|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$809.10
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$728.19 |
| Rate for Payer: Aetna Commercial |
$687.74
|
| Rate for Payer: Aetna Medicare |
$175.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.08
|
| Rate for Payer: BCBS Complete |
$96.99
|
| Rate for Payer: BCBS MAPPO |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$549.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.86
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cash Price |
$647.28
|
| Rate for Payer: Cofinity Commercial |
$695.83
|
| Rate for Payer: Cofinity Commercial |
$566.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.86
|
| Rate for Payer: Healthscope Commercial |
$728.19
|
| Rate for Payer: Mclaren Medicaid |
$92.37
|
| Rate for Payer: Mclaren Medicare |
$168.86
|
| Rate for Payer: Meridian Medicaid |
$96.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$687.74
|
| Rate for Payer: PACE Medicare |
$160.42
|
| Rate for Payer: PACE SWMI |
$168.86
|
| Rate for Payer: PHP Commercial |
$687.74
|
| Rate for Payer: PHP Medicare Advantage |
$168.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.36
|
| Rate for Payer: Priority Health Medicare |
$168.86
|
| Rate for Payer: Priority Health Narrow Network |
$453.89
|
| Rate for Payer: Priority Health SBD |
$509.73
|
| Rate for Payer: Railroad Medicare Medicare |
$168.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.86
|
| Rate for Payer: UHC Medicare Advantage |
$173.93
|
| Rate for Payer: VA VA |
$168.86
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$776.44 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.09
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Cofinity Commercial |
$862.71
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health SBD |
$776.44
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.74
|
| Rate for Payer: BCBS Complete |
$135.44
|
| Rate for Payer: BCBS MAPPO |
$235.79
|
| Rate for Payer: BCBS Trust/PPO |
$752.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.79
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Cofinity Commercial |
$862.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.79
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Mclaren Medicaid |
$128.98
|
| Rate for Payer: Mclaren Medicare |
$235.79
|
| Rate for Payer: Meridian Medicaid |
$135.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PACE Medicare |
$224.00
|
| Rate for Payer: PACE SWMI |
$235.79
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: PHP Medicare Advantage |
$235.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$776.97
|
| Rate for Payer: Priority Health Medicare |
$235.79
|
| Rate for Payer: Priority Health Narrow Network |
$621.58
|
| Rate for Payer: Priority Health SBD |
$776.44
|
| Rate for Payer: Railroad Medicare Medicare |
$235.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.79
|
| Rate for Payer: UHC Medicare Advantage |
$242.86
|
| Rate for Payer: VA VA |
$235.79
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.40
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health SBD |
$60.48
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$81.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$82.56
|
| Rate for Payer: Healthscope Commercial |
$86.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.60
|
| Rate for Payer: PHP Commercial |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.20
|
| Rate for Payer: Priority Health SBD |
$60.48
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.75
|
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$472.50
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health SBD |
$425.25
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$675.00
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$425.25 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna Commercial |
$573.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.75
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$472.50
|
| Rate for Payer: Cofinity Commercial |
$580.50
|
| Rate for Payer: Healthscope Commercial |
$607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.75
|
| Rate for Payer: PHP Commercial |
$573.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health SBD |
$425.25
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.65
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$140.70
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health SBD |
$126.63
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$201.00
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.63 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Aetna Commercial |
$170.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.65
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$140.70
|
| Rate for Payer: Cofinity Commercial |
$172.86
|
| Rate for Payer: Healthscope Commercial |
$180.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.85
|
| Rate for Payer: PHP Commercial |
$170.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.70
|
| Rate for Payer: Priority Health SBD |
$126.63
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health SBD |
$519.75
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$519.75 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.25
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health SBD |
$519.75
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$161.16
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$145.04 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.75
|
| 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 |
$128.93
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$112.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| 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 |
$136.99
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$136.99
|
| 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 |
$112.81
