|
HC POWDER MICANOZOLE
|
Facility
|
OP
|
$19.60
|
|
| Hospital Charge Code |
27000625
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$17.64 |
| Rate for Payer: Aetna Commercial |
$16.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.74
|
| Rate for Payer: BCBS Complete |
$7.84
|
| Rate for Payer: Cash Price |
$15.68
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.66
|
| Rate for Payer: PHP Commercial |
$16.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.72
|
| Rate for Payer: Priority Health SBD |
$12.35
|
|
|
HC POWDER OSTOMY
|
Facility
|
OP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$22.66 |
| Rate for Payer: Aetna Commercial |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: PHP Commercial |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
HC POWDER OSTOMY
|
Facility
|
IP
|
$25.18
|
|
| Hospital Charge Code |
27000139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$22.66 |
| Rate for Payer: Aetna Commercial |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.37
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$22.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.40
|
| Rate for Payer: PHP Commercial |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
HC POWER CVC
|
Facility
|
OP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.74 |
| Max. Negotiated Rate |
$487.67 |
| Rate for Payer: Aetna Commercial |
$460.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.21
|
| Rate for Payer: BCBS Complete |
$216.74
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$379.30
|
| Rate for Payer: Cofinity Commercial |
$466.00
|
| Rate for Payer: Healthscope Commercial |
$487.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: PHP Commercial |
$460.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health SBD |
$341.37
|
|
|
HC POWER CVC
|
Facility
|
IP
|
$541.86
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.37 |
| Max. Negotiated Rate |
$487.67 |
| Rate for Payer: Aetna Commercial |
$460.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.21
|
| Rate for Payer: Cash Price |
$433.49
|
| Rate for Payer: Cofinity Commercial |
$379.30
|
| Rate for Payer: Cofinity Commercial |
$466.00
|
| Rate for Payer: Healthscope Commercial |
$487.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.58
|
| Rate for Payer: PHP Commercial |
$460.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.30
|
| Rate for Payer: Priority Health SBD |
$341.37
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
OP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Aetna Commercial |
$32.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.67
|
| Rate for Payer: BCBS Complete |
$15.18
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$26.56
|
| Rate for Payer: Cofinity Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: PHP Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: Priority Health SBD |
$23.91
|
|
|
HC POWER CVC SPRINGWIRE GUIDE
|
Facility
|
IP
|
$37.95
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200236
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Aetna Commercial |
$32.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.67
|
| Rate for Payer: Cash Price |
$30.36
|
| Rate for Payer: Cofinity Commercial |
$26.56
|
| Rate for Payer: Cofinity Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$34.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.26
|
| Rate for Payer: PHP Commercial |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.56
|
| Rate for Payer: Priority Health SBD |
$23.91
|
|
|
HC POWERWAND CATHETER
|
Facility
|
OP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$474.69 |
| Rate for Payer: Aetna Commercial |
$448.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.83
|
| Rate for Payer: BCBS Complete |
$210.97
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$369.20
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Healthscope Commercial |
$474.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: PHP Commercial |
$448.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health SBD |
$332.28
|
|
|
HC POWERWAND CATHETER
|
Facility
|
IP
|
$527.43
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$332.28 |
| Max. Negotiated Rate |
$474.69 |
| Rate for Payer: Aetna Commercial |
$448.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.83
|
| Rate for Payer: Cash Price |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$369.20
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Healthscope Commercial |
$474.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.32
|
| Rate for Payer: PHP Commercial |
$448.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.20
|
| Rate for Payer: Priority Health SBD |
$332.28
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
OP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$439.10 |
| Max. Negotiated Rate |
$32,375.08 |
| Rate for Payer: Aetna Commercial |
$9,894.24
|
| Rate for Payer: Aetna Medicare |
$9,881.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,566.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,876.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,876.80
|
| Rate for Payer: BCBS Complete |
$5,457.63
|
| Rate for Payer: BCBS MAPPO |
$9,501.44
|
