|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$49.02
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.88 |
| Max. Negotiated Rate |
$44.12 |
| Rate for Payer: Aetna Commercial |
$41.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.86
|
| Rate for Payer: Cash Price |
$39.22
|
| Rate for Payer: Cofinity Advantage |
$34.31
|
| Rate for Payer: Cofinity Commercial |
$42.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.22
|
| Rate for Payer: Healthscope Commercial |
$44.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.77
|
| Rate for Payer: PHP Commercial |
$41.67
|
| Rate for Payer: Priority Health SBD |
$30.88
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$392.42
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$1,064.33 |
| Rate for Payer: Aetna Commercial |
$333.56
|
| Rate for Payer: Aetna Medicare |
$342.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$411.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$411.40
|
| Rate for Payer: BCBS Complete |
$180.75
|
| Rate for Payer: BCBS MAPPO |
$329.12
|
| Rate for Payer: BCBS Trust/PPO |
$498.37
|
| Rate for Payer: BCN Commercial |
$498.37
|
| Rate for Payer: BCN Medicare Advantage |
$329.12
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cofinity Advantage |
$274.69
|
| Rate for Payer: Cofinity Commercial |
$337.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.12
|
| Rate for Payer: Healthscope Commercial |
$353.18
|
| Rate for Payer: Mclaren Medicaid |
$172.13
|
| Rate for Payer: Mclaren Medicare |
$329.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.58
|
| Rate for Payer: Meridian Medicaid |
$345.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$362.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.56
|
| Rate for Payer: Nomi Health Commercial |
$987.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.31
|
| Rate for Payer: PACE Medicare |
$312.66
|
| Rate for Payer: PACE SWMI |
$329.12
|
| Rate for Payer: PHP Commercial |
$333.56
|
| Rate for Payer: PHP Medicare Advantage |
$329.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,064.33
|
| Rate for Payer: Priority Health Medicare |
$329.12
|
| Rate for Payer: Priority Health SBD |
$247.22
|
| Rate for Payer: Priority Health Tiered Network |
$851.46
|
| Rate for Payer: Railroad Medicare Medicare |
$329.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.07
|
| Rate for Payer: UHC Core |
$204.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$329.12
|
| Rate for Payer: UHC Exchange |
$154.22
|
| Rate for Payer: UHC Medicaid |
$172.13
|
| Rate for Payer: UHCCP Medicaid |
$172.13
|
| Rate for Payer: VA VA |
$329.12
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$392.42
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$353.18 |
| Rate for Payer: Aetna Commercial |
$333.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.07
|
| Rate for Payer: Cash Price |
$313.94
|
| Rate for Payer: Cofinity Advantage |
$274.69
|
| Rate for Payer: Cofinity Commercial |
$337.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.94
|
| Rate for Payer: Healthscope Commercial |
$353.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.31
|
| Rate for Payer: PHP Commercial |
$333.56
|
| Rate for Payer: Priority Health SBD |
$247.22
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.57
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.20
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cofinity Advantage |
$1.29
|
| Rate for Payer: Cofinity Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.48
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.85
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.20
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cofinity Advantage |
$1.29
|
| Rate for Payer: Cofinity Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.48
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.17
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
IP
|
$5,919.88
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3,729.52 |
| Max. Negotiated Rate |
$5,327.89 |
| Rate for Payer: Aetna Commercial |
$5,031.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,847.92
|
| Rate for Payer: Cash Price |
$4,735.90
|
| Rate for Payer: Cofinity Advantage |
$4,143.92
|
| Rate for Payer: Cofinity Commercial |
$5,091.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,735.90
|
| Rate for Payer: Healthscope Commercial |
$5,327.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,031.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,439.91
|
| Rate for Payer: PHP Commercial |
$5,031.90
|
| Rate for Payer: Priority Health SBD |
$3,729.52
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
OP
|
$5,919.88
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,326.51 |
| Max. Negotiated Rate |
