|
HC THYROXINE BINDING GLOBULIN
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
30100437
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$58.59 |
| Rate for Payer: Aetna Commercial |
$55.34
|
| Rate for Payer: Aetna Medicare |
$15.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.48
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$14.78
|
| Rate for Payer: BCBS Trust/PPO |
$11.58
|
| Rate for Payer: BCN Medicare Advantage |
$14.78
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cash Price |
$52.08
|
| Rate for Payer: Cofinity Commercial |
$55.99
|
| Rate for Payer: Cofinity Commercial |
$45.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.78
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Mclaren Medicaid |
$8.08
|
| Rate for Payer: Mclaren Medicare |
$14.78
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.34
|
| Rate for Payer: PACE Medicare |
$14.04
|
| Rate for Payer: PACE SWMI |
$14.78
|
| Rate for Payer: PHP Commercial |
$55.34
|
| Rate for Payer: PHP Medicare Advantage |
$14.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.57
|
| Rate for Payer: Priority Health Medicare |
$14.78
|
| Rate for Payer: Priority Health SBD |
$41.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.74
|
| Rate for Payer: UHC Core |
$25.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.78
|
| Rate for Payer: UHC Exchange |
$14.78
|
| Rate for Payer: UHC Medicare Advantage |
$15.22
|
| Rate for Payer: VA VA |
$14.78
|
|
|
HC THYROXINE FREE T4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.28
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS MAPPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$7.07
|
| Rate for Payer: BCN Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.02
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$4.93
|
| Rate for Payer: Mclaren Medicare |
$9.02
|
| Rate for Payer: Meridian Medicaid |
$5.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$8.57
|
| Rate for Payer: PACE SWMI |
$9.02
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$9.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health Medicare |
$9.02
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$9.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.82
|
| Rate for Payer: UHC Core |
$15.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.02
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: VA VA |
$9.02
|
|
|
HC THYROXINE FREE T4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
30100436
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
IP
|
$113.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.61 |
| Max. Negotiated Rate |
$102.29 |
| Rate for Payer: Aetna Commercial |
$96.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.88
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cofinity Commercial |
$79.56
|
| Rate for Payer: Cofinity Commercial |
$97.75
|
| Rate for Payer: Healthscope Commercial |
$102.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.61
|
| Rate for Payer: PHP Commercial |
$96.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health SBD |
$71.61
|
|
|
HC TIAGABINE LEVEL
|
Facility
|
OP
|
$113.66
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
30100058
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$102.29 |
| Rate for Payer: Aetna Commercial |
$96.61
|
| Rate for Payer: Aetna Medicare |
$28.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.89
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$27.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Medicare Advantage |
$27.11
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cash Price |
$90.93
|
| Rate for Payer: Cofinity Commercial |
$79.56
|
| Rate for Payer: Cofinity Commercial |
$97.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$102.29
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Mclaren Medicare |
$27.11
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.61
|
| Rate for Payer: PACE Medicare |
$25.75
|
| Rate for Payer: PACE SWMI |
$27.11
|
| Rate for Payer: PHP Commercial |
$96.61
|
| Rate for Payer: PHP Medicare Advantage |
$27.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health Medicare |
$27.11
|
| Rate for Payer: Priority Health SBD |
$71.61
|
| Rate for Payer: Railroad Medicare Medicare |
$27.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.53
|
| Rate for Payer: UHC Core |
$29.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.11
|
| Rate for Payer: UHC Exchange |
$27.11
|
| Rate for Payer: UHC Medicare Advantage |
$27.92
|
| Rate for Payer: VA VA |
$27.11
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
OP
|
$5,903.93
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,361.57 |
| Max. Negotiated Rate |
$5,313.54 |
| Rate for Payer: Aetna Commercial |
$5,018.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,837.55
|
| Rate for Payer: BCBS Complete |
$2,361.57
|
| Rate for Payer: Cash Price |
$4,723.14
|
| Rate for Payer: Cofinity Commercial |
$4,132.75
|
| Rate for Payer: Cofinity Commercial |
$5,077.38
|
| Rate for Payer: Healthscope Commercial |
$5,313.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,018.34
|
| Rate for Payer: PHP Commercial |
$5,018.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,132.75
|
| Rate for Payer: Priority Health SBD |
