|
HC FENTANYL UR
|
Facility
|
OP
|
$234.60
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
30100609
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.28 |
| 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: 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
|
| Rate for Payer: UHC Core |
$30.28
|
| Rate for Payer: UHC Exchange |
$30.28
|
|
|
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
|
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 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 |
$93.21 |
| 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 |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCN Commercial |
$55.01
|
| 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: Nomi Health Commercial |
$93.21
|
| 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 HMO/PPO/Tiered Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow Network |
$49.71
|
| Rate for Payer: Priority Health SBD |
$61.31
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| 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 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: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$12.06
|
| 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: Nomi Health Commercial |
$20.44
|
| 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 HMO/PPO/Tiered Network |
$14.03
|
| Rate for Payer: Priority Health Medicare |
$13.63
|
| Rate for Payer: Priority Health Narrow Network |
$11.22
|
| Rate for Payer: Priority Health SBD |
$39.32
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.36
|
| 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 |
$55.85 |
| Max. Negotiated Rate |
$327.48 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.24
|
| Rate for Payer: BCBS Complete |
$58.64
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$130.75
|
| Rate for Payer: BCN Commercial |
$130.75
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| 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 |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Mclaren Medicaid |
$55.85
|
| Rate for Payer: Mclaren Medicare |
$104.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: Meridian Medicaid |
$58.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$312.57
|
| Rate for Payer: PACE Medicare |
$98.98
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.48
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$261.98
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| Rate for Payer: Railroad Medicare Medicare |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Exchange |
$252.52
|
| Rate for Payer: UHC Medicare Advantage |
$104.19
|
| Rate for Payer: UHCCP Medicaid |
$58.66
|
| Rate for Payer: VA VA |
$104.19
|
|
|
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 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: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Commercial |
$57.02
|
| 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: Nomi Health Commercial |
$96.62
|
| 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 HMO/PPO/Tiered Network |
$66.27
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health Narrow Network |
$53.02
|
| Rate for Payer: Priority Health SBD |
$274.19
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.29
|
| 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 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: BCBS Trust/PPO |
$8.29
|
| Rate for Payer: BCN Commercial |
$8.29
|
| 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: Nomi Health Commercial |
$14.04
|
| 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 HMO/PPO/Tiered Network |
$9.36
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health Narrow Network |
$7.49
|
| Rate for Payer: Priority Health SBD |
$46.65
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.23
|
| 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 |
$221.28 |
| 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: BCBS Trust/PPO |
$221.28
|
| Rate for Payer: BCN Commercial |
$221.28
|
| Rate for Payer: Cash Price |
$165.31
|
| 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 All Payor (Choice/PPO) |
$207.69
|
| Rate for Payer: UHC Exchange |
$152.91
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$744.36 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$246.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.04
|
| Rate for Payer: BCBS Complete |
$133.29
|
| Rate for Payer: BCBS MAPPO |
$236.83
|
| Rate for Payer: BCBS Trust/PPO |
$526.79
|
| Rate for Payer: BCN Commercial |
$526.79
|
| Rate for Payer: BCN Medicare Advantage |
$236.83
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Cofinity Commercial |
$218.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.83
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Mclaren Medicaid |
$126.94
|
| Rate for Payer: Mclaren Medicare |
$236.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.67
|
| Rate for Payer: Meridian Medicaid |
$133.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$710.49
|
| Rate for Payer: PACE Medicare |
$224.99
|
| Rate for Payer: PACE SWMI |
$236.83
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$236.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$744.36
|
| Rate for Payer: Priority Health Medicare |
$236.83
|
| Rate for Payer: Priority Health Narrow Network |
$595.49
|
| Rate for Payer: Priority Health SBD |
$196.64
|
| Rate for Payer: Railroad Medicare Medicare |
$236.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.83
|
| Rate for Payer: UHC Exchange |
$230.97
|
| Rate for Payer: UHC Medicare Advantage |
$236.83
|
| Rate for Payer: UHCCP Medicaid |
$133.34
|
| Rate for Payer: VA VA |
$236.83
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$196.64 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.88
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$218.48
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health SBD |
$196.64
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,320.80 |
| Max. Negotiated Rate |
$1,886.85 |
| Rate for Payer: Aetna Commercial |
$1,782.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.72
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,467.55
|
| Rate for Payer: Cofinity Commercial |
$1,802.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,467.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.02
|
| Rate for Payer: PHP Commercial |
$1,782.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health SBD |
$1,320.80
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.60 |
| Max. Negotiated Rate |
$1,886.85 |
| Rate for Payer: Aetna Commercial |
$1,782.02
|
| Rate for Payer: Aetna Medicare |
$1,048.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.72
|
| Rate for Payer: BCBS Complete |
$838.60
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,467.55
|
| Rate for Payer: Cofinity Commercial |
$1,802.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,467.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$1,886.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.02
|
| Rate for Payer: PHP Commercial |
$1,782.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health SBD |
$1,320.80
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$577.37 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna Medicare |
$1,939.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.07
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS Trust/PPO |
$577.37
|
| Rate for Payer: BCN Commercial |
$577.37
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$2,715.00
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,715.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health SBD |
$2,443.50
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,443.50 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,521.07
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$2,715.00
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,715.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health SBD |
$2,443.50
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$529.55 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Aetna Commercial |
$714.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.36
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$588.39
|
| Rate for Payer: Cofinity Commercial |
$722.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: PHP Commercial |
$714.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health SBD |
$529.55
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$274.64 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$714.48
|
| Rate for Payer: Aetna Medicare |
$420.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.36
|
| Rate for Payer: BCBS Complete |
$336.22
|
| Rate for Payer: BCBS Trust/PPO |
$274.64
|
| Rate for Payer: BCN Commercial |
$274.64
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$588.39
|
| Rate for Payer: Cofinity Commercial |
$722.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$756.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: PHP Commercial |
$714.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health SBD |
$529.55
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.57 |
| Max. Negotiated Rate |
$2,408.79 |
| Rate for Payer: Aetna Commercial |
$2,274.97
|
| Rate for Payer: Aetna Medicare |
$1,338.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,739.68
|
| Rate for Payer: BCBS Complete |
$1,070.57
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$1,873.50
|
| Rate for Payer: Cofinity Commercial |
$2,301.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,873.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,408.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: PHP Commercial |
$2,274.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health SBD |
$1,686.15
|
|
