|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,923.65
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,030.01 |
| Max. Negotiated Rate |
$3,531.28 |
| Rate for Payer: Aetna Commercial |
$3,335.10
|
| Rate for Payer: Aetna Medicare |
$1,961.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.37
|
| Rate for Payer: BCBS Complete |
$1,569.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,003.00
|
| Rate for Payer: BCN Commercial |
$3,003.00
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cofinity Advantage |
$2,746.55
|
| Rate for Payer: Cofinity Commercial |
$3,374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.92
|
| Rate for Payer: Healthscope Commercial |
$3,531.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,138.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,335.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.74
|
| Rate for Payer: PHP Commercial |
$3,335.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,287.51
|
| Rate for Payer: Priority Health SBD |
$2,471.90
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,519.43
|
| Rate for Payer: UHC Core |
$2,519.43
|
| Rate for Payer: UHC Exchange |
$2,519.43
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,923.65
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,471.90 |
| Max. Negotiated Rate |
$3,531.28 |
| Rate for Payer: Aetna Commercial |
$3,335.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,550.37
|
| Rate for Payer: Cash Price |
$3,138.92
|
| Rate for Payer: Cofinity Advantage |
$2,746.55
|
| Rate for Payer: Cofinity Commercial |
$3,374.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,138.92
|
| Rate for Payer: Healthscope Commercial |
$3,531.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,335.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,942.74
|
| Rate for Payer: PHP Commercial |
$3,335.10
|
| Rate for Payer: Priority Health SBD |
$2,471.90
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$9.69
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$187.27
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.09
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Mclaren Medicaid |
$9.69
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$117.98
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$187.27
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.98 |
| Max. Negotiated Rate |
$168.54 |
| Rate for Payer: Aetna Commercial |
$159.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.09
|
| Rate for Payer: Cofinity Commercial |
$161.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.45
|
| Rate for Payer: PHP Commercial |
$159.18
|
| Rate for Payer: Priority Health SBD |
$117.98
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$80.65
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$72.58 |
| Rate for Payer: Aetna Commercial |
$68.55
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.15
|
| Rate for Payer: BCBS Complete |
$10.17
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.75
|
| Rate for Payer: BCN Commercial |
$19.75
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Advantage |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$72.58
|
| Rate for Payer: Mclaren Medicaid |
$9.69
|
| Rate for Payer: Mclaren Medicare |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.45
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Nomi Health Commercial |
$27.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$68.55
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.52
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$50.81
|
| Rate for Payer: Priority Health Tiered Network |
$14.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.78
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.52
|
| Rate for Payer: UHC Exchange |
$27.78
|
| Rate for Payer: UHC Medicaid |
$9.69
|
| Rate for Payer: UHCCP Medicaid |
$9.69
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$80.65
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$72.58 |
| Rate for Payer: Aetna Commercial |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.42
|
| Rate for Payer: Cash Price |
$64.52
|
| Rate for Payer: Cofinity Advantage |
$56.45
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.52
|
| Rate for Payer: Healthscope Commercial |
$72.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.49
|
| Rate for Payer: PHP Commercial |
$68.55
|
| Rate for Payer: Priority Health SBD |
$50.81
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$8.07
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.67
|
| Rate for Payer: BCN Commercial |
$15.67
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$7.68
|
| Rate for Payer: Mclaren Medicare |
$14.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.42
|
| Rate for Payer: Meridian Medicaid |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$22.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$11.75
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$22.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.69
|
| Rate for Payer: UHC Exchange |
$22.04
|
| Rate for Payer: UHC Medicaid |
$7.68
|
| Rate for Payer: UHCCP Medicaid |
$7.68
|
| Rate for Payer: VA VA |
$14.69
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$383.29
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$241.47 |
| Max. Negotiated Rate |
$344.96 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.14
|
| Rate for Payer: Cash Price |
$306.63
|
| Rate for Payer: Cofinity Advantage |
$268.30
|
| Rate for Payer: Cofinity Commercial |
$329.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$344.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.47
|
| Rate for Payer: PHP Commercial |
$325.80
|
| Rate for Payer: Priority Health SBD |
$241.47
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$383.29
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$344.96 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Medicare |
$191.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.14
|
| Rate for Payer: BCBS Complete |
$153.32
|
| Rate for Payer: BCBS Trust/PPO |
$78.47
|
| Rate for Payer: BCN Commercial |
$78.47
|
| Rate for Payer: Cash Price |
$306.63
|
| Rate for Payer: Cash Price |
$306.63
|
| Rate for Payer: Cofinity Advantage |
$268.30
|
| Rate for Payer: Cofinity Commercial |
$329.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.63
|
| Rate for Payer: Healthscope Commercial |
$344.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.47
|
| Rate for Payer: PHP Commercial |
$325.80
|
| Rate for Payer: Priority Health SBD |
$241.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.14
|
