|
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
|
|
|
HC LIPOPROTEIN A
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.90
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$15.27
|
| Rate for Payer: BCN Commercial |
$15.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$7.49
|
| Rate for Payer: Mclaren Medicare |
$14.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.04
|
| Rate for Payer: Meridian Medicaid |
$15.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$13.60
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.32
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$11.46
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$21.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.32
|
| Rate for Payer: UHC Exchange |
$21.48
|
| Rate for Payer: UHC Medicaid |
$7.49
|
| Rate for Payer: UHCCP Medicaid |
$7.49
|
| Rate for Payer: VA VA |
$14.32
|
|
|
HC LIPOPROTEIN A
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
IP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$234.58 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: Priority Health SBD |
$234.58
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
OP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$234.58
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.03
|
| Rate for Payer: UHC Core |
$193.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$146.33
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| 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 LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| 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 |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$56.04
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.31 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.43
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cofinity Advantage |
$39.23
|
| Rate for Payer: Cofinity Commercial |
$48.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.83
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.03
|
| Rate for Payer: PHP Commercial |
$47.63
|
| Rate for Payer: Priority Health SBD |
$35.31
|
|
|
HC LITHIUM LEVEL
|
Facility
|
OP
|
$56.04
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: Aetna Commercial |
$47.63
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$3.63
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$7.05
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cash Price |
$44.83
|
| Rate for Payer: Cofinity Advantage |
$39.23
|
| Rate for Payer: Cofinity Commercial |
$48.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$50.44
|
| Rate for Payer: Mclaren Medicaid |
$3.46
|
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.63
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.03
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$47.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.61
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health SBD |
$35.31
|
| Rate for Payer: Priority Health Tiered Network |
$5.29
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.92
|
| Rate for Payer: UHC Core |
$9.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.61
|
| Rate for Payer: UHC Exchange |
$9.92
|
| Rate for Payer: UHC Medicaid |
$3.46
|
| Rate for Payer: UHCCP Medicaid |
$3.46
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,909.09
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.64 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: Aetna Medicare |
$1,454.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.91
|
| Rate for Payer: BCBS Complete |
$1,163.64
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Advantage |
$2,036.36
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: Priority Health SBD |
$1,832.73
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,909.09
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,832.73 |
| Max. Negotiated Rate |
$2,618.18 |
| Rate for Payer: Aetna Commercial |
$2,472.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.91
|
| Rate for Payer: Cash Price |
$2,327.27
|
| Rate for Payer: Cofinity Advantage |
$2,036.36
|
| Rate for Payer: Cofinity Commercial |
$2,501.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,327.27
|
| Rate for Payer: Healthscope Commercial |
$2,618.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,472.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.82
|
| Rate for Payer: PHP Commercial |
$2,472.73
|
| Rate for Payer: Priority Health SBD |
$1,832.73
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,508.57
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$603.43 |
| Max. Negotiated Rate |
$1,357.71 |
| Rate for Payer: Aetna Commercial |
$1,282.28
|
| Rate for Payer: Aetna Medicare |
$754.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.57
|
| Rate for Payer: BCBS Complete |
$603.43
|
| Rate for Payer: Cash Price |
$1,206.86
|
| Rate for Payer: Cofinity Advantage |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$1,297.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,206.86
|
| Rate for Payer: Healthscope Commercial |
$1,357.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,206.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,282.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,131.43
|
| Rate for Payer: PHP Commercial |
$1,282.28
|
| Rate for Payer: Priority Health SBD |
$950.40
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,508.57
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$950.40 |
| Max. Negotiated Rate |
$1,357.71 |
| Rate for Payer: Aetna Commercial |
$1,282.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.57
|
| Rate for Payer: Cash Price |
$1,206.86
|
| Rate for Payer: Cofinity Advantage |
$1,056.00
|
| Rate for Payer: Cofinity Commercial |
$1,297.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,206.86
|
| Rate for Payer: Healthscope Commercial |
$1,357.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,282.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,131.43
|
| Rate for Payer: PHP Commercial |
$1,282.28
|
| Rate for Payer: Priority Health SBD |
$950.40
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$57.73
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$51.96 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.52
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Cofinity Advantage |
$40.41
|
| Rate for Payer: Cofinity Commercial |
$49.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.18
|
| Rate for Payer: Healthscope Commercial |
$51.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: PHP Commercial |
$49.07
|
| Rate for Payer: Priority Health SBD |
$36.37
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$57.73
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$51.96 |
| Rate for Payer: Aetna Commercial |
$49.07
