|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
OP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$613.72 |
| Max. Negotiated Rate |
$1,405.47 |
| Rate for Payer: Aetna Commercial |
$1,327.39
|
| Rate for Payer: Aetna Medicare |
$780.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.06
|
| Rate for Payer: BCBS Complete |
$624.65
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Advantage |
$1,093.14
|
| Rate for Payer: Cofinity Commercial |
$1,343.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Commercial |
$1,405.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,249.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: PHP Commercial |
$1,327.39
|
| Rate for Payer: Priority Health SBD |
$983.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,015.06
|
| Rate for Payer: UHC Core |
$813.61
|
| Rate for Payer: UHC Exchange |
$613.72
|
|
|
HC LABOR CAT (1) 0-2HRS
|
Facility
|
IP
|
$1,561.63
|
|
| Hospital Charge Code |
72000001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$983.83 |
| Max. Negotiated Rate |
$1,405.47 |
| Rate for Payer: Aetna Commercial |
$1,327.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.06
|
| Rate for Payer: Cash Price |
$1,249.30
|
| Rate for Payer: Cofinity Advantage |
$1,093.14
|
| Rate for Payer: Cofinity Commercial |
$1,343.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.30
|
| Rate for Payer: Healthscope Commercial |
$1,405.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,327.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,171.22
|
| Rate for Payer: PHP Commercial |
$1,327.39
|
| Rate for Payer: Priority Health SBD |
$983.83
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
IP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,311.81 |
| Max. Negotiated Rate |
$1,874.02 |
| Rate for Payer: Aetna Commercial |
$1,769.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.46
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Advantage |
$1,457.57
|
| Rate for Payer: Cofinity Commercial |
$1,790.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$1,874.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: PHP Commercial |
$1,769.90
|
| Rate for Payer: Priority Health SBD |
$1,311.81
|
|
|
HC LABOR CAT (2) 2-5HRS
|
Facility
|
OP
|
$2,082.24
|
|
| Hospital Charge Code |
72000002
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$818.32 |
| Max. Negotiated Rate |
$1,874.02 |
| Rate for Payer: Aetna Commercial |
$1,769.90
|
| Rate for Payer: Aetna Medicare |
$1,041.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,353.46
|
| Rate for Payer: BCBS Complete |
$832.90
|
| Rate for Payer: Cash Price |
$1,665.79
|
| Rate for Payer: Cofinity Advantage |
$1,457.57
|
| Rate for Payer: Cofinity Commercial |
$1,790.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,665.79
|
| Rate for Payer: Healthscope Commercial |
$1,874.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,665.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,769.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,561.68
|
| Rate for Payer: PHP Commercial |
$1,769.90
|
| Rate for Payer: Priority Health SBD |
$1,311.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,353.46
|
| Rate for Payer: UHC Core |
$1,084.85
|
| Rate for Payer: UHC Exchange |
$818.32
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
IP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,639.69 |
| Max. Negotiated Rate |
$2,342.41 |
| Rate for Payer: Aetna Commercial |
$2,212.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.74
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Advantage |
$1,821.88
|
| Rate for Payer: Cofinity Commercial |
$2,238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Healthscope Commercial |
$2,342.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: PHP Commercial |
$2,212.28
|
| Rate for Payer: Priority Health SBD |
$1,639.69
|
|
|
HC LABOR CAT (3) 5-8HRS
|
Facility
|
OP
|
$2,602.68
|
|
| Hospital Charge Code |
72000003
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,022.85 |
| Max. Negotiated Rate |
$2,342.41 |
| Rate for Payer: Aetna Commercial |
$2,212.28
|
| Rate for Payer: Aetna Medicare |
$1,301.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,691.74
|
| Rate for Payer: BCBS Complete |
$1,041.07
|
| Rate for Payer: Cash Price |
$2,082.14
|
| Rate for Payer: Cofinity Advantage |
$1,821.88
|
| Rate for Payer: Cofinity Commercial |
$2,238.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,082.14
|
| Rate for Payer: Healthscope Commercial |
$2,342.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,212.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.01
|
| Rate for Payer: PHP Commercial |
$2,212.28
|
| Rate for Payer: Priority Health SBD |
$1,639.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,691.74
|
| Rate for Payer: UHC Core |
$1,356.00
|
| Rate for Payer: UHC Exchange |
$1,022.85
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
IP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,967.66 |
| Max. Negotiated Rate |
$2,810.94 |
| Rate for Payer: Aetna Commercial |
$2,654.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,030.13
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Advantage |
$2,186.29
|
| Rate for Payer: Cofinity Commercial |
$2,686.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Healthscope Commercial |
$2,810.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: PHP Commercial |
$2,654.78
|
| Rate for Payer: Priority Health SBD |
$1,967.66
|
|
|
HC LABOR CAT (4) 8-12HRS
|
Facility
|
OP
|
$3,123.27
|
|
| Hospital Charge Code |
72000004
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,227.45 |
| Max. Negotiated Rate |
$2,810.94 |
| Rate for Payer: Aetna Commercial |
$2,654.78
|
| Rate for Payer: Aetna Medicare |
$1,561.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,030.13
|
| Rate for Payer: BCBS Complete |
$1,249.31
|
| Rate for Payer: Cash Price |
$2,498.62
|
| Rate for Payer: Cofinity Advantage |
$2,186.29
|
| Rate for Payer: Cofinity Commercial |
$2,686.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,498.62
|
| Rate for Payer: Healthscope Commercial |
$2,810.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,498.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,654.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,342.45
