|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.13
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Advantage |
$364.14
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$327.73
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$520.20
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$327.73 |
| Max. Negotiated Rate |
$468.18 |
| Rate for Payer: Aetna Commercial |
$442.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.13
|
| Rate for Payer: Cash Price |
$416.16
|
| Rate for Payer: Cofinity Advantage |
$364.14
|
| Rate for Payer: Cofinity Commercial |
$447.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.16
|
| Rate for Payer: Healthscope Commercial |
$468.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.15
|
| Rate for Payer: PHP Commercial |
$442.17
|
| Rate for Payer: Priority Health SBD |
$327.73
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.38 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health SBD |
$75.38
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: Priority Health SBD |
$31.42
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$49.88
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$23.10
|
| Rate for Payer: BCN Commercial |
$23.10
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cofinity Advantage |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$42.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$44.89
|
| Rate for Payer: Mclaren Medicaid |
$11.33
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$22.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.40
|
| Rate for Payer: Nomi Health Commercial |
$32.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.41
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$42.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health SBD |
$31.42
|
| Rate for Payer: Priority Health Tiered Network |
$17.34
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.51
|
| Rate for Payer: UHC Core |
$32.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.67
|
| Rate for Payer: UHC Exchange |
$32.51
|
| Rate for Payer: UHC Medicaid |
$11.33
|
| Rate for Payer: UHCCP Medicaid |
$11.33
|
| Rate for Payer: VA VA |
$21.67
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.20
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.69
|
| Rate for Payer: BCN Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Cofinity Advantage |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.65
|
| Rate for Payer: PHP Commercial |
$1.87
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Core |
$1.15
|
| Rate for Payer: UHC Exchange |
$0.86
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$33.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.13
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.41
|
| Rate for Payer: UHC Exchange |
$2.41
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.17 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health SBD |
$60.17
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$47.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: BCBS Complete |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$27.11
|
| Rate for Payer: BCN Commercial |
$27.11
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.00
|
| Rate for Payer: Priority Health SBD |
$60.17
|
| Rate for Payer: Priority Health Tiered Network |
$20.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$49.76
|
| Rate for Payer: UHC Exchange |
$37.54
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.09
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Advantage |
$101.33
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: Priority Health SBD |
$91.20
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$144.76
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$130.28 |
| Rate for Payer: Aetna Commercial |
$123.05
|
| Rate for Payer: Aetna Medicare |
$72.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.09
|
| Rate for Payer: BCBS Complete |
$57.90
|
| Rate for Payer: BCBS Trust/PPO |
$95.84
|
| Rate for Payer: BCN Commercial |
$95.84
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Cofinity Advantage |
$101.33
|
| Rate for Payer: Cofinity Commercial |
$124.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.81
|
| Rate for Payer: Healthscope Commercial |
$130.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.57
|
| Rate for Payer: PHP Commercial |
$123.05
|
| Rate for Payer: Priority Health SBD |
$91.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.47
|
| Rate for Payer: UHC Core |
$37.47
|
| Rate for Payer: UHC Exchange |
$37.47
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.42
|
| Rate for Payer: BCN Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Advantage |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.67
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$244.55
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$220.09 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.96
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cofinity Advantage |
$171.19
|
| Rate for Payer: Cofinity Commercial |
$210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.64
|
| Rate for Payer: Healthscope Commercial |
$220.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.41
|
| Rate for Payer: PHP Commercial |
$207.87
|
| Rate for Payer: Priority Health SBD |
$154.07
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$244.55
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$207.87
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$148.05
|
| Rate for Payer: BCN Commercial |
$148.05
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cash Price |
$195.64
|
| Rate for Payer: Cofinity Advantage |
$171.19
|
| Rate for Payer: Cofinity Commercial |
$210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$220.09
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.87
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.41
