|
HC FISH PROBES
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.62
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$54.51
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health SBD |
$49.06
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.66 |
| Max. Negotiated Rate |
$2,028.73 |
| Rate for Payer: Aetna Commercial |
$1,916.02
|
| Rate for Payer: Aetna Medicare |
$1,127.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.19
|
| Rate for Payer: BCBS Complete |
$901.66
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$1,577.90
|
| Rate for Payer: Cofinity Commercial |
$1,938.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: PHP Commercial |
$1,916.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health SBD |
$1,420.11
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,254.14
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,420.11 |
| Max. Negotiated Rate |
$2,028.73 |
| Rate for Payer: Aetna Commercial |
$1,916.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.19
|
| Rate for Payer: Cash Price |
$1,803.31
|
| Rate for Payer: Cofinity Commercial |
$1,577.90
|
| Rate for Payer: Cofinity Commercial |
$1,938.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,577.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.31
|
| Rate for Payer: Healthscope Commercial |
$2,028.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.02
|
| Rate for Payer: PHP Commercial |
$1,916.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,465.19
|
| Rate for Payer: Priority Health SBD |
$1,420.11
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$233.06 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$181.27
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$163.14
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$258.96
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.14 |
| Max. Negotiated Rate |
$233.06 |
| Rate for Payer: Aetna Commercial |
$220.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.32
|
| Rate for Payer: Cash Price |
$207.17
|
| Rate for Payer: Cofinity Commercial |
$181.27
|
| Rate for Payer: Cofinity Commercial |
$222.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.17
|
| Rate for Payer: Healthscope Commercial |
$233.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.12
|
| Rate for Payer: PHP Commercial |
$220.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.32
|
| Rate for Payer: Priority Health SBD |
$163.14
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$446.21
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$451.46
|
| Rate for Payer: Cofinity Commercial |
$367.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$472.45
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$446.21
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$330.72
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$524.95
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$472.45 |
| Rate for Payer: Aetna Commercial |
$446.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.22
|
| Rate for Payer: Cash Price |
$419.96
|
| Rate for Payer: Cofinity Commercial |
$367.46
|
| Rate for Payer: Cofinity Commercial |
$451.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$367.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.96
|
| Rate for Payer: Healthscope Commercial |
$472.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.21
|
| Rate for Payer: PHP Commercial |
$446.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.22
|
| Rate for Payer: Priority Health SBD |
$330.72
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.16 |
| Max. Negotiated Rate |
$1,600.11 |
| Rate for Payer: Aetna Commercial |
$1,511.21
|
| Rate for Payer: Aetna Medicare |
$888.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.63
|
| Rate for Payer: BCBS Complete |
$711.16
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,244.53
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,244.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.21
|
| Rate for Payer: PHP Commercial |
$1,511.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.63
|
| Rate for Payer: Priority Health SBD |
$1,120.08
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,777.90
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,120.08 |
| Max. Negotiated Rate |
$1,600.11 |
| Rate for Payer: Aetna Commercial |
$1,511.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.63
|
| Rate for Payer: Cash Price |
$1,422.32
|
| Rate for Payer: Cofinity Commercial |
$1,244.53
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,244.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,422.32
|
| Rate for Payer: Healthscope Commercial |
$1,600.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,511.21
|
| Rate for Payer: PHP Commercial |
$1,511.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,155.63
|
| Rate for Payer: Priority Health SBD |
$1,120.08
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$216.69
|
| Rate for Payer: Aetna Medicare |
$127.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.70
|
| Rate for Payer: BCBS Complete |
$101.97
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: PHP Commercial |
$216.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health SBD |
$160.61
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$254.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.61 |
| Max. Negotiated Rate |
$229.44 |
| Rate for Payer: Aetna Commercial |
$216.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.70
|
| Rate for Payer: Cash Price |
$203.94
|
| Rate for Payer: Cofinity Commercial |
$178.45
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$178.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.94
|
| Rate for Payer: Healthscope Commercial |
$229.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.69
|
| Rate for Payer: PHP Commercial |
$216.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.70
|
| Rate for Payer: Priority Health SBD |
$160.61
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
OP
|
$745.52
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.21 |
| Max. Negotiated Rate |
$670.97 |
| Rate for Payer: Aetna Commercial |
$633.69
|
| Rate for Payer: Aetna Medicare |
$372.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.59
|
| Rate for Payer: BCBS Complete |
$298.21
|
| Rate for Payer: Cash Price |
$596.42
|
| Rate for Payer: Cofinity Commercial |
$521.86
|
| Rate for Payer: Cofinity Commercial |
$641.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$521.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.42
|
| Rate for Payer: Healthscope Commercial |
$670.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.69
|
| Rate for Payer: PHP Commercial |
$633.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.59
|
