|
HC FELBAMATE (FELBATOL)
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100470
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC FEMOSTOP
|
Facility
|
OP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.92 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna Medicare |
$239.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: BCBS Complete |
$191.92
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
|
|
HC FEMOSTOP
|
Facility
|
IP
|
$479.81
|
|
| Hospital Charge Code |
62200003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$302.28 |
| Max. Negotiated Rate |
$431.83 |
| Rate for Payer: Aetna Commercial |
$407.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.88
|
| Rate for Payer: Cash Price |
$383.85
|
| Rate for Payer: Cofinity Commercial |
$335.87
|
| Rate for Payer: Cofinity Commercial |
$412.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.85
|
| Rate for Payer: Healthscope Commercial |
$431.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.84
|
| Rate for Payer: PHP Commercial |
$407.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.88
|
| Rate for Payer: Priority Health SBD |
$302.28
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$263.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$263.81
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC FEMUR 1 VIEW
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
32000315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.59 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.59
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
OP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$224.59
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$263.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$263.81
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC FEMUR 2 VIEWS
|
Facility
|
IP
|
$356.50
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
32000316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.59 |
| Max. Negotiated Rate |
$320.85 |
| Rate for Payer: Aetna Commercial |
$303.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.72
|
| Rate for Payer: Cash Price |
$285.20
|
| Rate for Payer: Cofinity Commercial |
$249.55
|
| Rate for Payer: Cofinity Commercial |
$306.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.20
|
| Rate for Payer: Healthscope Commercial |
$320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.02
|
| Rate for Payer: PHP Commercial |
$303.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.72
|
| Rate for Payer: Priority Health SBD |
$224.59
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
IP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
|
|
HC FENTANYL SERUM LVL
|
Facility
|
OP
|
$202.98
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100564
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.19 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna Medicare |
$101.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.38
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.94
|
| Rate for Payer: Priority Health SBD |
$127.88
|
|
|
HC FENTANYL UR
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna Medicare |
$117.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: BCBS Complete |
$93.84
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: Priority Health SBD |
$147.80
|
|
|
HC FENTANYL UR
|
Facility
|
IP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$211.14 |
| Rate for Payer: Aetna Commercial |
$199.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.49
|
| Rate for Payer: Cash Price |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Cofinity Commercial |
$201.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.68
|
| Rate for Payer: Healthscope Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.41
|
| Rate for Payer: PHP Commercial |
$199.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.49
|
| Rate for Payer: Priority Health SBD |
$147.80
|
|
|
HC FENTANYL URINE.
|
Facility
|
OP
|
$97.31
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$82.71
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.25
|
| 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 |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cofinity Commercial |
$83.69
|
| Rate for Payer: Cofinity Commercial |
$68.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$87.58
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.71
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$82.71
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.25
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$61.31
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC FENTANYL URINE.
|
Facility
|
IP
|
$97.31
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000152
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$87.58 |
| Rate for Payer: Aetna Commercial |
$82.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.25
|
| Rate for Payer: Cash Price |
$77.85
|
| Rate for Payer: Cofinity Commercial |
$68.12
|
| Rate for Payer: Cofinity Commercial |
$83.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.85
|
| Rate for Payer: Healthscope Commercial |
$87.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.71
|
| Rate for Payer: PHP Commercial |
$82.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.25
|
| Rate for Payer: Priority Health SBD |
$61.31
|
|
|
HC FERRITIN LEVEL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$39.32
|
|
|
HC FERRITIN LEVEL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
30100202
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.57
|
| 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 |
$7.67
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$43.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| 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 |
$7.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: PACE Medicare |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.63
|
| Rate for Payer: UHC Medicare Advantage |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
| Rate for Payer: VA VA |
$13.63
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$214.99 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$238.88
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health SBD |
$214.99
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.64
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Cofinity Commercial |
$238.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Mclaren Medicare |
$103.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: PACE Medicare |
$98.52
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| Rate for Payer: Railroad Medicare Medicare |
$103.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.93
|
| Rate for Payer: UHC Core |
$252.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Exchange |
$252.53
|
| Rate for Payer: UHC Medicare Advantage |
$103.71
|
| Rate for Payer: UHCCP Medicaid |
$58.39
|
| Rate for Payer: VA VA |
$103.71
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.52 |
| Max. Negotiated Rate |
$391.71 |
| Rate for Payer: Aetna Commercial |
$369.95
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: BCBS Complete |
$36.25
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$374.30
|
| Rate for Payer: Cofinity Commercial |
$304.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$391.71
|
| Rate for Payer: Mclaren Medicaid |
$34.52
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$36.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$369.95
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health SBD |
$274.19
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.41
|
| Rate for Payer: UHC Medicare Advantage |
$64.41
|
| Rate for Payer: UHCCP Medicaid |
$36.26
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$274.19 |
| Max. Negotiated Rate |
$391.71 |
| Rate for Payer: Aetna Commercial |
$369.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.90
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$304.66
|
| Rate for Payer: Cofinity Commercial |
$374.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Healthscope Commercial |
$391.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: PHP Commercial |
$369.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: Priority Health SBD |
$274.19
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.31 |
| Max. Negotiated Rate |
$274.73 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.42
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$213.68
|
| Rate for Payer: Cofinity Commercial |
$262.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Healthscope Commercial |
$274.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: PHP Commercial |
$259.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: Priority Health SBD |
$192.31
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$274.73 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna Medicare |
$152.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.42
|
| Rate for Payer: BCBS Complete |
$122.10
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$213.68
|
| Rate for Payer: Cofinity Commercial |
$262.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Healthscope Commercial |
$274.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: PHP Commercial |
$259.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: Priority Health SBD |
$192.31
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$66.64 |
| Rate for Payer: Aetna Commercial |
$62.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.13
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$51.84
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Healthscope Commercial |
$66.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: PHP Commercial |
$62.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health SBD |
$46.65
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$66.64 |
| Rate for Payer: Aetna Commercial |
$62.94
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$5.27
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Cofinity Commercial |
$51.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$66.64
|
| Rate for Payer: Mclaren Medicaid |
$5.02
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: PACE Medicare |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$62.94
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health SBD |
$46.65
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.36
|
| Rate for Payer: UHC Medicare Advantage |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$5.27
|
| Rate for Payer: VA VA |
$9.36
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$130.18 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.32
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$144.65
|
| Rate for Payer: Cofinity Commercial |
$177.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$185.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: PHP Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health SBD |
$130.18
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$103.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.32
|
| Rate for Payer: BCBS Complete |
$82.66
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$144.65
|
| Rate for Payer: Cofinity Commercial |
$177.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$185.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: PHP Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health SBD |
$130.18
|
| Rate for Payer: UHC Core |
$152.91
|
| Rate for Payer: UHC Exchange |
$152.91
|
|