$5,327.89 |
| Rate for Payer: Aetna Commercial |
$5,031.90
|
| Rate for Payer: Aetna Medicare |
$2,959.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,847.92
|
| Rate for Payer: BCBS Complete |
$2,367.95
|
| Rate for Payer: Cash Price |
$4,735.90
|
| Rate for Payer: Cofinity Advantage |
$4,143.92
|
| Rate for Payer: Cofinity Commercial |
$5,091.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,735.90
|
| Rate for Payer: Healthscope Commercial |
$5,327.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,735.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,031.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,439.91
|
| Rate for Payer: PHP Commercial |
$5,031.90
|
| Rate for Payer: Priority Health SBD |
$3,729.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,847.92
|
| Rate for Payer: UHC Core |
$3,084.26
|
| Rate for Payer: UHC Exchange |
$2,326.51
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$962.88
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$606.61 |
| Max. Negotiated Rate |
$866.59 |
| Rate for Payer: Aetna Commercial |
$818.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.87
|
| Rate for Payer: Cash Price |
$770.30
|
| Rate for Payer: Cofinity Advantage |
$674.02
|
| Rate for Payer: Cofinity Commercial |
$828.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.30
|
| Rate for Payer: Healthscope Commercial |
$866.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.16
|
| Rate for Payer: PHP Commercial |
$818.45
|
| Rate for Payer: Priority Health SBD |
$606.61
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$962.88
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$866.59 |
| Rate for Payer: Aetna Commercial |
$818.45
|
| Rate for Payer: Aetna Medicare |
$481.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.87
|
| Rate for Payer: BCBS Complete |
$385.15
|
| Rate for Payer: Cash Price |
$770.30
|
| Rate for Payer: Cofinity Advantage |
$674.02
|
| Rate for Payer: Cofinity Commercial |
$828.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.30
|
| Rate for Payer: Healthscope Commercial |
$866.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$770.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$722.16
|
| Rate for Payer: PHP Commercial |
$818.45
|
| Rate for Payer: Priority Health SBD |
$606.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.87
|
| Rate for Payer: UHC Core |
$501.66
|
| Rate for Payer: UHC Exchange |
$378.41
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$563.42
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$354.95 |
| Max. Negotiated Rate |
$507.08 |
| Rate for Payer: Aetna Commercial |
$478.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.22
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cofinity Advantage |
$394.39
|
| Rate for Payer: Cofinity Commercial |
$484.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.74
|
| Rate for Payer: Healthscope Commercial |
$507.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.56
|
| Rate for Payer: PHP Commercial |
$478.91
|
| Rate for Payer: Priority Health SBD |
$354.95
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$563.42
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.42 |
| Max. Negotiated Rate |
$507.08 |
| Rate for Payer: Aetna Commercial |
$478.91
|
| Rate for Payer: Aetna Medicare |
$281.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.22
|
| Rate for Payer: BCBS Complete |
$225.37
|
| Rate for Payer: Cash Price |
$450.74
|
| Rate for Payer: Cofinity Advantage |
$394.39
|
| Rate for Payer: Cofinity Commercial |
$484.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.74
|
| Rate for Payer: Healthscope Commercial |
$507.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.56
|
| Rate for Payer: PHP Commercial |
$478.91
|
| Rate for Payer: Priority Health SBD |
$354.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.22
|
| Rate for Payer: UHC Core |
$293.54
|
| Rate for Payer: UHC Exchange |
$221.42
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$356.21
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$320.59 |
| Rate for Payer: Aetna Commercial |
$302.78
|
| Rate for Payer: Aetna Medicare |
$178.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.54
|
| Rate for Payer: BCBS Complete |
$142.48
|
| Rate for Payer: Cash Price |
$284.97
|
| Rate for Payer: Cofinity Advantage |
$249.35
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.97
|
| Rate for Payer: Healthscope Commercial |
$320.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.16
|
| Rate for Payer: PHP Commercial |
$302.78
|
| Rate for Payer: Priority Health SBD |
$224.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.54
|
| Rate for Payer: UHC Core |
$185.59
|
| Rate for Payer: UHC Exchange |
$139.99
