|
HC NG/CT DETECT BY NUCLEIC ACID HOLOGIC
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna Medicare |
$72.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$36.70
|
| Rate for Payer: Mclaren Medicare |
$70.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: Meridian Medicaid |
$73.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$105.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.67
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.18
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health SBD |
$85.21
|
| Rate for Payer: Priority Health Tiered Network |
$56.14
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.27
|
| Rate for Payer: UHC Core |
$105.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.18
|
| Rate for Payer: UHC Exchange |
$105.27
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$70.18
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID HOLOGIC
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600358
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: Priority Health SBD |
$85.21
|
|
|
HC NG/CT DETECT BY PCR CEPHEID
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600355
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: Priority Health SBD |
$85.21
|
|
|
HC NG/CT DETECT BY PCR CEPHEID
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600355
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.85
|
| Rate for Payer: BCN Commercial |
$74.85
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$36.71
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.20
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$85.21
|
| Rate for Payer: Priority Health Tiered Network |
$56.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.30
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC NG/CT DETECTION BY NUCLEIC ACID AMP
|
Facility
|
IP
|
$137.97
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600348
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$86.92 |
| Max. Negotiated Rate |
$124.17 |
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.68
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Advantage |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Healthscope Commercial |
$124.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: Priority Health SBD |
$86.92
|
|
|
HC NG/CT DETECTION BY NUCLEIC ACID AMP
|
Facility
|
OP
|
$137.97
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
30600348
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$124.17 |
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$38.55
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.85
|
| Rate for Payer: BCN Commercial |
$74.85
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cash Price |
$110.38
|
| Rate for Payer: Cofinity Advantage |
$96.58
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$124.17
|
| Rate for Payer: Mclaren Medicaid |
$36.71
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: Meridian Medicaid |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.27
|
| Rate for Payer: Nomi Health Commercial |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.48
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.20
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$86.92
|
| Rate for Payer: Priority Health Tiered Network |
$56.16
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.30
|
| Rate for Payer: UHC Core |
$105.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.20
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHC Medicaid |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$36.71
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health SBD |
$39.98
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health SBD |
$39.98
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,499.11
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$2,204.44 |
| Max. Negotiated Rate |
$3,149.20 |
| Rate for Payer: Aetna Commercial |
$2,974.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.42
|
| Rate for Payer: Cash Price |
$2,799.29
|
| Rate for Payer: Cofinity Advantage |
$2,449.38
|
| Rate for Payer: Cofinity Commercial |
$3,009.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,799.29
|
| Rate for Payer: Healthscope Commercial |
$3,149.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,974.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,624.33
|
| Rate for Payer: PHP Commercial |
$2,974.24
|
| Rate for Payer: Priority Health SBD |
$2,204.44
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$5,187.47
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$3,268.11 |
| Max. Negotiated Rate |
$4,668.72 |
| Rate for Payer: Aetna Commercial |
$4,409.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,371.86
|
| Rate for Payer: Cash Price |
$4,149.98
|
| Rate for Payer: Cofinity Advantage |
$3,631.23
|
| Rate for Payer: Cofinity Commercial |
$4,461.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,149.98
|
| Rate for Payer: Healthscope Commercial |
$4,668.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,409.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,890.60
|
| Rate for Payer: PHP Commercial |
$4,409.35
|
| Rate for Payer: Priority Health SBD |
$3,268.11
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,432.11
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$3,422.23 |
| Max. Negotiated Rate |
$4,888.90 |
| Rate for Payer: Aetna Commercial |
$4,617.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,530.87
|
| Rate for Payer: Cash Price |
$4,345.69
|
| Rate for Payer: Cofinity Advantage |
$3,802.48
|
| Rate for Payer: Cofinity Commercial |
$4,671.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,345.69
|
| Rate for Payer: Healthscope Commercial |
$4,888.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,617.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,074.08
|
| Rate for Payer: PHP Commercial |
$4,617.29
|
| Rate for Payer: Priority Health SBD |
$3,422.23
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.98 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna Medicare |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.22
|
| Rate for Payer: BCBS Complete |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Advantage |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$176.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$184.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: PHP Commercial |
$174.22
|
| Rate for Payer: Priority Health SBD |
$129.12
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$129.12 |
| Max. Negotiated Rate |
$184.46 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.22
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Advantage |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$176.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$184.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: PHP Commercial |
$174.22
|
| Rate for Payer: Priority Health SBD |
$129.12
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,409.92
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,518.25 |
| Max. Negotiated Rate |
$2,168.93 |
| Rate for Payer: Aetna Commercial |
$2,048.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,927.94
|
| Rate for Payer: Cofinity Advantage |
$1,686.94
|
| Rate for Payer: Cofinity Commercial |
$2,072.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,927.94
|
| Rate for Payer: Healthscope Commercial |
$2,168.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,048.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,807.44
|
| Rate for Payer: PHP Commercial |
$2,048.43
|
| Rate for Payer: Priority Health SBD |
$1,518.25
