|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
OP
|
$1,535.61
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,382.05 |
| Rate for Payer: Aetna Commercial |
$1,305.27
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$698.84
|
| Rate for Payer: BCN Commercial |
$698.84
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$1,228.49
|
| Rate for Payer: Cash Price |
$1,228.49
|
| Rate for Payer: Cofinity Advantage |
$1,074.93
|
| Rate for Payer: Cofinity Commercial |
$1,320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,228.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,382.05
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,305.27
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,151.71
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$1,305.27
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$967.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$998.15
|
| Rate for Payer: UHC Core |
$800.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$603.49
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL TRANSIT
|
Facility
|
IP
|
$1,535.61
|
|
|
Service Code
|
CPT 78265
|
| Hospital Charge Code |
34100080
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$967.43 |
| Max. Negotiated Rate |
$1,382.05 |
| Rate for Payer: Aetna Commercial |
$1,305.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.15
|
| Rate for Payer: Cash Price |
$1,228.49
|
| Rate for Payer: Cofinity Advantage |
$1,074.93
|
| Rate for Payer: Cofinity Commercial |
$1,320.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,228.49
|
| Rate for Payer: Healthscope Commercial |
$1,382.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,305.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,151.71
|
| Rate for Payer: PHP Commercial |
$1,305.27
|
| Rate for Payer: Priority Health SBD |
$967.43
|
|
|
HC GASTRIN LEVEL
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$18.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.04
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS MAPPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.79
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: BCN Medicare Advantage |
$17.63
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Mclaren Medicaid |
$9.22
|
| Rate for Payer: Mclaren Medicare |
$17.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: Meridian Medicaid |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PACE Medicare |
$16.75
|
| Rate for Payer: PACE SWMI |
$17.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: PHP Medicare Advantage |
$17.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.63
|
| Rate for Payer: Priority Health Medicare |
$17.63
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: Priority Health Tiered Network |
$14.10
|
| Rate for Payer: Railroad Medicare Medicare |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.45
|
| Rate for Payer: UHC Core |
$26.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.63
|
| Rate for Payer: UHC Exchange |
$26.45
|
| Rate for Payer: UHC Medicaid |
$9.22
|
| Rate for Payer: UHCCP Medicaid |
$9.22
|
| Rate for Payer: VA VA |
$17.63
|
|
|
HC GASTRIN LEVEL
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
30100220
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
IP
|
$3.55
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
|
|
HC GASTROGRAFIN PER ML
|
Facility
|
OP
|
$3.55
|
|
|
Service Code
|
HCPCS Q9963
|
| Hospital Charge Code |
63600010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$3.19 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.54
|
| Rate for Payer: BCN Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Advantage |
$2.48
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.66
|
| Rate for Payer: PHP Commercial |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.36
|
| Rate for Payer: UHC Core |
$0.36
|
| Rate for Payer: UHC Exchange |
$0.36
|
|
|
HC GASTROSCOPY
|
Facility
|
OP
|
$2,001.39
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$800.56 |
| Max. Negotiated Rate |
$1,801.25 |
| Rate for Payer: Aetna Commercial |
$1,701.18
|
| Rate for Payer: Aetna Medicare |
$1,000.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.90
|
| Rate for Payer: BCBS Complete |
$800.56
|
| Rate for Payer: Cash Price |
$1,601.11
|
| Rate for Payer: Cofinity Advantage |
$1,400.97
|
| Rate for Payer: Cofinity Commercial |
$1,721.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.11
|
| Rate for Payer: Healthscope Commercial |
$1,801.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,601.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.04
|
| Rate for Payer: PHP Commercial |
$1,701.18
|
| Rate for Payer: Priority Health SBD |
$1,260.88
|
|
|
HC GASTROSCOPY
|
Facility
|
IP
|
$2,001.39
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,260.88 |
| Max. Negotiated Rate |
$1,801.25 |
| Rate for Payer: Aetna Commercial |
$1,701.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,300.90
|
| Rate for Payer: Cash Price |
$1,601.11
|
| Rate for Payer: Cofinity Advantage |
$1,400.97
|
| Rate for Payer: Cofinity Commercial |
$1,721.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,601.11
|
| Rate for Payer: Healthscope Commercial |
$1,801.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,701.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.04
|
| Rate for Payer: PHP Commercial |
$1,701.18
|
| Rate for Payer: Priority Health SBD |
$1,260.88
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$81.82
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$73.64 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.18
