|
HC FUSARIUM PROLIFERATUM IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200085
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Commercial |
$8.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Priority Health SBD |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABA-B-R AB CBA, SERUM
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200418
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health SBD |
$321.30
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCN Commercial |
$8.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.40
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$9.92
|
| Rate for Payer: Priority Health SBD |
$73.90
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GABA-B-R AB IF TITER ASSAY, S
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200419
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.90 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.24
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health SBD |
$73.90
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
OP
|
$48.90
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.09
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$21.67
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: BCN Medicare Advantage |
$21.67
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Mclaren Medicare |
$21.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.75
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: Nomi Health Commercial |
$32.50
|
| Rate for Payer: PACE Medicare |
$20.59
|
| Rate for Payer: PACE SWMI |
$21.67
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: PHP Medicare Advantage |
$21.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.67
|
| Rate for Payer: Priority Health Medicare |
$21.67
|
| Rate for Payer: Priority Health Narrow Network |
$17.34
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Railroad Medicare Medicare |
$21.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.67
|
| Rate for Payer: UHC Medicare Advantage |
$21.67
|
| Rate for Payer: UHCCP Medicaid |
$12.20
|
| Rate for Payer: VA VA |
$21.67
|
|
|
HC GABAPENTIN LEVEL NEURONTIN
|
Facility
|
IP
|
$48.90
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
30100160
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$41.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.78
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Cofinity Commercial |
$42.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.12
|
| Rate for Payer: Healthscope Commercial |
$44.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.56
|
| Rate for Payer: PHP Commercial |
$41.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health SBD |
$30.81
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.36
|
|
|
HC GADOBUTROL INJ 0.1 ML
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
HCPCS A9585
|
| Hospital Charge Code |
25500003
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health SBD |
$1.36
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$32.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
|
|
HC GADOLINIUM PER ML
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
HCPCS A9579
|
| Hospital Charge Code |
63600015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC GAIT TRAINING EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: BCN Commercial |
$24.17
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.00
|
| Rate for Payer: Priority Health Narrow Network |
$20.00
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Exchange |
$69.29
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
IP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.41 |
| Max. Negotiated Rate |
$127.73 |
| Rate for Payer: Aetna Commercial |
$120.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.25
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$122.05
|
| Rate for Payer: Cofinity Commercial |
$99.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$127.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: Priority Health SBD |
$89.41
|
|
|
HC GALIUM 67 PER MCI
|
Facility
|
OP
|
$141.92
|
|
|
Service Code
|
HCPCS A9556
|
| Hospital Charge Code |
34300007
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.77 |
| Max. Negotiated Rate |
$127.73 |
| Rate for Payer: Aetna Commercial |
$120.63
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.25
|
| Rate for Payer: BCBS Complete |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$79.58
|
| Rate for Payer: BCN Commercial |
$79.58
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cash Price |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$122.05
|
| Rate for Payer: Cofinity Commercial |
$99.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.54
|
| Rate for Payer: Healthscope Commercial |
$127.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.63
|
| Rate for Payer: PHP Commercial |
$120.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.25
|
| Rate for Payer: Priority Health SBD |
$89.41
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
IP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
|
HC GARAMYCIN GENTAMICIN INJ UP TO 80 MG
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
HCPCS J1580
|
| Hospital Charge Code |
63600139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.74
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.62
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
OP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.99 |
| Max. Negotiated Rate |
$481.80 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: Aetna Medicare |
$159.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.62
|
| Rate for Payer: BCBS Complete |
$86.28
|
| Rate for Payer: BCBS MAPPO |
$153.30
|
| Rate for Payer: BCBS Trust/PPO |
$146.19
|
| Rate for Payer: BCN Commercial |
$146.19
|
| Rate for Payer: BCN Medicare Advantage |
$153.30
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$206.18
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.30
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Mclaren Medicaid |
$82.17
|
| Rate for Payer: Mclaren Medicare |
$153.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.96
|
| Rate for Payer: Meridian Medicaid |
$86.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: Nomi Health Commercial |
$459.90
|
| Rate for Payer: PACE Medicare |
$145.64
|
| Rate for Payer: PACE SWMI |