|
| Rate for Payer: PHP Commercial |
$2,654.78
|
| Rate for Payer: Priority Health SBD |
$1,967.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,030.13
|
| Rate for Payer: UHC Core |
$1,627.22
|
| Rate for Payer: UHC Exchange |
$1,227.45
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
IP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,949.24 |
| Max. Negotiated Rate |
$4,213.21 |
| Rate for Payer: Aetna Commercial |
$3,979.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,042.87
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Advantage |
$3,276.94
|
| Rate for Payer: Cofinity Commercial |
$4,025.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Healthscope Commercial |
$4,213.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: PHP Commercial |
$3,979.14
|
| Rate for Payer: Priority Health SBD |
$2,949.24
|
|
|
HC LABOR CAT (5) 12-17HRS
|
Facility
|
OP
|
$4,681.34
|
|
| Hospital Charge Code |
72000007
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,839.77 |
| Max. Negotiated Rate |
$4,213.21 |
| Rate for Payer: Aetna Commercial |
$3,979.14
|
| Rate for Payer: Aetna Medicare |
$2,340.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,042.87
|
| Rate for Payer: BCBS Complete |
$1,872.54
|
| Rate for Payer: Cash Price |
$3,745.07
|
| Rate for Payer: Cofinity Advantage |
$3,276.94
|
| Rate for Payer: Cofinity Commercial |
$4,025.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,745.07
|
| Rate for Payer: Healthscope Commercial |
$4,213.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,745.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,979.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,511.01
|
| Rate for Payer: PHP Commercial |
$3,979.14
|
| Rate for Payer: Priority Health SBD |
$2,949.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,042.87
|
| Rate for Payer: UHC Core |
$2,438.98
|
| Rate for Payer: UHC Exchange |
$1,839.77
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
OP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$2,721.86 |
| Max. Negotiated Rate |
$6,233.27 |
| Rate for Payer: Aetna Commercial |
$5,886.97
|
| Rate for Payer: Aetna Medicare |
$3,462.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,501.80
|
| Rate for Payer: BCBS Complete |
$2,770.34
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Advantage |
$4,848.10
|
| Rate for Payer: Cofinity Commercial |
$5,956.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Healthscope Commercial |
$6,233.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,540.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: PHP Commercial |
$5,886.97
|
| Rate for Payer: Priority Health SBD |
$4,363.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,501.80
|
| Rate for Payer: UHC Core |
$3,608.37
|
| Rate for Payer: UHC Exchange |
$2,721.86
|
|
|
HC LABOR CAT (6) 17 OR MORE HRS
|
Facility
|
IP
|
$6,925.85
|
|
| Hospital Charge Code |
72000008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,363.29 |
| Max. Negotiated Rate |
$6,233.27 |
| Rate for Payer: Aetna Commercial |
$5,886.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,501.80
|
| Rate for Payer: Cash Price |
$5,540.68
|
| Rate for Payer: Cofinity Advantage |
$4,848.10
|
| Rate for Payer: Cofinity Commercial |
$5,956.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,540.68
|
| Rate for Payer: Healthscope Commercial |
$6,233.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,886.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,194.39
|
| Rate for Payer: PHP Commercial |
$5,886.97
|
| Rate for Payer: Priority Health SBD |
$4,363.29
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
OP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Commercial |
$3,481.64
|
| Rate for Payer: Aetna Commercial |
$5,222.47
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,993.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,662.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,144.52
|
| Rate for Payer: BCN Commercial |
$1,144.52
|
| Rate for Payer: BCN Commercial |
$1,144.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cofinity Advantage |
$4,300.86
|
| Rate for Payer: Cofinity Advantage |
$2,867.24
|
| Rate for Payer: Cofinity Commercial |
$3,522.60
|
| Rate for Payer: Cofinity Commercial |
$5,283.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$3,686.45
|
| Rate for Payer: Healthscope Commercial |
$5,529.67
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$3,481.64
|
| Rate for Payer: PHP Commercial |
$5,222.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health SBD |
$3,870.77
|
| Rate for Payer: Priority Health SBD |
$2,580.51
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,662.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,993.65
|
| Rate for Payer: UHC Core |
$3,201.07
|
| Rate for Payer: UHC Core |
$2,134.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$2,414.62
|
| Rate for Payer: UHC Exchange |
$1,609.75
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC LABYRINTHOTOMY TRANSCANAL
|
Facility
|
IP
|
$4,096.05
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
76100487
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,580.51 |
| Max. Negotiated Rate |
$3,686.45 |
| Rate for Payer: Aetna Commercial |
$3,481.64
|
| Rate for Payer: Aetna Commercial |
$5,222.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,662.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,993.65
|
| Rate for Payer: Cash Price |
$3,276.84
|
| Rate for Payer: Cash Price |
$4,915.26
|
| Rate for Payer: Cofinity Advantage |
$2,867.24
|
| Rate for Payer: Cofinity Advantage |
$4,300.86
|
| Rate for Payer: Cofinity Commercial |
$3,522.60
|
| Rate for Payer: Cofinity Commercial |
$5,283.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,915.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.84
|
| Rate for Payer: Healthscope Commercial |
$5,529.67
|
| Rate for Payer: Healthscope Commercial |
$3,686.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,481.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,222.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,072.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,608.06
|
