|
HC PROTEIN S ANTIGEN FREE
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
30500074
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna Commercial |
$72.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.25
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$73.10
|
| Rate for Payer: Healthscope Commercial |
$76.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.25
|
| Rate for Payer: PHP Commercial |
$72.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health SBD |
$53.55
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$30.24
|
|
|
HC PROTHROMBIN TIME
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500073
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$41.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$43.20
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.80
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$40.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health SBD |
$30.24
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.42
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTIME WITH INR
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health SBD |
$17.99
|
|
|
HC PROTIME WITH INR
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500058
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.42
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health SBD |
$52.29
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.96
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.26
|
| Rate for Payer: Priority Health SBD |
$53.34
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.18 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$18.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$13.18
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$13.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.96
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.91
|
| Rate for Payer: UHC Core |
$30.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.81
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health SBD |
$43.04
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.14
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$15.12
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Mclaren Medicaid |
$10.56
|
| Rate for Payer: Mclaren Medicare |
$19.31
|
| Rate for Payer: Meridian Medicaid |
$11.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Medicare |
$18.34
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health Medicare |
$19.31
|
| Rate for Payer: Priority Health SBD |
$43.04
|
| Rate for Payer: Railroad Medicare Medicare |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.17
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.31
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicare Advantage |
$19.89
|
| Rate for Payer: VA VA |
$19.31
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health SBD |
$43.04
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health SBD |
$43.04
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$18.39
|
| Rate for Payer: UHC Medicare Advantage |
$18.94
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health SBD |
$43.04
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$58.06
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.99
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$14.40
|
| Rate for Payer: BCN Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cash Price |
$54.65
|
| Rate for Payer: Cofinity Commercial |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.39
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.06
|
| Rate for Payer: PACE Medicare |
$17.47
|
| Rate for Payer: PACE SWMI |
$18.39
|
| Rate for Payer: PHP Commercial |
$58.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.82
|
| Rate for Payer: Priority Health Medicare |
$18.39
|
| Rate for Payer: Priority Health SBD |
$43.04
|
| Rate for Payer: Railroad Medicare Medicare |
$18.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.07
|
| Rate for Payer: UHC Core |
$31.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.39
|
| Rate for Payer: UHC Exchange |
$18.39
|
| Rate for Payer: UHC Medicare Advantage |
$18.94
|
| Rate for Payer: VA VA |
$18.39
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$642.33 |
| Max. Negotiated Rate |
$917.61 |
| Rate for Payer: Aetna Commercial |
$866.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.72
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$713.70
|
| Rate for Payer: Cofinity Commercial |
$876.83
|
| Rate for Payer: Healthscope Commercial |
$917.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: PHP Commercial |
$866.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health SBD |
$642.33
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,019.57
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Commercial |
$866.63
|
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$320.91
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cash Price |
$815.66
|
| Rate for Payer: Cofinity Commercial |
$876.83
|
| Rate for Payer: Cofinity Commercial |
$713.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Healthscope Commercial |
$917.61
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$866.63
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Commercial |
$866.63
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.40
|
| Rate for Payer: Priority Health SBD |
$642.33
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.22
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$100.20
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$8.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$6.16
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$4.30
|
| Rate for Payer: Mclaren Medicare |
$7.87
|
| Rate for Payer: Meridian Medicaid |
$4.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$7.87
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC Core |
$13.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UHC Medicare Advantage |
$8.11
|
| Rate for Payer: VA VA |
$7.87
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$5,112.58 |
| Rate for Payer: Aetna Commercial |
$4,828.54
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,692.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$3,803.94
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$4,885.35
|
| Rate for Payer: Cofinity Commercial |
$3,976.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$5,112.58
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$4,828.54
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$3,578.80
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,058.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$962.02
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,680.64
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,578.80 |
| Max. Negotiated Rate |
$5,112.58 |
| Rate for Payer: Aetna Commercial |
$4,828.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,692.42
|
| Rate for Payer: Cash Price |
$4,544.51
|
| Rate for Payer: Cofinity Commercial |
$4,885.35
|
| Rate for Payer: Cofinity Commercial |
$3,976.45
|
| Rate for Payer: Healthscope Commercial |
$5,112.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,828.54
|
| Rate for Payer: PHP Commercial |
$4,828.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,976.45
|
| Rate for Payer: Priority Health SBD |
$3,578.80
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,695.40 |
| Max. Negotiated Rate |
$5,279.14 |
| Rate for Payer: Aetna Commercial |
$4,985.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,812.71
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$4,106.00
|
| Rate for Payer: Cofinity Commercial |
$5,044.51
|
| Rate for Payer: Healthscope Commercial |
$5,279.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: PHP Commercial |
$4,985.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: Priority Health SBD |
$3,695.40
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,865.71
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$5,279.14 |
| Rate for Payer: Aetna Commercial |
$4,985.85
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,812.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$4,012.71
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cash Price |
$4,692.57
|
| Rate for Payer: Cofinity Commercial |
$4,106.00
|
| Rate for Payer: Cofinity Commercial |
$5,044.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$5,279.14
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,985.85
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$4,985.85
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.00
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$3,695.40
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,121.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$1,019.98
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$281.61 |
| Max. Negotiated Rate |
$1,903.16 |
| Rate for Payer: Aetna Commercial |
$1,797.43
|
| Rate for Payer: Aetna Medicare |
$535.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$643.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$643.54
|
| Rate for Payer: BCBS Complete |
$295.72
|
| Rate for Payer: BCBS MAPPO |
$514.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,679.17
|
| Rate for Payer: BCN Medicare Advantage |
$514.83
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,818.57
|
| Rate for Payer: Cofinity Commercial |
$1,480.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.83
|
| Rate for Payer: Healthscope Commercial |
$1,903.16
|
| Rate for Payer: Mclaren Medicaid |
$281.61
|
| Rate for Payer: Mclaren Medicare |
$514.83
|
| Rate for Payer: Meridian Medicaid |
$295.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$540.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$592.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: PACE Medicare |
$489.09
|
| Rate for Payer: PACE SWMI |
$514.83
|
| Rate for Payer: PHP Commercial |
$1,797.43
|
| Rate for Payer: PHP Medicare Advantage |
$514.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,817.43
|
| Rate for Payer: Priority Health Medicare |
$514.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,453.94
|
| Rate for Payer: Priority Health SBD |
$1,332.21
|
| Rate for Payer: Railroad Medicare Medicare |
$514.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$514.83
|
| Rate for Payer: UHC Medicare Advantage |
$530.27
|
| Rate for Payer: VA VA |
$514.83
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,114.62
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,332.21 |
| Max. Negotiated Rate |
$1,903.16 |
| Rate for Payer: Aetna Commercial |
$1,797.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.50
|
| Rate for Payer: Cash Price |
$1,691.70
|
| Rate for Payer: Cofinity Commercial |
$1,480.23
|
| Rate for Payer: Cofinity Commercial |
$1,818.57
|
| Rate for Payer: Healthscope Commercial |
$1,903.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,797.43
|
| Rate for Payer: PHP Commercial |
$1,797.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.23
|
| Rate for Payer: Priority Health SBD |
$1,332.21
|
|