$153.30
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: PHP Medicare Advantage |
$153.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.80
|
| Rate for Payer: Priority Health Medicare |
$153.30
|
| Rate for Payer: Priority Health Narrow Network |
$385.44
|
| Rate for Payer: Priority Health SBD |
$151.04
|
| Rate for Payer: Railroad Medicare Medicare |
$153.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.30
|
| Rate for Payer: UHC Exchange |
$177.42
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: UHCCP Medicaid |
$86.31
|
| Rate for Payer: VA VA |
$153.30
|
|
|
HC GAS DILUTION/WASHOUT VOLUMES
|
Facility
|
IP
|
$239.75
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$151.04 |
| Max. Negotiated Rate |
$215.78 |
| Rate for Payer: Aetna Commercial |
$203.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.84
|
| Rate for Payer: Cash Price |
$191.80
|
| Rate for Payer: Cofinity Commercial |
$167.82
|
| Rate for Payer: Cofinity Commercial |
$206.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.80
|
| Rate for Payer: Healthscope Commercial |
$215.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.79
|
| Rate for Payer: PHP Commercial |
$203.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.84
|
| Rate for Payer: Priority Health SBD |
$151.04
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
OP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$180.27
|
| Rate for Payer: BCN Commercial |
$180.27
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$247.81
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$223.03
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC GASTRIC ASPIRATION
|
Facility
|
IP
|
$354.02
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
45000002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.03 |
| Max. Negotiated Rate |
$318.62 |
| Rate for Payer: Aetna Commercial |
$300.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.11
|
| Rate for Payer: Cash Price |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$247.81
|
| Rate for Payer: Cofinity Commercial |
$304.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.22
|
| Rate for Payer: Healthscope Commercial |
$318.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.92
|
| Rate for Payer: PHP Commercial |
$300.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.11
|
| Rate for Payer: Priority Health SBD |
$223.03
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
OP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.17 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: Aetna Medicare |
$195.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: BCBS Complete |
$156.17
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$273.29
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health SBD |
$245.96
|
|
|
HC GASTRIC/COLON CLIPPING
|
Facility
|
IP
|
$390.42
|
|
| Hospital Charge Code |
27200124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.96 |
| Max. Negotiated Rate |
$351.38 |
| Rate for Payer: Aetna Commercial |
$331.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: Cash Price |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$273.29
|
| Rate for Payer: Cofinity Commercial |
$335.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$273.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.34
|
| Rate for Payer: Healthscope Commercial |
$351.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.86
|
| Rate for Payer: PHP Commercial |
$331.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.77
|
| Rate for Payer: Priority Health SBD |
$245.96
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
OP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.68 |
| Max. Negotiated Rate |
$1,657.56 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: Aetna Medicare |
$548.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$659.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$659.24
|
| Rate for Payer: BCBS Complete |
$296.82
|
| Rate for Payer: BCBS MAPPO |
$527.39
|
| Rate for Payer: BCBS Trust/PPO |
$679.55
|
| Rate for Payer: BCN Commercial |
$679.55
|
| Rate for Payer: BCN Medicare Advantage |
$527.39
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Cofinity Commercial |
$1,011.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,011.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.39
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Mclaren Medicaid |
$282.68
|
| Rate for Payer: Mclaren Medicare |
$527.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.76
|
| Rate for Payer: Meridian Medicaid |
$296.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: Nomi Health Commercial |
$1,582.17
|
| Rate for Payer: PACE Medicare |
$501.02
|
| Rate for Payer: PACE SWMI |
$527.39
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: PHP Medicare Advantage |
$527.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$282.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,657.56
|
| Rate for Payer: Priority Health Medicare |
$527.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,326.05
|
| Rate for Payer: Priority Health SBD |
$910.52
|
| Rate for Payer: Railroad Medicare Medicare |
$527.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$406.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.39
|
| Rate for Payer: UHC Exchange |
$1,069.50
|
| Rate for Payer: UHC Medicare Advantage |
$527.39
|
| Rate for Payer: UHCCP Medicaid |
$296.92
|
| Rate for Payer: VA VA |
$527.39
|
|
|
HC GASTRIC EMPTYING WITH SMALL BOWEL AND COLON TRANSIT MULTI DAYS
|
Facility
|
IP
|
$1,445.27
|
|
|
Service Code
|
CPT 78266
|
| Hospital Charge Code |
34100079
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$910.52 |
| Max. Negotiated Rate |
$1,300.74 |
| Rate for Payer: Aetna Commercial |
$1,228.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.43
|
| Rate for Payer: Cash Price |
$1,156.22
|
| Rate for Payer: Cofinity Commercial |
$1,011.69
|
| Rate for Payer: Cofinity Commercial |
$1,242.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,011.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,156.22
|
| Rate for Payer: Healthscope Commercial |
$1,300.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,228.48
|
| Rate for Payer: PHP Commercial |
$1,228.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.43
|
| Rate for Payer: Priority Health SBD |
$910.52
|
|
