|
HC LEVETIRACETAM LEVEL
|
Facility
|
IP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.38 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.91
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health SBD |
$48.38
|
|
|
HC LEVETIRACETAM LEVEL
|
Facility
|
OP
|
$76.79
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
30100057
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$69.11 |
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$66.04
|
| Rate for Payer: Cofinity Commercial |
$53.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$69.11
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.27
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$65.27
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.91
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$48.38
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
IP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,423.43 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,500.37
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$2,692.70
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,692.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health SBD |
$2,423.43
|
|
|
HC LEVONORGESTREL-RELEASING ICS, 52MG, 5 YR
|
Facility
|
OP
|
$3,846.72
|
|
|
Service Code
|
CPT J7298
|
| Hospital Charge Code |
63600106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,538.69 |
| Max. Negotiated Rate |
$3,462.05 |
| Rate for Payer: Aetna Commercial |
$3,269.71
|
| Rate for Payer: Aetna Medicare |
$1,923.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,500.37
|
| Rate for Payer: BCBS Complete |
$1,538.69
|
| Rate for Payer: Cash Price |
$3,077.38
|
| Rate for Payer: Cofinity Commercial |
$2,692.70
|
| Rate for Payer: Cofinity Commercial |
$3,308.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,692.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,077.38
|
| Rate for Payer: Healthscope Commercial |
$3,462.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,269.71
|
| Rate for Payer: PHP Commercial |
$3,269.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,500.37
|
| Rate for Payer: Priority Health SBD |
$2,423.43
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC LH (LUTEINIZING HORMONE)
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100231
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$10.43
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
| 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 |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Cofinity Commercial |
$128.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$115.67
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$10.43
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LH PEDS, S
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.67 |
| Max. Negotiated Rate |
$165.24 |
| Rate for Payer: Aetna Commercial |
$156.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.34
|
| Rate for Payer: Cash Price |
$146.88
|
| Rate for Payer: Cofinity Commercial |
$128.52
|
| Rate for Payer: Cofinity Commercial |
$157.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.88
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.06
|
| Rate for Payer: PHP Commercial |
$156.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.34
|
| Rate for Payer: Priority Health SBD |
$115.67
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
IP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.40
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$55.35
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Healthscope Commercial |
$71.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: PHP Commercial |
$67.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health SBD |
$49.81
|
|
|
HC LH ULTRASENSITIVE
|
Facility
|
OP
|
$79.07
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
30100232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$71.16 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Medicare |
$19.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.40
|
| 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 |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.52
|
| Rate for Payer: BCN Medicare Advantage |
$18.52
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cash Price |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$55.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$71.16
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| 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 |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.21
|
| Rate for Payer: PACE Medicare |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.52
|
| Rate for Payer: PHP Commercial |
$67.21
|
| Rate for Payer: PHP Medicare Advantage |
$18.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.40
|
| Rate for Payer: Priority Health Medicare |
$18.52
|
| Rate for Payer: Priority Health SBD |
$49.81
|
| Rate for Payer: Railroad Medicare Medicare |
$18.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
| Rate for Payer: UHCCP Medicaid |
$10.43
|
| Rate for Payer: VA VA |
$18.52
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC LIDOCAINE XYLOCAINE LEVEL
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 80176
|
| Hospital Charge Code |
30100033
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| 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 |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| 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 |
$8.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PACE Medicare |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$14.69
|
| Rate for Payer: UHCCP Medicaid |
$8.27
|
| Rate for Payer: VA VA |
$14.69
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
IP
|
$375.77
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$236.74 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$319.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.25
|
