|
|
|
HC FENTANYL URINE.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
|
HC FENTANYL URINE.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| 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 |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC FERRITIN LEVEL
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$14.53
|
| Rate for Payer: BCN Commercial |
$14.53
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.31
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$20.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.63
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$10.90
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.45
|
| Rate for Payer: UHC Core |
$20.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.63
|
| Rate for Payer: UHC Exchange |
$20.45
|
| Rate for Payer: UHC Medicaid |
$7.13
|
| Rate for Payer: UHCCP Medicaid |
$7.13
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
