|
HC LIPID PANEL
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| 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 |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| 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 |
$7.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.39
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$13.39
|
|
|
HC LIPID PANEL LMPP
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC LIPID PANEL LMPP
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100767
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| 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 |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| 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 |
$7.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PACE Medicare |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.39
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
| Rate for Payer: UHCCP Medicaid |
$7.54
|
| Rate for Payer: VA VA |
$13.39
|
|
|
HC LIPOPROTEIN A
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC LIPOPROTEIN A
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$40.31 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$14.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| 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 |
$8.06
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$7.68
|
| 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 |
$8.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$13.60
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$14.32
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.32
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
| Rate for Payer: UHCCP Medicaid |
$8.06
|
| Rate for Payer: VA VA |
$14.32
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health SBD |
$229.98
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.41
|
| Rate for Payer: UHC Core |
$270.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$270.14
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$46.28
|
| Rate for Payer: VA VA |
$82.21
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$229.98 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health SBD |
$229.98
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| 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 |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC LITHIUM LEVEL
|
Facility
|
OP
|
$54.94
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| 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 |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Commercial |
$38.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| 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 |
$3.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.71
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health SBD |
$34.61
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.61
|
| Rate for Payer: UHCCP Medicaid |
$3.72
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$54.94
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$49.45 |
| Rate for Payer: Aetna Commercial |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$38.46
|
| Rate for Payer: Cofinity Commercial |
$47.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.95
|
| Rate for Payer: Healthscope Commercial |
$49.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.70
|
| Rate for Payer: PHP Commercial |
$46.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.71
|
| Rate for Payer: Priority Health SBD |
$34.61
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,796.79 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.43
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,852.05
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.82 |
| Max. Negotiated Rate |
$2,566.84 |
| Rate for Payer: Aetna Commercial |
$2,424.24
|
| Rate for Payer: Aetna Medicare |
$1,426.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,853.83
|
| Rate for Payer: BCBS Complete |
$1,140.82
|
| Rate for Payer: Cash Price |
$2,281.64
|
| Rate for Payer: Cofinity Commercial |
$1,996.43
|
| Rate for Payer: Cofinity Commercial |
$2,452.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,996.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,281.64
|
| Rate for Payer: Healthscope Commercial |
$2,566.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,424.24
|
| Rate for Payer: PHP Commercial |
$2,424.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,853.83
|
| Rate for Payer: Priority Health SBD |
$1,796.79
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$1,331.09 |
| Rate for Payer: Aetna Commercial |
$1,257.14
|
| Rate for Payer: Aetna Medicare |
$739.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.34
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,035.29
|
| Rate for Payer: Cofinity Commercial |
$1,271.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,331.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: PHP Commercial |
$1,257.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: Priority Health SBD |
$931.76
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,478.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$931.76 |
| Max. Negotiated Rate |
$1,331.09 |
| Rate for Payer: Aetna Commercial |
$1,257.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.34
|
| Rate for Payer: Cash Price |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,035.29
|
| Rate for Payer: Cofinity Commercial |
$1,271.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.19
|
| Rate for Payer: Healthscope Commercial |
$1,331.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.14
|
| Rate for Payer: PHP Commercial |
$1,257.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.34
|
| Rate for Payer: Priority Health SBD |
$931.76
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna Medicare |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| 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 |
$8.19
|
| Rate for Payer: BCBS MAPPO |
$14.55
|
| Rate for Payer: BCN Medicare Advantage |
$14.55
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Cofinity Commercial |
$39.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.55
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Mclaren Medicaid |
$7.80
|
| 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 |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: PACE Medicare |
$13.82
|
| Rate for Payer: PACE SWMI |
$14.55
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: PHP Medicare Advantage |
$14.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: Priority Health Medicare |
$14.55
|
| Rate for Payer: Priority Health SBD |
$35.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.55
|
| Rate for Payer: UHCCP Medicaid |
$8.19
|
| Rate for Payer: VA VA |
$14.55
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Commercial |
$39.62
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.79
|
| Rate for Payer: Priority Health SBD |
$35.66
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| 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 |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| 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 |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna Commercial |
$81.91
|
| Rate for Payer: Aetna Medicare |
$48.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.64
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Commercial |
$82.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: PHP Commercial |
$81.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: Priority Health SBD |
$60.71
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$96.37
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$86.73 |
| Rate for Payer: Aetna Commercial |
$81.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.64
|
| Rate for Payer: Cash Price |
$77.10
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Commercial |
$82.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$86.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.91
|
| Rate for Payer: PHP Commercial |
$81.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.64
|
| Rate for Payer: Priority Health SBD |
$60.71
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$139.86 |
| Max. Negotiated Rate |
$314.68 |
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: Aetna Medicare |
$174.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.27
|
| Rate for Payer: BCBS Complete |
$139.86
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$244.75
|
| Rate for Payer: Cofinity Commercial |
$300.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$314.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: PHP Commercial |
$297.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: Priority Health SBD |
$220.27
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$349.64
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$314.68 |
| Rate for Payer: Aetna Commercial |
$297.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.27
|
| Rate for Payer: Cash Price |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$244.75
|
| Rate for Payer: Cofinity Commercial |
$300.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$244.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.71
|
| Rate for Payer: Healthscope Commercial |
$314.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.19
|
| Rate for Payer: PHP Commercial |
$297.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.27
|
| Rate for Payer: Priority Health SBD |
$220.27
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$82.73 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.44
|
| Rate for Payer: BCBS Complete |
$82.73
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Cofinity Commercial |
$177.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$186.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: PHP Commercial |
$175.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: Priority Health SBD |
$130.30
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$206.83
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.30 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: Aetna Commercial |
$175.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.44
|
| Rate for Payer: Cash Price |
$165.46
|
| Rate for Payer: Cofinity Commercial |
$144.78
|
| Rate for Payer: Cofinity Commercial |
$177.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.46
|
| Rate for Payer: Healthscope Commercial |
$186.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.81
|
| Rate for Payer: PHP Commercial |
$175.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.44
|
| Rate for Payer: Priority Health SBD |
$130.30
|
|
