|
HC OVA & PARASITES
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$54.24 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health SBD |
$54.24
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$10.33
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.08
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$9.84
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$10.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.58
|
| Rate for Payer: UHC Core |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC OXALATE URINE
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC OXALATE URINE
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.06
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS MAPPO |
$14.45
|
| Rate for Payer: BCBS Trust/PPO |
$11.32
|
| Rate for Payer: BCN Medicare Advantage |
$14.45
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$7.90
|
| Rate for Payer: Mclaren Medicare |
$14.45
|
| Rate for Payer: Meridian Medicaid |
$8.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$13.73
|
| Rate for Payer: PACE SWMI |
$14.45
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$14.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.34
|
| Rate for Payer: UHC Core |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.45
|
| Rate for Payer: UHC Exchange |
$14.45
|
| Rate for Payer: UHC Medicare Advantage |
$14.88
|
| Rate for Payer: VA VA |
$14.45
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.61
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.38
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Mclaren Medicaid |
$7.25
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Medicaid |
$7.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$45.62
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.90
|
| Rate for Payer: UHC Core |
$21.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.62 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$50.69
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health SBD |
$45.62
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UHC Core |
$31.91
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health SBD |
$49.14
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 OXYCODONE URINE.
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 |
$82.04
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| 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 OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health SBD |
$34.02
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.90
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health SBD |
$34.02
|
| Rate for Payer: UHC Core |
$31.91
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$907.22 |
| Max. Negotiated Rate |
$1,296.03 |
| Rate for Payer: Aetna Commercial |
$1,224.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.02
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,008.02
|
| Rate for Payer: Cofinity Commercial |
$1,238.43
|
| Rate for Payer: Healthscope Commercial |
$1,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: PHP Commercial |
$1,224.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: Priority Health SBD |
$907.22
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,440.03
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$576.01 |
| Max. Negotiated Rate |
$1,296.03 |
| Rate for Payer: Aetna Commercial |
$1,224.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.02
|
| Rate for Payer: BCBS Complete |
$576.01
|
| Rate for Payer: Cash Price |
$1,152.02
|
| Rate for Payer: Cofinity Commercial |
$1,008.02
|
| Rate for Payer: Cofinity Commercial |
$1,238.43
|
| Rate for Payer: Healthscope Commercial |
$1,296.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,224.03
|
| Rate for Payer: PHP Commercial |
$1,224.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,008.02
|
| Rate for Payer: Priority Health SBD |
$907.22
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$765.45 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna Commercial |
$1,032.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.75
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,044.90
|
| Rate for Payer: Cofinity Commercial |
$850.50
|
| Rate for Payer: Healthscope Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: PHP Commercial |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health SBD |
$765.45
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,215.00
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,093.50 |
| Rate for Payer: Aetna Commercial |
$1,032.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.75
|
| Rate for Payer: BCBS Complete |
$486.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cofinity Commercial |
$1,044.90
|
| Rate for Payer: Cofinity Commercial |
$850.50
|
| Rate for Payer: Healthscope Commercial |
$1,093.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.75
|
| Rate for Payer: PHP Commercial |
$1,032.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.50
|
| Rate for Payer: Priority Health SBD |
$765.45
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$774.90 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,045.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.50
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.80
|
| Rate for Payer: Cofinity Commercial |
$861.00
|
| Rate for Payer: Healthscope Commercial |
$1,107.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: PHP Commercial |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health SBD |
$774.90
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,230.00
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,045.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.50
|
| Rate for Payer: BCBS Complete |
$492.00
|
| Rate for Payer: Cash Price |
$984.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.80
|
| Rate for Payer: Cofinity Commercial |
$861.00
|
| Rate for Payer: Healthscope Commercial |
$1,107.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,045.50
|
| Rate for Payer: PHP Commercial |
$1,045.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.00
|
| Rate for Payer: Priority Health SBD |
$774.90
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,386.12 |
| Max. Negotiated Rate |
$3,408.75 |
| Rate for Payer: Aetna Commercial |
$3,219.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,461.88
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$2,651.25
|
| Rate for Payer: Cofinity Commercial |
$3,257.25
|
| Rate for Payer: Healthscope Commercial |
$3,408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: PHP Commercial |
$3,219.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: Priority Health SBD |
$2,386.12
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,787.50
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,515.00 |
| Max. Negotiated Rate |
$3,408.75 |
| Rate for Payer: Aetna Commercial |
$3,219.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,461.88
|
| Rate for Payer: BCBS Complete |
$1,515.00
|
| Rate for Payer: Cash Price |
$3,030.00
|
| Rate for Payer: Cofinity Commercial |
$2,651.25
|
| Rate for Payer: Cofinity Commercial |
$3,257.25
|
| Rate for Payer: Healthscope Commercial |
$3,408.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,219.38
|
| Rate for Payer: PHP Commercial |
$3,219.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,651.25
|
| Rate for Payer: Priority Health SBD |
$2,386.12
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$707.83 |
| Rate for Payer: Aetna Commercial |
$668.51
|
| Rate for Payer: Aetna Medicare |
$184.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.64
|
| Rate for Payer: BCBS Complete |
$101.85
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$25.14
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$550.54
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$707.83
|
| Rate for Payer: Mclaren Medicaid |
$96.99
|
| Rate for Payer: Mclaren Medicare |
$177.31
|
| Rate for Payer: Meridian Medicaid |
$101.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: PACE Medicare |
$168.44
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Commercial |
$668.51
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health SBD |
$495.48
|
| Rate for Payer: Railroad Medicare Medicare |
$177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.31
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
| Rate for Payer: VA VA |
$177.31
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$786.48
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$495.48 |
| Max. Negotiated Rate |
$707.83 |
| Rate for Payer: Aetna Commercial |
$668.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.21
|
| Rate for Payer: Cash Price |
$629.18
|
| Rate for Payer: Cofinity Commercial |
$676.37
|
| Rate for Payer: Cofinity Commercial |
$550.54
|
| Rate for Payer: Healthscope Commercial |
$707.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$668.51
|
| Rate for Payer: PHP Commercial |
$668.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.54
|
| Rate for Payer: Priority Health SBD |
$495.48
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| 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 |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