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$101.53
|
| 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 PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$161.16
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.53 |
| Max. Negotiated Rate |
$145.04 |
| Rate for Payer: Aetna Commercial |
$136.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.75
|
| Rate for Payer: Cash Price |
$128.93
|
| Rate for Payer: Cofinity Commercial |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$112.81
|
| Rate for Payer: Healthscope Commercial |
$145.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.99
|
| Rate for Payer: PHP Commercial |
$136.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.81
|
| Rate for Payer: Priority Health SBD |
$101.53
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$51.75
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
IP
|
$905.51
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$570.47 |
| Max. Negotiated Rate |
$814.96 |
| Rate for Payer: Aetna Commercial |
$769.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.58
|
| Rate for Payer: Cash Price |
$724.41
|
| Rate for Payer: Cofinity Commercial |
$633.86
|
| Rate for Payer: Cofinity Commercial |
$778.74
|
| Rate for Payer: Healthscope Commercial |
$814.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.68
|
| Rate for Payer: PHP Commercial |
$769.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.86
|
| Rate for Payer: Priority Health SBD |
$570.47
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
OP
|
$905.51
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$362.20 |
| Max. Negotiated Rate |
$814.96 |
| Rate for Payer: Aetna Commercial |
$769.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.58
|
| Rate for Payer: BCBS Complete |
$362.20
|
| Rate for Payer: Cash Price |
$724.41
|
| Rate for Payer: Cofinity Commercial |
$633.86
|
| Rate for Payer: Cofinity Commercial |
$778.74
|
| Rate for Payer: Healthscope Commercial |
$814.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$769.68
|
| Rate for Payer: PHP Commercial |
$769.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.86
|
| Rate for Payer: Priority Health SBD |
$570.47
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health SBD |
$41.58
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$5.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$56.76
|
| Rate for Payer: Cofinity Commercial |
$46.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.10
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$56.10
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health SBD |
$41.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.78
|
| Rate for Payer: UHC Core |
$11.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.48
|
| Rate for Payer: UHC Exchange |
$6.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.67
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.71
|
| Rate for Payer: BCBS Complete |
$13.19
|
| Rate for Payer: BCBS MAPPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$17.99
|
| Rate for Payer: BCN Medicare Advantage |
$22.97
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Mclaren Medicaid |
$12.56
|
| Rate for Payer: Mclaren Medicare |
$22.97
|
| Rate for Payer: Meridian Medicaid |
$13.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PACE Medicare |
$21.82
|
| Rate for Payer: PACE SWMI |
$22.97
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: PHP Medicare Advantage |
$22.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health Medicare |
$22.97
|
| Rate for Payer: Priority Health SBD |
$72.45
|
| Rate for Payer: Railroad Medicare Medicare |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.97
|
| Rate for Payer: UHC Exchange |
$22.97
|
| Rate for Payer: UHC Medicare Advantage |
$23.66
|
| Rate for Payer: VA VA |
$22.97
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$80.50
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health SBD |
$72.45
|
|
|
HC PAPER WASP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
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 PAPER WASP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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
|
|
|
HC PAP NAP
|
Facility
|
IP
|
$2,266.90
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
92000019
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,428.15 |
| Max. Negotiated Rate |
$2,040.21 |
| Rate for Payer: Aetna Commercial |
$1,926.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.48
|
| Rate for Payer: Cash Price |
$1,813.52
|
| Rate for Payer: Cofinity Commercial |
$1,586.83
|
| Rate for Payer: Cofinity Commercial |
$1,949.53
|
| Rate for Payer: Healthscope Commercial |
$2,040.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,926.86
|
| Rate for Payer: PHP Commercial |
$1,926.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,586.83
|
| Rate for Payer: Priority Health SBD |
$1,428.15
|
|
|
HC PAP NAP
|
Facility
|
OP
|
$2,266.90
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
92000019
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$2,040.21 |
| Rate for Payer: Aetna Commercial |
$1,926.86
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,473.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.27
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,813.52
|
| Rate for Payer: Cash Price |
$1,813.52
|
| Rate for Payer: Cofinity Commercial |
$1,586.83
|
| Rate for Payer: Cofinity Commercial |
$1,949.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,040.21
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,926.86
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$1,926.86
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,586.83
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,428.15
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$402.75
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
