|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Exchange |
$6.22
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health SBD |
$26.49
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.87
|
| Rate for Payer: UHC Core |
$34.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$27.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$28.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.24
|
| Rate for Payer: BCBS Complete |
$15.73
|
| Rate for Payer: BCBS MAPPO |
$27.39
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Medicare Advantage |
$27.39
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Mclaren Medicaid |
$14.98
|
| Rate for Payer: Mclaren Medicare |
$27.39
|
| Rate for Payer: Meridian Medicaid |
$15.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Medicare |
$26.02
|
| Rate for Payer: PACE SWMI |
$27.39
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$27.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health Medicare |
$27.39
|
| Rate for Payer: Priority Health SBD |
$26.49
|
| Rate for Payer: Railroad Medicare Medicare |
$27.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.87
|
| Rate for Payer: UHC Core |
$34.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.39
|
| Rate for Payer: UHC Exchange |
$27.39
|
| Rate for Payer: UHC Medicare Advantage |
$28.21
|
| Rate for Payer: VA VA |
$27.39
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.33
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health SBD |
$26.49
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$636.96 |
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: Aetna Medicare |
$313.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$376.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$376.68
|
| Rate for Payer: BCBS Complete |
$173.09
|
| Rate for Payer: BCBS MAPPO |
$301.34
|
| Rate for Payer: BCBS Trust/PPO |
$528.79
|
| Rate for Payer: BCN Medicare Advantage |
$301.34
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.34
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Mclaren Medicaid |
$164.83
|
| Rate for Payer: Mclaren Medicare |
$301.34
|
| Rate for Payer: Meridian Medicaid |
$173.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$316.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$346.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PACE Medicare |
$286.27
|
| Rate for Payer: PACE SWMI |
$301.34
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: PHP Medicare Advantage |
$301.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$636.96
|
| Rate for Payer: Priority Health Medicare |
$301.34
|
| Rate for Payer: Priority Health Narrow Network |
$509.57
|
| Rate for Payer: Priority Health SBD |
$237.63
|
| Rate for Payer: Railroad Medicare Medicare |
$301.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.34
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$310.38
|
| Rate for Payer: VA VA |
$301.34
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$237.63 |
| Max. Negotiated Rate |
$339.47 |
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.17
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Cofinity Commercial |
$264.03
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health SBD |
$237.63
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.12
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.15
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health SBD |
$1.12
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$583.06 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.57
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$647.84
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health SBD |
$583.06
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.57
|
| Rate for Payer: BCBS Complete |
$370.20
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Cofinity Commercial |
$647.84
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health SBD |
$583.06
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$341.17 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$379.08
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$341.17
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.62 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.00
|
| Rate for Payer: BCBS Complete |
$216.62
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$379.08
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health SBD |
$341.17
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.55
|
| Rate for Payer: BCBS Complete |
$136.95
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health SBD |
$215.70
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$215.70 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.55
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health SBD |
$215.70
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.16
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health SBD |
$119.37
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$340.12 |
| Max. Negotiated Rate |
$2,039.31 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$646.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$777.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$777.24
|
| Rate for Payer: BCBS Complete |
$357.16
|
| Rate for Payer: BCBS MAPPO |
$621.79
|
| Rate for Payer: BCN Medicare Advantage |
$621.79
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$621.79
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$340.12
|
| Rate for Payer: Mclaren Medicare |
$621.79
|
| Rate for Payer: Meridian Medicaid |
$357.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$652.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$715.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Medicare |
$590.70
|
| Rate for Payer: PACE SWMI |
$621.79
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$621.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,039.31
|
| Rate for Payer: Priority Health Medicare |
$621.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.45
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$621.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$621.79
|
| Rate for Payer: UHC Medicare Advantage |
$640.44
|
| Rate for Payer: VA VA |
$621.79
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health SBD |
$60.10
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.01
|
| 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 |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$60.10
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UHC Core |
$41.98
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