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Advantage |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.46
|
| Rate for Payer: Healthscope Commercial |
$73.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.37
|
| Rate for Payer: PHP Commercial |
$69.55
|
| Rate for Payer: Priority Health SBD |
$51.55
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$81.82
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$73.64 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: Aetna Medicare |
$40.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.18
|
| Rate for Payer: BCBS Complete |
$32.73
|
| Rate for Payer: Cash Price |
$65.46
|
| Rate for Payer: Cofinity Advantage |
$57.27
|
| Rate for Payer: Cofinity Commercial |
$70.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.46
|
| Rate for Payer: Healthscope Commercial |
$73.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.37
|
| Rate for Payer: PHP Commercial |
$69.55
|
| Rate for Payer: Priority Health SBD |
$51.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.18
|
| Rate for Payer: UHC Core |
$42.63
|
| Rate for Payer: UHC Exchange |
$32.16
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.85
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$1.67
|
| Rate for Payer: BCN Commercial |
$1.67
|
| Rate for Payer: BCN Medicare Advantage |
$0.68
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.68
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.71
|
| Rate for Payer: Meridian Medicaid |
$0.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$2.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PACE Medicare |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.68
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: Priority Health Tiered Network |
$1.75
|
| Rate for Payer: Railroad Medicare Medicare |
$0.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.11
|
| Rate for Payer: UHC Core |
$1.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.68
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicaid |
$0.36
|
| Rate for Payer: UHCCP Medicaid |
$0.36
|
| Rate for Payer: VA VA |
$0.68
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$152.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$137.63 |
| Rate for Payer: Aetna Commercial |
$129.98
|
| Rate for Payer: Aetna Medicare |
$76.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.40
|
| Rate for Payer: BCBS Complete |
$61.17
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cofinity Advantage |
$107.04
|
| Rate for Payer: Cofinity Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.34
|
| Rate for Payer: Healthscope Commercial |
$137.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.69
|
| Rate for Payer: PHP Commercial |
$129.98
|
| Rate for Payer: Priority Health SBD |
$96.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.40
|
| Rate for Payer: UHC Core |
$79.67
|
| Rate for Payer: UHC Exchange |
$60.10
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$152.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$96.34 |
| Max. Negotiated Rate |
$137.63 |
| Rate for Payer: Aetna Commercial |
$129.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.40
|
| Rate for Payer: Cash Price |
$122.34
|
| Rate for Payer: Cofinity Advantage |
$107.04
|
| Rate for Payer: Cofinity Commercial |
$131.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.34
|
| Rate for Payer: Healthscope Commercial |
$137.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.69
|
| Rate for Payer: PHP Commercial |
$129.98
|
| Rate for Payer: Priority Health SBD |
$96.34
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$601.51
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$378.95 |
| Max. Negotiated Rate |
$541.36 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.98
|
| Rate for Payer: Cash Price |
$481.21
|
| Rate for Payer: Cofinity Advantage |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$517.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.21
|
| Rate for Payer: Healthscope Commercial |
$541.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.13
|
| Rate for Payer: PHP Commercial |
$511.28
|
| Rate for Payer: Priority Health SBD |
$378.95
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$601.51
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$541.36 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Aetna Medicare |
$300.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.98
|
| Rate for Payer: BCBS Complete |
$240.60
|
| Rate for Payer: Cash Price |
$481.21
|
| Rate for Payer: Cofinity Advantage |
$421.06
|
| Rate for Payer: Cofinity Commercial |
$517.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.21
|
| Rate for Payer: Healthscope Commercial |
$541.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$481.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.13
|
| Rate for Payer: PHP Commercial |
$511.28
|
| Rate for Payer: Priority Health SBD |
$378.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.98
|
| Rate for Payer: UHC Core |
$313.39
|
| Rate for Payer: UHC Exchange |
$236.39
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
IP
|
$16.32
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health SBD |
$10.28
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
OP
|
$16.32
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health SBD |
$10.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$8.50
|
| Rate for Payer: UHC Exchange |
$6.41
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$235.33