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$85.81
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.06 |
| Max. Negotiated Rate |
$77.23 |
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.78
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Cofinity Advantage |
$60.07
|
| Rate for Payer: Cofinity Commercial |
$73.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$77.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.36
|
| Rate for Payer: PHP Commercial |
$72.94
|
| Rate for Payer: Priority Health SBD |
$54.06
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$85.81
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$77.23 |
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Medicare |
$42.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.78
|
| Rate for Payer: BCBS Complete |
$34.32
|
| Rate for Payer: Cash Price |
$68.65
|
| Rate for Payer: Cofinity Advantage |
$60.07
|
| Rate for Payer: Cofinity Commercial |
$73.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.65
|
| Rate for Payer: Healthscope Commercial |
$77.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.36
|
| Rate for Payer: PHP Commercial |
$72.94
|
| Rate for Payer: Priority Health SBD |
$54.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.78
|
| Rate for Payer: UHC Core |
$44.71
|
| Rate for Payer: UHC Exchange |
$33.72
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$31.80
|
| Rate for Payer: BCN Commercial |
$31.80
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health SBD |
$32.21
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.23
|
| Rate for Payer: UHC Core |
$26.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Exchange |
$20.09
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$51.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.21 |
| Max. Negotiated Rate |
$46.01 |
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Cash Price |
$40.90
|
| Rate for Payer: Cofinity Advantage |
$35.78
|
| Rate for Payer: Cofinity Commercial |
$43.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.90
|
| Rate for Payer: Healthscope Commercial |
$46.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.34
|
| Rate for Payer: PHP Commercial |
$43.45
|
| Rate for Payer: Priority Health SBD |
$32.21
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,146.17 |
| Max. Negotiated Rate |
$4,494.53 |
| Rate for Payer: Aetna Commercial |
$4,244.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,246.05
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Advantage |
$3,495.74
|
| Rate for Payer: Cofinity Commercial |
$4,294.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Healthscope Commercial |
$4,494.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: PHP Commercial |
$4,244.83
|
| Rate for Payer: Priority Health SBD |
$3,146.17
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,993.92
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.21 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$4,244.83
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,246.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.75
|
| Rate for Payer: BCN Commercial |
$1,090.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cash Price |
$3,995.14
|
| Rate for Payer: Cofinity Advantage |
$3,495.74
|
| Rate for Payer: Cofinity Commercial |
$4,294.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,995.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$4,494.53
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,244.83
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,745.44
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$4,244.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$3,146.17
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,246.05
|
| Rate for Payer: UHC Core |
$2,601.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,055.86
|
| Rate for Payer: UHC Exchange |
$1,962.61
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
IP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$579.41 |
| Max. Negotiated Rate |
$827.73 |
| Rate for Payer: Aetna Commercial |
$781.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.80
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Advantage |
$643.79
|
| Rate for Payer: Cofinity Commercial |
$790.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Healthscope Commercial |
$827.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: PHP Commercial |
$781.75
|
| Rate for Payer: Priority Health SBD |
$579.41
|
|
|
HC NM BONE MARROW LIMITED AREA
|
Facility
|
OP
|
$919.70
|
|
|
Service Code
|
CPT 78102
|
| Hospital Charge Code |
34100009
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$781.75
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$305.13
|
| Rate for Payer: BCN Commercial |
$305.13
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cash Price |
$735.76
|
| Rate for Payer: Cofinity Advantage |
$643.79
|
| Rate for Payer: Cofinity Commercial |
$790.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$827.73
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.75
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.77
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$781.75
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$579.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.80
|
| Rate for Payer: UHC Core |
$479.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$361.44
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
|
HC NM BONE MARROW MULTIPLE AREA
|
Facility
|
OP
|
$1,172.40
|
|
|
Service Code
|
CPT 78103
|
| Hospital Charge Code |
34100010
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$1,288.18 |
| Rate for Payer: Aetna Commercial |
$996.54
|
| Rate for Payer: Aetna Medicare |
$414.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$497.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$497.91
|
| Rate for Payer: BCBS Complete |
$218.76
|
| Rate for Payer: BCBS MAPPO |
$398.33
|
| Rate for Payer: BCBS Trust/PPO |
$316.49
|
| Rate for Payer: BCN Commercial |
$316.49
|
| Rate for Payer: BCN Medicare Advantage |
$398.33
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cash Price |
$937.92
|
| Rate for Payer: Cofinity Advantage |
$820.68
|
| Rate for Payer: Cofinity Commercial |
$1,008.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$937.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.33
|
| Rate for Payer: Healthscope Commercial |
$1,055.16
|
| Rate for Payer: Mclaren Medicaid |
$208.33
|
| Rate for Payer: Mclaren Medicare |
$398.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.25
|
| Rate for Payer: Meridian Medicaid |
$418.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$438.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$996.54
|
| Rate for Payer: Nomi Health Commercial |
$1,194.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$879.30
|
| Rate for Payer: PACE Medicare |
$378.41
|
| Rate for Payer: PACE SWMI |
$398.33
|
| Rate for Payer: PHP Commercial |
$996.54
|
| Rate for Payer: PHP Medicare Advantage |
$398.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,288.18
|
| Rate for Payer: Priority Health Medicare |
$398.33
|
| Rate for Payer: Priority Health SBD |
$738.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,030.54
|
| Rate for Payer: Railroad Medicare Medicare |
$398.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.06
|
| Rate for Payer: UHC Core |
$610.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$398.33
|
| Rate for Payer: UHC Exchange |
$460.75
|
| Rate for Payer: UHC Medicaid |
$208.33
|
| Rate for Payer: UHCCP Medicaid |
$208.33
|
| Rate for Payer: VA VA |
$398.33
|
|
