|
HC GLUCOSE STICK (ACCU-CHEK)
|
Facility
|
OP
|
$9.57
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
30000010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.90
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cash Price |
$7.66
|
| Rate for Payer: Cofinity Commercial |
$8.23
|
| Rate for Payer: Cofinity Commercial |
$6.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$8.61
|
| Rate for Payer: Mclaren Medicaid |
$1.76
|
| Rate for Payer: Mclaren Medicare |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: Meridian Medicaid |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$4.92
|
| Rate for Payer: PACE Medicare |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.28
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: Priority Health SBD |
$6.03
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: UHCCP Medicaid |
$1.85
|
| Rate for Payer: VA VA |
$3.28
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health SBD |
$59.25
|
|
|
HC GLUC TOLER 3 SPECIMENS
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCN Commercial |
$11.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Cofinity Commercial |
$65.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$38.61
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$10.60
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$35.36
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.57
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$18.86
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$13.27
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC GLUTAMIC ACID DECARBOXYLASE AB
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100255
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$8.59
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$5.20
|
| Rate for Payer: Mclaren Medicare |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: Nomi Health Commercial |
$14.56
|
| Rate for Payer: PACE Medicare |
$9.22
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.99
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health Narrow Network |
$7.99
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Medicare Advantage |
$9.71
|
| Rate for Payer: UHCCP Medicaid |
$5.47
|
| Rate for Payer: VA VA |
$9.71
|
|
|
HC GLYCOHEMOGLOBIN (A1C)
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
30100238
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
IP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
|
|
HC GMU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$58.03 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$72.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.30
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS Trust/PPO |
$108.07
|
| Rate for Payer: BCN Commercial |
$108.07
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$101.56
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health SBD |
$91.40
|
| Rate for Payer: UHC Core |
$107.36
|
| Rate for Payer: UHC Exchange |
$107.36
|
|
|
HC GOLDENROD IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
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 GOLDENROD IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200086
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
OP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.98 |
| Max. Negotiated Rate |
$551.20 |
| Rate for Payer: Aetna Commercial |
$520.57
|
| Rate for Payer: Aetna Medicare |
$306.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.09
|
| Rate for Payer: BCBS Complete |
$244.98
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$428.71
|
| Rate for Payer: Cofinity Commercial |
$526.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Healthscope Commercial |
$551.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: PHP Commercial |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: Priority Health SBD |
$385.84
|
|
|
HC GOLD PROBE HEMOSTASIS
|
Facility
|
IP
|
$612.44
|
|
| Hospital Charge Code |
27000080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$385.84 |
| Max. Negotiated Rate |
$551.20 |
| Rate for Payer: Aetna Commercial |
$520.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.09
|
| Rate for Payer: Cash Price |
$489.95
|
| Rate for Payer: Cofinity Commercial |
$428.71
|
| Rate for Payer: Cofinity Commercial |
$526.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$428.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.95
|
| Rate for Payer: Healthscope Commercial |
$551.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.57
|
| Rate for Payer: PHP Commercial |
$520.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.09
|
| Rate for Payer: Priority Health SBD |
$385.84
|
|
|
HC GOOSE FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
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 GOOSE FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200087
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.63
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.37
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.30
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
OP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.83 |
| Max. Negotiated Rate |
$686.67 |
| Rate for Payer: Aetna Commercial |
$648.52
|
| Rate for Payer: Aetna Medicare |
$381.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.93
|
| Rate for Payer: BCBS Complete |
$305.19
|
| Rate for Payer: BCBS Trust/PPO |
$159.83
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$534.08
|
| Rate for Payer: Cofinity Commercial |
$656.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Healthscope Commercial |
$686.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: PHP Commercial |
$648.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health SBD |
$480.67
|
|
|
HC GRAFIX PRIME 1.5 X 2 PER SQ CM
|
Facility
|
IP
|
$762.97
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$480.67 |
| Max. Negotiated Rate |
$686.67 |
| Rate for Payer: Aetna Commercial |
$648.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.93
|
| Rate for Payer: Cash Price |
$610.38
|
| Rate for Payer: Cofinity Commercial |
$534.08
|
| Rate for Payer: Cofinity Commercial |
$656.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$534.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.38
|
| Rate for Payer: Healthscope Commercial |