$3,719.48
|
|
|
HC TIER 1 MAJOR TRAUMA RESUSCITATION
|
Facility
|
IP
|
$5,903.93
|
|
| Hospital Charge Code |
68100001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$3,719.48 |
| Max. Negotiated Rate |
$5,313.54 |
| Rate for Payer: Aetna Commercial |
$5,018.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,837.55
|
| Rate for Payer: Cash Price |
$4,723.14
|
| Rate for Payer: Cofinity Commercial |
$4,132.75
|
| Rate for Payer: Cofinity Commercial |
$5,077.38
|
| Rate for Payer: Healthscope Commercial |
$5,313.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,018.34
|
| Rate for Payer: PHP Commercial |
$5,018.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,132.75
|
| Rate for Payer: Priority Health SBD |
$3,719.48
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
IP
|
$4,502.61
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,836.64 |
| Max. Negotiated Rate |
$4,052.35 |
| Rate for Payer: Aetna Commercial |
$3,827.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,926.70
|
| Rate for Payer: Cash Price |
$3,602.09
|
| Rate for Payer: Cofinity Commercial |
$3,151.83
|
| Rate for Payer: Cofinity Commercial |
$3,872.24
|
| Rate for Payer: Healthscope Commercial |
$4,052.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,827.22
|
| Rate for Payer: PHP Commercial |
$3,827.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,151.83
|
| Rate for Payer: Priority Health SBD |
$2,836.64
|
|
|
HC TIER 2 TRAUMA RESUSCITATION
|
Facility
|
OP
|
$4,502.61
|
|
| Hospital Charge Code |
68200001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,801.04 |
| Max. Negotiated Rate |
$4,052.35 |
| Rate for Payer: Aetna Commercial |
$3,827.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,926.70
|
| Rate for Payer: BCBS Complete |
$1,801.04
|
| Rate for Payer: Cash Price |
$3,602.09
|
| Rate for Payer: Cofinity Commercial |
$3,151.83
|
| Rate for Payer: Cofinity Commercial |
$3,872.24
|
| Rate for Payer: Healthscope Commercial |
$4,052.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,827.22
|
| Rate for Payer: PHP Commercial |
$3,827.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,151.83
|
| Rate for Payer: Priority Health SBD |
$2,836.64
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
IP
|
$3,434.34
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$2,163.63 |
| Max. Negotiated Rate |
$3,090.91 |
| Rate for Payer: Aetna Commercial |
$2,919.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,232.32
|
| Rate for Payer: Cash Price |
$2,747.47
|
| Rate for Payer: Cofinity Commercial |
$2,404.04
|
| Rate for Payer: Cofinity Commercial |
$2,953.53
|
| Rate for Payer: Healthscope Commercial |
$3,090.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,919.19
|
| Rate for Payer: PHP Commercial |
$2,919.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,404.04
|
| Rate for Payer: Priority Health SBD |
$2,163.63
|
|
|
HC TIER 3 TRAUMA CONSULT
|
Facility
|
OP
|
$3,434.34
|
|
| Hospital Charge Code |
68100002
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,373.74 |
| Max. Negotiated Rate |
$3,090.91 |
| Rate for Payer: Aetna Commercial |
$2,919.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,232.32
|
| Rate for Payer: BCBS Complete |
$1,373.74
|
| Rate for Payer: Cash Price |
$2,747.47
|
| Rate for Payer: Cofinity Commercial |
$2,404.04
|
| Rate for Payer: Cofinity Commercial |
$2,953.53
|
| Rate for Payer: Healthscope Commercial |
$3,090.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,919.19
|
| Rate for Payer: PHP Commercial |
$2,919.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,404.04
|
| Rate for Payer: Priority Health SBD |
$2,163.63
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
OP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,048.15 |
| Max. Negotiated Rate |
$2,358.34 |
| Rate for Payer: Aetna Commercial |
$2,227.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.25
|
| Rate for Payer: BCBS Complete |
$1,048.15
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$1,834.27
|
| Rate for Payer: Cofinity Commercial |
$2,253.53
|
| Rate for Payer: Healthscope Commercial |
$2,358.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: PHP Commercial |
$2,227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: Priority Health SBD |
$1,650.84
|
|
|
HC TIER 4 TRAUMA CONSULT
|
Facility
|
IP
|
$2,620.38
|
|
| Hospital Charge Code |
68100003
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,650.84 |
| Max. Negotiated Rate |
$2,358.34 |
| Rate for Payer: Aetna Commercial |
$2,227.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.25
|
| Rate for Payer: Cash Price |
$2,096.30
|
| Rate for Payer: Cofinity Commercial |
$1,834.27
|
| Rate for Payer: Cofinity Commercial |
$2,253.53
|
| Rate for Payer: Healthscope Commercial |
$2,358.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,227.32
|
| Rate for Payer: PHP Commercial |
$2,227.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.27
|
| Rate for Payer: Priority Health SBD |
$1,650.84
|
|
|
HC TILT TABLE STRESS
|
Facility
|
IP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$693.53 |
| Max. Negotiated Rate |
$990.76 |
| Rate for Payer: Aetna Commercial |
$935.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.55