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$356.21
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$224.41 |
| Max. Negotiated Rate |
$320.59 |
| Rate for Payer: Aetna Commercial |
$302.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.54
|
| Rate for Payer: Cash Price |
$284.97
|
| Rate for Payer: Cofinity Advantage |
$249.35
|
| Rate for Payer: Cofinity Commercial |
$306.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.97
|
| Rate for Payer: Healthscope Commercial |
$320.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.16
|
| Rate for Payer: PHP Commercial |
$302.78
|
| Rate for Payer: Priority Health SBD |
$224.41
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$197.13
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$124.19 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$197.13
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$177.42 |
| Rate for Payer: Aetna Commercial |
$167.56
|
| Rate for Payer: Aetna Medicare |
$98.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.13
|
| Rate for Payer: BCBS Complete |
$78.85
|
| Rate for Payer: Cash Price |
$157.70
|
| Rate for Payer: Cofinity Advantage |
$137.99
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.70
|
| Rate for Payer: Healthscope Commercial |
$177.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.85
|
| Rate for Payer: PHP Commercial |
$167.56
|
| Rate for Payer: Priority Health SBD |
$124.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.13
|
| Rate for Payer: UHC Core |
$102.70
|
| Rate for Payer: UHC Exchange |
$77.47
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$988.38
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$622.68 |
| Max. Negotiated Rate |
$889.54 |
| Rate for Payer: Aetna Commercial |
$840.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.45
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Advantage |
$691.87
|
| Rate for Payer: Cofinity Commercial |
$850.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$889.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: PHP Commercial |
$840.12
|
| Rate for Payer: Priority Health SBD |
$622.68
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$988.38
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$357.65 |
| Max. Negotiated Rate |
$2,211.50 |
| Rate for Payer: Aetna Commercial |
$840.12
|
| Rate for Payer: Aetna Medicare |
$711.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$854.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$854.81
|
| Rate for Payer: BCBS Complete |
$375.57
|
| Rate for Payer: BCBS MAPPO |
$683.85
|
| Rate for Payer: BCN Medicare Advantage |
$683.85
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Advantage |
$691.87
|
| Rate for Payer: Cofinity Commercial |
$850.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.85
|
| Rate for Payer: Healthscope Commercial |
$889.54
|
| Rate for Payer: Mclaren Medicaid |
$357.65
|
| Rate for Payer: Mclaren Medicare |
$683.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.04
|
| Rate for Payer: Meridian Medicaid |
$718.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$786.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$752.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Nomi Health Commercial |
$2,051.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: PACE Medicare |
$649.66
|
| Rate for Payer: PACE SWMI |
$683.85
|
| Rate for Payer: PHP Commercial |
$840.12
|
| Rate for Payer: PHP Medicare Advantage |
$683.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,211.50
|
| Rate for Payer: Priority Health Medicare |
$683.85
|
| Rate for Payer: Priority Health SBD |
$622.68
|
| Rate for Payer: Priority Health Tiered Network |
$1,769.20
|
| Rate for Payer: Railroad Medicare Medicare |
$683.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.45
|
| Rate for Payer: UHC Core |
$514.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$683.85
|
| Rate for Payer: UHC Exchange |
$388.43
|
| Rate for Payer: UHC Medicaid |
$357.65
|
| Rate for Payer: UHCCP Medicaid |
$357.65
|
| Rate for Payer: VA VA |
$683.85
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$32.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.92
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Advantage |
$45.15
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health SBD |
$40.63
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.60
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$10.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.90
|
| Rate for Payer: UHC Core |
$18.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.60
|
| Rate for Payer: UHC Exchange |
$18.90
|
| Rate for Payer: UHC Medicaid |
$6.59
|
| Rate for Payer: UHCCP Medicaid |
$6.59
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