| Rate for Payer: Cash Price |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$263.04
|
| Rate for Payer: Cofinity Commercial |
$323.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.62
|
| Rate for Payer: Healthscope Commercial |
$338.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.40
|
| Rate for Payer: PHP Commercial |
$319.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.25
|
| Rate for Payer: Priority Health SBD |
$236.74
|
|
|
HC LIMITED SPECTRAL DOPPLER
|
Facility
|
OP
|
$375.77
|
|
|
Service Code
|
HCPCS 93321
|
| Hospital Charge Code |
48000025
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$338.19 |
| Rate for Payer: Aetna Commercial |
$319.40
|
| Rate for Payer: Aetna Medicare |
$187.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.25
|
| Rate for Payer: BCBS Complete |
$150.31
|
| Rate for Payer: Cash Price |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$263.04
|
| Rate for Payer: Cofinity Commercial |
$323.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.62
|
| Rate for Payer: Healthscope Commercial |
$338.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.40
|
| Rate for Payer: PHP Commercial |
$319.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.25
|
| Rate for Payer: Priority Health SBD |
$236.74
|
| Rate for Payer: UHC Core |
$278.07
|
| Rate for Payer: UHC Exchange |
$278.07
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
OP
|
$126.23
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$113.61 |
| Rate for Payer: Aetna Commercial |
$107.30
|
| Rate for Payer: Aetna Medicare |
$63.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.05
|
| Rate for Payer: BCBS Complete |
$50.49
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cofinity Commercial |
$108.56
|
| Rate for Payer: Cofinity Commercial |
$88.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.98
|
| Rate for Payer: Healthscope Commercial |
$113.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.30
|
| Rate for Payer: PHP Commercial |
$107.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.05
|
| Rate for Payer: Priority Health SBD |
$79.52
|
|
|
HC LINE DELIVERY EXTRA
|
Facility
|
IP
|
$126.23
|
|
| Hospital Charge Code |
27000660
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.52 |
| Max. Negotiated Rate |
$113.61 |
| Rate for Payer: Aetna Commercial |
$107.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.05
|
| Rate for Payer: Cash Price |
$100.98
|
| Rate for Payer: Cofinity Commercial |
$108.56
|
| Rate for Payer: Cofinity Commercial |
$88.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.98
|
| Rate for Payer: Healthscope Commercial |
$113.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.30
|
| Rate for Payer: PHP Commercial |
$107.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.05
|
| Rate for Payer: Priority Health SBD |
$79.52
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
IP
|
$91.80
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC LINE ISOLATOR (PRESSURE TRANSDUC)
|
Facility
|
OP
|
$91.80
|
|
| Hospital Charge Code |
27000673
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC LINE VACUUM
|
Facility
|
IP
|
$13.77
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.95
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.02
|
| Rate for Payer: Healthscope Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: PHP Commercial |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.95
|
| Rate for Payer: Priority Health SBD |
$8.68
|
|
|
HC LINE VACUUM
|
Facility
|
OP
|
$13.77
|
|
| Hospital Charge Code |
27000665
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Aetna Commercial |
$11.70
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.95
|
| Rate for Payer: BCBS Complete |
$5.51
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$9.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.02
|
| Rate for Payer: Healthscope Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: PHP Commercial |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.95
|
| Rate for Payer: Priority Health SBD |
$8.68
|
|
|
HC LIPASE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC LIPASE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100279
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| 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 |
$3.88
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Mclaren Medicaid |
$3.69
|
| 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 |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$6.89
|
| Rate for Payer: UHCCP Medicaid |
$3.88
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPASE BF
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.24
|
| Rate for Payer: Priority Health SBD |
$36.10
|
|
|
HC LIPASE BF
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
30100713
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| 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 |
$3.88
|
| Rate for Payer: BCBS MAPPO |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.89
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Cofinity Commercial |
$40.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.89
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Mclaren Medicaid |
$3.69
|
| 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 |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: PACE Medicare |
$6.55
|
| Rate for Payer: PACE SWMI |
$6.89
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.24
|
| Rate for Payer: Priority Health Medicare |
$6.89
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.89
|
| Rate for Payer: UHC Medicare Advantage |
$6.89
|
| Rate for Payer: UHCCP Medicaid |
$3.88
|
| Rate for Payer: VA VA |
$6.89
|
|
|
HC LIPID PANEL
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
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 Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| 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: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