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$770.59
|
| Rate for Payer: Cofinity Commercial |
$946.72
|
| Rate for Payer: Healthscope Commercial |
$990.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: PHP Commercial |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health SBD |
$693.53
|
|
|
HC TILT TABLE STRESS
|
Facility
|
OP
|
$1,100.84
|
|
|
Service Code
|
CPT 93660
|
| Hospital Charge Code |
48200002
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$159.14 |
| Max. Negotiated Rate |
$990.76 |
| Rate for Payer: Aetna Commercial |
$935.71
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$322.36
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cash Price |
$880.67
|
| Rate for Payer: Cofinity Commercial |
$946.72
|
| Rate for Payer: Cofinity Commercial |
$770.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$990.76
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.71
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$935.71
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.59
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$693.53
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$159.14
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC TIMOTHY GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200063
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health SBD |
$26.46
|
|
|
HC TIP PUMP SUCTION
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
27000111
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Aetna Commercial |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.30
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Healthscope Commercial |
$37.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.70
|
| Rate for Payer: PHP Commercial |
$35.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health SBD |
$26.46
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.43 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.72
|
| Rate for Payer: BCBS Complete |
$105.67
|
| Rate for Payer: BCBS Trust/PPO |
$110.87
|
| Rate for Payer: BCCCP Commercial |
$123.01
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health SBD |
$166.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.68
|
| Rate for Payer: UHC Core |
$58.43
|
| Rate for Payer: UHC Exchange |
$126.07
|
|
|
HC TISSUE IN SITU HYB QUANT EA ADD
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88369
|
| Hospital Charge Code |
31000123
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.72
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health SBD |
$166.43
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
OP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$280.68
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$170.86
|
| Rate for Payer: BCCCP Commercial |
$181.78
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$231.15
|
| Rate for Payer: Cofinity Commercial |
$283.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$297.19
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$280.68
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$208.03
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.62
|
| Rate for Payer: UHC Core |
$69.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$174.20
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC TISSUE IN SITU HYBRIDIZATION
|
Facility
|
IP
|
$330.21
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
31000060
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$208.03 |
| Max. Negotiated Rate |
$297.19 |
| Rate for Payer: Aetna Commercial |
$280.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.64
|
| Rate for Payer: Cash Price |
$264.17
|
| Rate for Payer: Cofinity Commercial |
$231.15
|
| Rate for Payer: Cofinity Commercial |
$283.98
|
| Rate for Payer: Healthscope Commercial |
$297.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$280.68
|
| Rate for Payer: PHP Commercial |
$280.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.15
|
| Rate for Payer: Priority Health SBD |
$208.03
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
IP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$237.76 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.72
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health SBD |
$166.43
|
|
|
HC TISSUE IN SITU HYBRID QUANT
|
Facility
|
OP
|
$264.18
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
31000122
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$399.80 |
| Rate for Payer: Aetna Commercial |
$224.55
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$125.34
|
| Rate for Payer: BCCCP Commercial |
$143.46
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cash Price |
$211.34
|
| Rate for Payer: Cofinity Commercial |
$184.93
|
| Rate for Payer: Cofinity Commercial |
$227.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$237.76
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.55
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$224.55
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.93
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health SBD |
$166.43
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.92
|
| Rate for Payer: UHC Core |
$69.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$145.38
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