| Rate for Payer: Priority Health SBD |
$469.68
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
IP
|
$745.52
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.68 |
| Max. Negotiated Rate |
$670.97 |
| Rate for Payer: Aetna Commercial |
$633.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.59
|
| Rate for Payer: Cash Price |
$596.42
|
| Rate for Payer: Cofinity Commercial |
$521.86
|
| Rate for Payer: Cofinity Commercial |
$641.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$521.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.42
|
| Rate for Payer: Healthscope Commercial |
$670.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.69
|
| Rate for Payer: PHP Commercial |
$633.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$484.59
|
| Rate for Payer: Priority Health SBD |
$469.68
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
IP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$38.97 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Aetna Commercial |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.20
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: PHP Commercial |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: Priority Health SBD |
$38.97
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
OP
|
$61.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$24.74 |
| Max. Negotiated Rate |
$55.66 |
| Rate for Payer: Aetna Commercial |
$52.57
|
| Rate for Payer: Aetna Medicare |
$30.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.20
|
| Rate for Payer: BCBS Complete |
$24.74
|
| Rate for Payer: Cash Price |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$53.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.48
|
| Rate for Payer: Healthscope Commercial |
$55.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.57
|
| Rate for Payer: PHP Commercial |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.20
|
| Rate for Payer: Priority Health SBD |
$38.97
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
IP
|
$203.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$183.47 |
| Rate for Payer: Aetna Commercial |
$173.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.51
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.09
|
| Rate for Payer: Healthscope Commercial |
$183.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.28
|
| Rate for Payer: PHP Commercial |
$173.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.51
|
| Rate for Payer: Priority Health SBD |
$128.43
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
OP
|
$203.86
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$987.55 |
| Rate for Payer: Aetna Commercial |
$173.28
|
| Rate for Payer: Aetna Medicare |
$364.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.54
|
| Rate for Payer: BCBS Complete |
$197.45
|
| Rate for Payer: BCBS MAPPO |
$350.83
|
| Rate for Payer: BCN Medicare Advantage |
$350.83
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cash Price |
$163.09
|
| Rate for Payer: Cofinity Commercial |
$175.32
|
| Rate for Payer: Cofinity Commercial |
$142.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.83
|
| Rate for Payer: Healthscope Commercial |
$183.47
|
| Rate for Payer: Mclaren Medicaid |
$188.04
|
| Rate for Payer: Mclaren Medicare |
$350.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.37
|
| Rate for Payer: Meridian Medicaid |
$197.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.28
|
| Rate for Payer: PACE Medicare |
$333.29
|
| Rate for Payer: PACE SWMI |
$350.83
|
| Rate for Payer: PHP Commercial |
$173.28
|
| Rate for Payer: PHP Medicare Advantage |
$350.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.51
|
| Rate for Payer: Priority Health Medicare |
$350.83
|
| Rate for Payer: Priority Health SBD |
$128.43
|
| Rate for Payer: Railroad Medicare Medicare |
$350.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$987.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.83
|
| Rate for Payer: UHC Medicare Advantage |
$350.83
|
| Rate for Payer: UHCCP Medicaid |
$197.52
|
| Rate for Payer: VA VA |
$350.83
|
|
|
HC FLUID CREATININE
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC FLUID CREATININE
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
IP
|
$108.20
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.17 |
| Max. Negotiated Rate |
$97.38 |
| Rate for Payer: Aetna Commercial |
$91.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.33
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$93.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: PHP Commercial |
$91.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.33
|
| Rate for Payer: Priority Health SBD |
$68.17
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
OP
|
$108.20
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.28 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$91.97
|
| Rate for Payer: Aetna Medicare |
$54.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.33
|
| Rate for Payer: BCBS Complete |
$43.28
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cash Price |
$86.56
|
| Rate for Payer: Cofinity Commercial |
$93.05
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.56
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.97
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$91.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.33
|
| Rate for Payer: Priority Health SBD |
$68.17
|
| Rate for Payer: UHC Core |
$80.07
|
| Rate for Payer: UHC Exchange |
$80.07
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$78.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$70.53
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$21.55
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC FLUID SMEAR AND INTERPRETATION
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100002
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health SBD |
$70.53
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
IP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$70.53 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$78.36
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health SBD |
$70.53
|
|
|
HC FLUID SMEAR WITH INTERPRETATION
|
Facility
|
OP
|
$111.95
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
31100030
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$95.16
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cash Price |
$89.56
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$78.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$100.75
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.16
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$95.16
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$70.53
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$21.55
|
| Rate for Payer: VA VA |
$38.28
|
|