| Rate for Payer: UHC Core |
$199.69
|
| Rate for Payer: UHC Exchange |
$150.63
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$128.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$115.88 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna Medicare |
$64.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.69
|
| Rate for Payer: BCBS Complete |
$51.50
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cofinity Advantage |
$90.12
|
| Rate for Payer: Cofinity Commercial |
$110.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.00
|
| Rate for Payer: Healthscope Commercial |
$115.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.56
|
| Rate for Payer: PHP Commercial |
$109.44
|
| Rate for Payer: Priority Health SBD |
$81.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.69
|
| Rate for Payer: UHC Core |
$67.08
|
| Rate for Payer: UHC Exchange |
$50.60
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$128.75
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$115.88 |
| Rate for Payer: Aetna Commercial |
$109.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.69
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cofinity Advantage |
$90.12
|
| Rate for Payer: Cofinity Commercial |
$110.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.00
|
| Rate for Payer: Healthscope Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.56
|
| Rate for Payer: PHP Commercial |
$109.44
|
| Rate for Payer: Priority Health SBD |
$81.11
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
OP
|
$93.64
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$48.79
|
| Rate for Payer: UHC Exchange |
$36.80
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
IP
|
$93.64
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC LINE VACUUM
|
Facility
|
OP
|
$14.05
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna Medicare |
$7.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.13
|
| Rate for Payer: BCBS Complete |
$5.62
|
| Rate for Payer: Cash Price |
$11.24
|
| Rate for Payer: Cofinity Advantage |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.24
|
| Rate for Payer: Healthscope Commercial |
$12.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.94
|
| Rate for Payer: Priority Health SBD |
$8.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.13
|
| Rate for Payer: UHC Core |
$7.32
|
| Rate for Payer: UHC Exchange |
$5.52
|
|
|
HC LINE VACUUM
|
Facility
|
IP
|
$14.05
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Aetna Commercial |
$11.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.13
|
| Rate for Payer: Cash Price |
$11.24
|
| Rate for Payer: Cofinity Advantage |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$12.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.24
|
| Rate for Payer: Healthscope Commercial |
$12.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.94
|
| Rate for Payer: Priority Health SBD |
$8.85
|
|
|
HC LIPASE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.35
|
| Rate for Payer: BCN Commercial |
$7.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$3.60
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$10.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.89
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$5.51
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$10.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.89
|
| Rate for Payer: UHC Exchange |
$10.34
|
| Rate for Payer: UHC Medicaid |
$3.60
|
| Rate for Payer: UHCCP Medicaid |
$3.60
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC LIPASE BF
|
Facility
|
OP
|
$58.45
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$52.60 |
| Rate for Payer: Aetna Commercial |
$49.68
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.61
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.35
|
| Rate for Payer: BCN Commercial |
$7.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$46.76
|
| Rate for Payer: Cash Price |
$46.76
|
| Rate for Payer: Cofinity Advantage |
$40.91
|
| Rate for Payer: Cofinity Commercial |
$50.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$52.60
|
| Rate for Payer: Mclaren Medicaid |
$3.60
|
| Rate for Payer: Mclaren Medicare |
$6.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.23
|
| Rate for Payer: Meridian Medicaid |
$7.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.68
|
| Rate for Payer: Nomi Health Commercial |
$10.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.84
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$49.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.89
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$36.82
|
| Rate for Payer: Priority Health Tiered Network |
$5.51
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$10.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.89
|
| Rate for Payer: UHC Exchange |
$10.34
|
| Rate for Payer: UHC Medicaid |
$3.60
|
| Rate for Payer: UHCCP Medicaid |
$3.60
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPASE BF
|
Facility
|
IP
|
$58.45
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.82 |
| Max. Negotiated Rate |
$52.60 |
| Rate for Payer: Aetna Commercial |
$49.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.99
|
| Rate for Payer: Cash Price |
$46.76
|
| Rate for Payer: Cofinity Advantage |
$40.91
|
| Rate for Payer: Cofinity Commercial |
$50.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.76
|
| Rate for Payer: Healthscope Commercial |
$52.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.84
|
| Rate for Payer: PHP Commercial |
$49.68
|
| Rate for Payer: Priority Health SBD |
$36.82
|
|
|
HC LIPID PANEL
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC LIPID PANEL
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.74
|
| Rate for Payer: BCBS Complete |
$7.35
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCN Commercial |
$16.46
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$7.00
|
| Rate for Payer: Mclaren Medicare |
$13.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: Meridian Medicaid |
$14.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$40.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.39
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$10.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.09
|
| Rate for Payer: UHC Core |
$20.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.39
|
| Rate for Payer: UHC Exchange |
$20.09
|
| Rate for Payer: UHC Medicaid |
$7.00
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
| Rate for Payer: VA VA |
$13.39
|
|
|
HC LIPID PANEL LMPP
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