| Rate for Payer: BCBS Trust/PPO |
$7,823.65
|
| Rate for Payer: BCN Medicare Advantage |
$9,501.44
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$8,148.20
|
| Rate for Payer: Cofinity Commercial |
$10,010.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,501.44
|
| Rate for Payer: Healthscope Commercial |
$10,476.25
|
| Rate for Payer: Mclaren Medicaid |
$5,197.29
|
| Rate for Payer: Mclaren Medicare |
$9,501.44
|
| Rate for Payer: Meridian Medicaid |
$5,457.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,976.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,926.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: PACE Medicare |
$9,026.37
|
| Rate for Payer: PACE SWMI |
$9,501.44
|
| Rate for Payer: PHP Commercial |
$9,894.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,501.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,197.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,375.08
|
| Rate for Payer: Priority Health Medicare |
$9,501.44
|
| Rate for Payer: Priority Health Narrow Network |
$25,900.06
|
| Rate for Payer: Priority Health SBD |
$7,333.38
|
| Rate for Payer: Railroad Medicare Medicare |
$9,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.01
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,501.44
|
| Rate for Payer: UHC Exchange |
$439.10
|
| Rate for Payer: UHC Medicare Advantage |
$9,786.48
|
| Rate for Payer: VA VA |
$9,501.44
|
|
|
HC PPM SINGLE/A LEAD
|
Facility
|
IP
|
$11,640.28
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
36100057
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,333.38 |
| Max. Negotiated Rate |
$10,476.25 |
| Rate for Payer: Aetna Commercial |
$9,894.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,566.18
|
| Rate for Payer: Cash Price |
$9,312.22
|
| Rate for Payer: Cofinity Commercial |
$10,010.64
|
| Rate for Payer: Cofinity Commercial |
$8,148.20
|
| Rate for Payer: Healthscope Commercial |
$10,476.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,894.24
|
| Rate for Payer: PHP Commercial |
$9,894.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,148.20
|
| Rate for Payer: Priority Health SBD |
$7,333.38
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
IP
|
$12,804.30
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,066.71 |
| Max. Negotiated Rate |
$11,523.87 |
| Rate for Payer: Aetna Commercial |
$10,883.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,322.80
|
| Rate for Payer: Cash Price |
$10,243.44
|
| Rate for Payer: Cofinity Commercial |
$11,011.70
|
| Rate for Payer: Cofinity Commercial |
$8,963.01
|
| Rate for Payer: Healthscope Commercial |
$11,523.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,883.66
|
| Rate for Payer: PHP Commercial |
$10,883.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,963.01
|
| Rate for Payer: Priority Health SBD |
$8,066.71
|
|
|
HC PPM SINGLE/V LEAD
|
Facility
|
OP
|
$12,804.30
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
36100058
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$461.37 |
| Max. Negotiated Rate |
$32,375.08 |
| Rate for Payer: Aetna Commercial |
$10,883.66
|
| Rate for Payer: Aetna Medicare |
$9,881.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,322.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,876.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,876.80
|
| Rate for Payer: BCBS Complete |
$5,457.63
|
| Rate for Payer: BCBS MAPPO |
$9,501.44
|
| Rate for Payer: BCBS Trust/PPO |
$7,202.85
|
| Rate for Payer: BCN Medicare Advantage |
$9,501.44
|
| Rate for Payer: Cash Price |
$10,243.44
|
| Rate for Payer: Cash Price |
$10,243.44
|
| Rate for Payer: Cofinity Commercial |
$8,963.01
|
| Rate for Payer: Cofinity Commercial |
$11,011.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,501.44
|
| Rate for Payer: Healthscope Commercial |
$11,523.87
|
| Rate for Payer: Mclaren Medicaid |
$5,197.29
|
| Rate for Payer: Mclaren Medicare |
$9,501.44
|
| Rate for Payer: Meridian Medicaid |
$5,457.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,976.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,926.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,883.66
|
| Rate for Payer: PACE Medicare |
$9,026.37
|
| Rate for Payer: PACE SWMI |
$9,501.44
|
| Rate for Payer: PHP Commercial |
$10,883.66
|
| Rate for Payer: PHP Medicare Advantage |
$9,501.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,197.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,963.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,375.08
|
| Rate for Payer: Priority Health Medicare |
$9,501.44
|
| Rate for Payer: Priority Health Narrow Network |
$25,900.06
|
| Rate for Payer: Priority Health SBD |
$8,066.71
|
| Rate for Payer: Railroad Medicare Medicare |
$9,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.51
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,501.44
|
| Rate for Payer: UHC Exchange |
$461.37
|
| Rate for Payer: UHC Medicare Advantage |
$9,786.48
|
| Rate for Payer: VA VA |
$9,501.44
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC PPU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: Aetna Medicare |
$53.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.84