| Rate for Payer: PHP Commercial |
$3,481.64
|
| Rate for Payer: PHP Commercial |
$5,222.47
|
| Rate for Payer: Priority Health SBD |
$2,580.51
|
| Rate for Payer: Priority Health SBD |
$3,870.77
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
IP
|
$1,587.03
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$999.83 |
| Max. Negotiated Rate |
$1,428.33 |
| Rate for Payer: Aetna Commercial |
$1,348.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.57
|
| Rate for Payer: Cash Price |
$1,269.62
|
| Rate for Payer: Cofinity Advantage |
$1,110.92
|
| Rate for Payer: Cofinity Commercial |
$1,364.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.62
|
| Rate for Payer: Healthscope Commercial |
$1,428.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,348.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.27
|
| Rate for Payer: PHP Commercial |
$1,348.98
|
| Rate for Payer: Priority Health SBD |
$999.83
|
|
|
HC LA/CS PACING + RECORDING
|
Facility
|
OP
|
$1,587.03
|
|
|
Service Code
|
CPT 93621
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.81 |
| Max. Negotiated Rate |
$4,577.22 |
| Rate for Payer: Aetna Commercial |
$1,348.98
|
| Rate for Payer: Aetna Medicare |
$793.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.57
|
| Rate for Payer: BCBS Complete |
$634.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,577.22
|
| Rate for Payer: BCN Commercial |
$4,577.22
|
| Rate for Payer: Cash Price |
$1,269.62
|
| Rate for Payer: Cash Price |
$1,269.62
|
| Rate for Payer: Cofinity Advantage |
$1,110.92
|
| Rate for Payer: Cofinity Commercial |
$1,364.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,269.62
|
| Rate for Payer: Healthscope Commercial |
$1,428.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,269.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,348.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.27
|
| Rate for Payer: PHP Commercial |
$1,348.98
|
| Rate for Payer: Priority Health SBD |
$999.83
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$22.64
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cofinity Advantage |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$19.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Mclaren Medicare |
$6.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: Meridian Medicaid |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$9.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: PACE Medicare |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.04
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health SBD |
$14.26
|
| Rate for Payer: Priority Health Tiered Network |
$4.83
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.06
|
| Rate for Payer: UHC Core |
$9.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.04
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UHC Medicaid |
$3.16
|
| Rate for Payer: UHCCP Medicaid |
$3.16
|
| Rate for Payer: VA VA |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$22.64
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
30100272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$20.38 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.72
|
| Rate for Payer: Cash Price |
$18.11
|
| Rate for Payer: Cofinity Advantage |
$15.85
|
| Rate for Payer: Cofinity Commercial |
$19.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: PHP Commercial |
$19.24
|
| Rate for Payer: Priority Health SBD |
$14.26
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
IP
|
$60.49
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$54.44 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.32
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Advantage |
$42.34
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Healthscope Commercial |
$54.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.37
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: Priority Health SBD |
$38.11
|
|
|
HC LACTATE LACTIC ACID
|
Facility
|
OP
|
$60.49
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100270
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$54.44 |
| Rate for Payer: Aetna Commercial |
$51.42
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$12.34
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cash Price |
$48.39
|
| Rate for Payer: Cofinity Advantage |
$42.34
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$54.44
|
| Rate for Payer: Mclaren Medicaid |
$6.05
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.42
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.37
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$51.42
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.57
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$38.11
|
| Rate for Payer: Priority Health Tiered Network |
$9.26
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.36
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.57
|
| Rate for Payer: UHC Exchange |
$17.36
|
| Rate for Payer: UHC Medicaid |
$6.05
|
| Rate for Payer: UHCCP Medicaid |
$6.05
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
OP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Advantage |
$67.15
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Nomi Health Commercial |
$38.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$60.44
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
IP
|
$95.93
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
30100226
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.44 |
| Max. Negotiated Rate |
$86.34 |
| Rate for Payer: Aetna Commercial |
$81.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.35
|
| Rate for Payer: Cash Price |
$76.74
|
| Rate for Payer: Cofinity Advantage |
$67.15
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.74
|
| Rate for Payer: Healthscope Commercial |
$86.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.95
|
| Rate for Payer: PHP Commercial |
$81.54
|
| Rate for Payer: Priority Health SBD |
$60.44
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.75
|
|
|
HC LAMBDA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$49.75
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC LAMBS QUARTERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200091
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