$686.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$648.52
|
| Rate for Payer: PHP Commercial |
$648.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.93
|
| Rate for Payer: Priority Health SBD |
$480.67
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
OP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.83 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$656.62
|
| Rate for Payer: Aetna Medicare |
$386.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.12
|
| Rate for Payer: BCBS Complete |
$309.00
|
| Rate for Payer: BCBS Trust/PPO |
$159.83
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$540.75
|
| Rate for Payer: Cofinity Commercial |
$664.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Healthscope Commercial |
$695.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: PHP Commercial |
$656.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: Priority Health SBD |
$486.68
|
|
|
HC GRAFIX PRIME (16 MM) DISC PER SQ CM
|
Facility
|
IP
|
$772.50
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600158
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$486.68 |
| Max. Negotiated Rate |
$695.25 |
| Rate for Payer: Aetna Commercial |
$656.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.12
|
| Rate for Payer: Cash Price |
$618.00
|
| Rate for Payer: Cofinity Commercial |
$540.75
|
| Rate for Payer: Cofinity Commercial |
$664.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$540.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$618.00
|
| Rate for Payer: Healthscope Commercial |
$695.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.62
|
| Rate for Payer: PHP Commercial |
$656.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.12
|
| Rate for Payer: Priority Health SBD |
$486.68
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
OP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.83 |
| Max. Negotiated Rate |
$429.17 |
| Rate for Payer: Aetna Commercial |
$405.33
|
| Rate for Payer: Aetna Medicare |
$238.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.96
|
| Rate for Payer: BCBS Complete |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$159.83
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$333.80
|
| Rate for Payer: Cofinity Commercial |
$410.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Healthscope Commercial |
$429.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: PHP Commercial |
$405.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: Priority Health SBD |
$300.42
|
|
|
HC GRAFIX PRIME 2 X 3 PER SQ CM
|
Facility
|
IP
|
$476.86
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$300.42 |
| Max. Negotiated Rate |
$429.17 |
| Rate for Payer: Aetna Commercial |
$405.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.96
|
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Cofinity Commercial |
$333.80
|
| Rate for Payer: Cofinity Commercial |
$410.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.49
|
| Rate for Payer: Healthscope Commercial |
$429.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.33
|
| Rate for Payer: PHP Commercial |
$405.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.96
|
| Rate for Payer: Priority Health SBD |
$300.42
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
OP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.58 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna Commercial |
$285.99
|
| Rate for Payer: Aetna Medicare |
$168.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.70
|
| Rate for Payer: BCBS Complete |
$134.58
|
| Rate for Payer: BCBS Trust/PPO |
$159.83
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$235.52
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Healthscope Commercial |
$302.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: PHP Commercial |
$285.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: Priority Health SBD |
$211.97
|
|
|
HC GRAFIX PRIME 3 X 3 PER SQ CM
|
Facility
|
IP
|
$336.46
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600244
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.97 |
| Max. Negotiated Rate |
$302.81 |
| Rate for Payer: Aetna Commercial |
$285.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.70
|
| Rate for Payer: Cash Price |
$269.17
|
| Rate for Payer: Cofinity Commercial |
$235.52
|
| Rate for Payer: Cofinity Commercial |
$289.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$235.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.17
|
| Rate for Payer: Healthscope Commercial |
$302.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.99
|
| Rate for Payer: PHP Commercial |
$285.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.70
|
| Rate for Payer: Priority Health SBD |
$211.97
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
IP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.13 |
| Max. Negotiated Rate |
$250.18 |
| Rate for Payer: Aetna Commercial |
$236.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.69
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Commercial |
$239.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Healthscope Commercial |
$250.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: PHP Commercial |
$236.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: Priority Health SBD |
$175.13
|
|
|
HC GRAFIX PRIME 3 X 4 PER SQ CM
|
Facility
|
OP
|
$277.98
|
|
|
Service Code
|
HCPCS Q4133
|
| Hospital Charge Code |
63600161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.19 |
| Max. Negotiated Rate |
$250.18 |
| Rate for Payer: Aetna Commercial |
$236.28
|
| Rate for Payer: Aetna Medicare |
$138.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.69
|
| Rate for Payer: BCBS Complete |
$111.19
|
| Rate for Payer: BCBS Trust/PPO |
$159.83
|
| Rate for Payer: BCN Commercial |
$159.83
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cash Price |
$222.38
|
| Rate for Payer: Cofinity Commercial |
$194.59
|
| Rate for Payer: Cofinity Commercial |
$239.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.38
|
| Rate for Payer: Healthscope Commercial |
$250.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.28
|
| Rate for Payer: PHP Commercial |
$236.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.69
|
| Rate for Payer: Priority Health SBD |
$175.13
|
|