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: Cash Price |
$188.26
|
| Rate for Payer: Cofinity Advantage |
$164.73
|
| Rate for Payer: Cofinity Commercial |
$202.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.26
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.50
|
| Rate for Payer: PHP Commercial |
$200.03
|
| Rate for Payer: Priority Health SBD |
$148.26
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$235.33
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.61 |
| Max. Negotiated Rate |
$211.80 |
| Rate for Payer: Aetna Commercial |
$200.03
|
| Rate for Payer: Aetna Medicare |
$117.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.96
|
| Rate for Payer: BCBS Complete |
$94.13
|
| Rate for Payer: BCBS Trust/PPO |
$50.85
|
| Rate for Payer: BCN Commercial |
$50.85
|
| Rate for Payer: Cash Price |
$188.26
|
| Rate for Payer: Cash Price |
$188.26
|
| Rate for Payer: Cofinity Advantage |
$164.73
|
| Rate for Payer: Cofinity Commercial |
$202.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.26
|
| Rate for Payer: Healthscope Commercial |
$211.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.50
|
| Rate for Payer: PHP Commercial |
$200.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.01
|
| Rate for Payer: Priority Health SBD |
$148.26
|
| Rate for Payer: Priority Health Tiered Network |
$37.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.71
|
| Rate for Payer: UHC Core |
$58.71
|
| Rate for Payer: UHC Exchange |
$58.71
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$125.47
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$106.65
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: BCBS MAPPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.47
|
| Rate for Payer: BCN Commercial |
$17.47
|
| Rate for Payer: BCN Medicare Advantage |
$16.38
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Advantage |
$87.83
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.38
|
| Rate for Payer: Healthscope Commercial |
$112.92
|
| Rate for Payer: Mclaren Medicaid |
$8.57
|
| Rate for Payer: Mclaren Medicare |
$16.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.20
|
| Rate for Payer: Meridian Medicaid |
$17.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.65
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.10
|
| Rate for Payer: PACE Medicare |
$15.56
|
| Rate for Payer: PACE SWMI |
$16.38
|
| Rate for Payer: PHP Commercial |
$106.65
|
| Rate for Payer: PHP Medicare Advantage |
$16.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.38
|
| Rate for Payer: Priority Health Medicare |
$16.38
|
| Rate for Payer: Priority Health SBD |
$79.05
|
| Rate for Payer: Priority Health Tiered Network |
$13.10
|
| Rate for Payer: Railroad Medicare Medicare |
$16.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.57
|
| Rate for Payer: UHC Core |
$24.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.38
|
| Rate for Payer: UHC Exchange |
$24.57
|
| Rate for Payer: UHC Medicaid |
$8.57
|
| Rate for Payer: UHCCP Medicaid |
$8.57
|
| Rate for Payer: VA VA |
$16.38
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$125.47
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.05 |
| Max. Negotiated Rate |
$112.92 |
| Rate for Payer: Aetna Commercial |
$106.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.56
|
| Rate for Payer: Cash Price |
$100.38
|
| Rate for Payer: Cofinity Advantage |
$87.83
|
| Rate for Payer: Cofinity Commercial |
$107.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$112.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.10
|
| Rate for Payer: PHP Commercial |
$106.65
|
| Rate for Payer: Priority Health SBD |
$79.05
|
|
|
HC GGTP
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.57 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health SBD |
$44.57
|
|
|
HC GGTP
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$7.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.00
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$7.20
|
| Rate for Payer: BCN Medicare Advantage |
$7.20
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Advantage |
$49.52
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Mclaren Medicare |
$7.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.56
|
| Rate for Payer: Meridian Medicaid |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$10.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Medicare |
$6.84
|
| Rate for Payer: PACE SWMI |
$7.20
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.20
|
| Rate for Payer: Priority Health Medicare |
$7.20
|
| Rate for Payer: Priority Health SBD |
$44.57
|
| Rate for Payer: Priority Health Tiered Network |
$5.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.80
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.20
|
| Rate for Payer: UHC Exchange |
$10.80
|
| Rate for Payer: UHC Medicaid |
$3.77
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$7.20
|
|
|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.58
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$6.27
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$12.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.98
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health SBD |
$29.42
|
| Rate for Payer: Priority Health Tiered Network |
$9.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.97
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.98
|
| Rate for Payer: UHC Exchange |
$17.97
|
| Rate for Payer: UHC Medicaid |
$6.27
|
| Rate for Payer: UHCCP Medicaid |
$6.27
|
| Rate for Payer: VA VA |
$11.98
|
|