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$207.87
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$154.07
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.96
|
| Rate for Payer: UHC Core |
$127.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$96.11
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$361.10
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$695.77 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$230.91
|
| Rate for Payer: BCN Commercial |
$230.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cofinity Advantage |
$252.77
|
| Rate for Payer: Cofinity Commercial |
$310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$324.99
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.94
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.82
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$306.94
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$227.49
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$361.10
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.49 |
| Max. Negotiated Rate |
$324.99 |
| Rate for Payer: Aetna Commercial |
$306.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.72
|
| Rate for Payer: Cash Price |
$288.88
|
| Rate for Payer: Cofinity Advantage |
$252.77
|
| Rate for Payer: Cofinity Commercial |
$310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.88
|
| Rate for Payer: Healthscope Commercial |
$324.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.82
|
| Rate for Payer: PHP Commercial |
$306.94
|
| Rate for Payer: Priority Health SBD |
$227.49
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$398.23
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$358.41 |
| Rate for Payer: Aetna Commercial |
$338.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.85
|
| Rate for Payer: Cash Price |
$318.58
|
| Rate for Payer: Cofinity Advantage |
$278.76
|
| Rate for Payer: Cofinity Commercial |
$342.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.58
|
| Rate for Payer: Healthscope Commercial |
$358.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.67
|
| Rate for Payer: PHP Commercial |
$338.50
|
| Rate for Payer: Priority Health SBD |
$250.88
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$398.23
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.50 |
| Max. Negotiated Rate |
$358.41 |
| Rate for Payer: Aetna Commercial |
$338.50
|
| Rate for Payer: Aetna Medicare |
$199.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.85
|
| Rate for Payer: BCBS Complete |
$159.29
|
| Rate for Payer: Cash Price |
$318.58
|
| Rate for Payer: Cofinity Advantage |
$278.76
|
| Rate for Payer: Cofinity Commercial |
$342.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.58
|
| Rate for Payer: Healthscope Commercial |
$358.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.67
|
| Rate for Payer: PHP Commercial |
$338.50
|
| Rate for Payer: Priority Health SBD |
$250.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.85
|
| Rate for Payer: UHC Core |
$207.48
|
| Rate for Payer: UHC Exchange |
$156.50
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,474.18
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$928.73 |
| Max. Negotiated Rate |
$1,326.76 |
| Rate for Payer: Aetna Commercial |
$1,253.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.22
|
| Rate for Payer: Cash Price |
$1,179.34
|
| Rate for Payer: Cofinity Advantage |
$1,031.93
|
| Rate for Payer: Cofinity Commercial |
$1,267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.34
|
| Rate for Payer: Healthscope Commercial |
$1,326.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,105.63
|
| Rate for Payer: PHP Commercial |
$1,253.05
|
| Rate for Payer: Priority Health SBD |
$928.73
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,474.18
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.95 |
| Max. Negotiated Rate |
$1,749.61 |
| Rate for Payer: Aetna Commercial |
$1,253.05
|
| Rate for Payer: Aetna Medicare |
$562.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$676.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$676.27
|
| Rate for Payer: BCBS Complete |
$297.13
|
| Rate for Payer: BCBS MAPPO |
$541.02
|
| Rate for Payer: BCBS Trust/PPO |
$791.97
|
| Rate for Payer: BCN Commercial |
$791.97
|
| Rate for Payer: BCN Medicare Advantage |
$541.02
|
| Rate for Payer: Cash Price |
$1,179.34
|
| Rate for Payer: Cash Price |
$1,179.34
|
| Rate for Payer: Cofinity Advantage |
$1,031.93
|
| Rate for Payer: Cofinity Commercial |
$1,267.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$541.02
|
| Rate for Payer: Healthscope Commercial |
$1,326.76
|
| Rate for Payer: Mclaren Medicaid |
$282.95
|
| Rate for Payer: Mclaren Medicare |
$541.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$568.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$622.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$595.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.05
|
| Rate for Payer: Nomi Health Commercial |
$1,623.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,105.63
|
| Rate for Payer: PACE Medicare |
$513.97
|
| Rate for Payer: PACE SWMI |
$541.02
|
| Rate for Payer: PHP Commercial |
$1,253.05
|
| Rate for Payer: PHP Medicare Advantage |
$541.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,749.61
|
| Rate for Payer: Priority Health Medicare |
$541.02
|
| Rate for Payer: Priority Health SBD |
$928.73
|
| Rate for Payer: Priority Health Tiered Network |
$1,399.69
|
| Rate for Payer: Railroad Medicare Medicare |
$541.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.22
|
| Rate for Payer: UHC Core |
$768.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$541.02
|
| Rate for Payer: UHC Exchange |
$579.35
|
| Rate for Payer: UHC Medicaid |
$282.95
|
| Rate for Payer: UHCCP Medicaid |
$282.95
|
| Rate for Payer: VA VA |
$541.02
|
|