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.19
|
| Rate for Payer: BCBS Complete |
$7.99
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.51
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Cofinity Advantage |
$40.41
|
| Rate for Payer: Cofinity Commercial |
$49.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$51.96
|
| Rate for Payer: Mclaren Medicaid |
$7.61
|
| Rate for Payer: Mclaren Medicare |
$14.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.28
|
| Rate for Payer: Meridian Medicaid |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.07
|
| Rate for Payer: Nomi Health Commercial |
$21.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.30
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$49.07
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.55
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$36.37
|
| Rate for Payer: Priority Health Tiered Network |
$11.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.83
|
| Rate for Payer: UHC Core |
$21.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.55
|
| Rate for Payer: UHC Exchange |
$21.83
|
| Rate for Payer: UHC Medicaid |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$7.61
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| 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: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
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
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$98.30
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$61.93 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$83.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.90
|
| Rate for Payer: Cash Price |
$78.64
|
| Rate for Payer: Cofinity Advantage |
$68.81
|
| Rate for Payer: Cofinity Commercial |
$84.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.64
|
| Rate for Payer: Healthscope Commercial |
$88.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.72
|
| Rate for Payer: PHP Commercial |
$83.56
|
| Rate for Payer: Priority Health SBD |
$61.93
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$98.30
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$38.63 |
| Max. Negotiated Rate |
$88.47 |
| Rate for Payer: Aetna Commercial |
$83.56
|
| Rate for Payer: Aetna Medicare |
$49.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.90
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: Cash Price |
$78.64
|
| Rate for Payer: Cofinity Advantage |
$68.81
|
| Rate for Payer: Cofinity Commercial |
$84.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.64
|
| Rate for Payer: Healthscope Commercial |
$88.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.72
|
| Rate for Payer: PHP Commercial |
$83.56
|
| Rate for Payer: Priority Health SBD |
$61.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.90
|
| Rate for Payer: UHC Core |
$51.21
|
| Rate for Payer: UHC Exchange |
$38.63
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$356.63
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$320.97 |
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.81
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cofinity Advantage |
$249.64
|
| Rate for Payer: Cofinity Commercial |
$306.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.30
|
| Rate for Payer: Healthscope Commercial |
$320.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.47
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: Priority Health SBD |
$224.68
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$356.63
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$140.16 |
| Max. Negotiated Rate |
$320.97 |
| Rate for Payer: Aetna Commercial |
$303.14
|
| Rate for Payer: Aetna Medicare |
$178.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.81
|
| Rate for Payer: BCBS Complete |
$142.65
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cofinity Advantage |
$249.64
|
| Rate for Payer: Cofinity Commercial |
$306.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.30
|
| Rate for Payer: Healthscope Commercial |
$320.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.47
|
| Rate for Payer: PHP Commercial |
$303.14
|
| Rate for Payer: Priority Health SBD |
$224.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.81
|
| Rate for Payer: UHC Core |
$185.80
|
| Rate for Payer: UHC Exchange |
$140.16
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$210.97
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$189.87 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Aetna Medicare |
$105.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.13
|
| Rate for Payer: BCBS Complete |
$84.39
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cofinity Advantage |
$147.68
|
| Rate for Payer: Cofinity Commercial |
$181.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.78
|
| Rate for Payer: Healthscope Commercial |
$189.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.23
|
| Rate for Payer: PHP Commercial |
$179.32
|
| Rate for Payer: Priority Health SBD |
$132.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.13
|
| Rate for Payer: UHC Core |
$109.92
|
| Rate for Payer: UHC Exchange |
$82.91
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$210.97
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$189.87 |
| Rate for Payer: Aetna Commercial |
$179.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.13
|
| Rate for Payer: Cash Price |
$168.78
|
| Rate for Payer: Cofinity Advantage |
$147.68
|
| Rate for Payer: Cofinity Commercial |
$181.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.78
|
| Rate for Payer: Healthscope Commercial |
$189.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.23
|
| Rate for Payer: PHP Commercial |
$179.32
|
| Rate for Payer: Priority Health SBD |
$132.91
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.53 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Advantage |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.16
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health SBD |
$92.53
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$146.88
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$132.19 |
| Rate for Payer: Aetna Commercial |
$124.85
|
| Rate for Payer: Aetna Medicare |
$73.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.47
|
| Rate for Payer: BCBS Complete |
$58.75
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cofinity Advantage |
$102.82
|
| Rate for Payer: Cofinity Commercial |
$126.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$132.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.16
|
| Rate for Payer: PHP Commercial |
$124.85
|
| Rate for Payer: Priority Health SBD |
$92.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.47
|
| Rate for Payer: UHC Core |
$76.52
|
| Rate for Payer: UHC Exchange |
$57.72
|
|