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$51.07
|
| Rate for Payer: BCBS Trust/PPO |
$39.99
|
| Rate for Payer: BCN Medicare Advantage |
$51.07
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.07
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Mclaren Medicaid |
$27.94
|
| Rate for Payer: Mclaren Medicare |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: PACE Medicare |
$48.52
|
| Rate for Payer: PACE SWMI |
$51.07
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: PHP Medicare Advantage |
$51.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health Medicare |
$51.07
|
| Rate for Payer: Priority Health SBD |
$270.90
|
| Rate for Payer: Railroad Medicare Medicare |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.28
|
| Rate for Payer: UHC Core |
$61.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.07
|
| Rate for Payer: UHC Exchange |
$51.07
|
| Rate for Payer: UHC Medicare Advantage |
$52.60
|
| Rate for Payer: VA VA |
$51.07
|
|
|
HC PRADER WILLI MOL ANALYSIS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 81331
|
| Hospital Charge Code |
31000103
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$270.90 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.50
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health SBD |
$270.90
|
|
|
HC PREALBUMIN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
|
|
HC PREALBUMIN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
30100398
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$15.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.24
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: BCBS MAPPO |
$14.59
|
| Rate for Payer: BCBS Trust/PPO |
$11.42
|
| Rate for Payer: BCN Medicare Advantage |
$14.59
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$7.98
|
| Rate for Payer: Mclaren Medicare |
$14.59
|
| Rate for Payer: Meridian Medicaid |
$8.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$13.86
|
| Rate for Payer: PACE SWMI |
$14.59
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health Medicare |
$14.59
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.51
|
| Rate for Payer: UHC Core |
$24.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.59
|
| Rate for Payer: UHC Exchange |
$14.59
|
| Rate for Payer: UHC Medicare Advantage |
$15.03
|
| Rate for Payer: VA VA |
$14.59
|
|
|
HC PREGNANCY TEST SERUM
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
30100467
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.40
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$5.89
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Mclaren Medicaid |
$4.11
|
| Rate for Payer: Mclaren Medicare |
$7.52
|
| Rate for Payer: Meridian Medicaid |
$4.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Medicare |
$7.14
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: Priority Health SBD |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.02
|
| Rate for Payer: UHC Core |
$12.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Exchange |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.75
|
| Rate for Payer: VA VA |
$7.52
|
|
|
HC PREGNANCY TEST SERUM
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
30100467
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC PREGNENOLONE
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
30100561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.84
|
| Rate for Payer: BCBS Complete |
$11.87
|
| Rate for Payer: BCBS MAPPO |
$20.67
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$20.67
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.67
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Mclaren Medicaid |
$11.31
|
| Rate for Payer: Mclaren Medicare |
$20.67
|
| Rate for Payer: Meridian Medicaid |
$11.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Medicare |
$19.64
|
| Rate for Payer: PACE SWMI |
$20.67
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$20.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health Medicare |
$20.67
|
| Rate for Payer: Priority Health SBD |
$56.70
|
| Rate for Payer: Railroad Medicare Medicare |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.80
|
| Rate for Payer: UHC Core |
$35.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.67
|
| Rate for Payer: UHC Exchange |
$20.67
|
| Rate for Payer: UHC Medicare Advantage |
$21.29
|
| Rate for Payer: VA VA |
$20.67
|
|
|
HC PREGNENOLONE
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
30100561
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$63.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health SBD |
$56.70
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.30
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$16.78
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Mclaren Medicaid |
$11.72
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Medicaid |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health SBD |
$59.76
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC PRENATAL ANEUPLOIDY DETECTION, FISH
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000130
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.63
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.40
|
| Rate for Payer: Priority Health SBD |
$59.76
|
|
