|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$8,845.22
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$462.68 |
| Max. Negotiated Rate |
$32,375.08 |
| Rate for Payer: Aetna Commercial |
$7,518.44
|
| Rate for Payer: Aetna Medicare |
$9,881.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,749.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,876.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,876.80
|
| Rate for Payer: BCBS Complete |
$5,457.63
|
| Rate for Payer: BCBS MAPPO |
$9,501.44
|
| Rate for Payer: BCBS Trust/PPO |
$7,675.50
|
| Rate for Payer: BCN Medicare Advantage |
$9,501.44
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cofinity Commercial |
$6,191.65
|
| Rate for Payer: Cofinity Commercial |
$7,606.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,501.44
|
| Rate for Payer: Healthscope Commercial |
$7,960.70
|
| Rate for Payer: Mclaren Medicaid |
$5,197.29
|
| Rate for Payer: Mclaren Medicare |
$9,501.44
|
| Rate for Payer: Meridian Medicaid |
$5,457.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,976.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,926.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,518.44
|
| Rate for Payer: PACE Medicare |
$9,026.37
|
| Rate for Payer: PACE SWMI |
$9,501.44
|
| Rate for Payer: PHP Commercial |
$7,518.44
|
| Rate for Payer: PHP Medicare Advantage |
$9,501.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,197.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,191.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,375.08
|
| Rate for Payer: Priority Health Medicare |
$9,501.44
|
| Rate for Payer: Priority Health Narrow Network |
$25,900.06
|
| Rate for Payer: Priority Health SBD |
$5,572.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.95
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,501.44
|
| Rate for Payer: UHC Exchange |
$462.68
|
| Rate for Payer: UHC Medicare Advantage |
$9,786.48
|
| Rate for Payer: VA VA |
$9,501.44
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,556.67
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,870.70 |
| Max. Negotiated Rate |
$4,101.00 |
| Rate for Payer: Aetna Commercial |
$3,873.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.84
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cofinity Commercial |
$3,918.74
|
| Rate for Payer: Cofinity Commercial |
$3,189.67
|
| Rate for Payer: Healthscope Commercial |
$4,101.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,873.17
|
| Rate for Payer: PHP Commercial |
$3,873.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,189.67
|
| Rate for Payer: Priority Health SBD |
$2,870.70
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,556.67
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$32,375.08 |
| Rate for Payer: Aetna Commercial |
$3,873.17
|
| Rate for Payer: Aetna Medicare |
$9,881.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,961.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,876.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,876.80
|
| Rate for Payer: BCBS Complete |
$5,457.63
|
| Rate for Payer: BCBS MAPPO |
$9,501.44
|
| Rate for Payer: BCBS Trust/PPO |
$10,224.07
|
| Rate for Payer: BCN Medicare Advantage |
$9,501.44
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cofinity Commercial |
$3,918.74
|
| Rate for Payer: Cofinity Commercial |
$3,189.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,501.44
|
| Rate for Payer: Healthscope Commercial |
$4,101.00
|
| Rate for Payer: Mclaren Medicaid |
$5,197.29
|
| Rate for Payer: Mclaren Medicare |
$9,501.44
|
| Rate for Payer: Meridian Medicaid |
$5,457.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,976.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,926.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,873.17
|
| Rate for Payer: PACE Medicare |
$9,026.37
|
| Rate for Payer: PACE SWMI |
$9,501.44
|
| Rate for Payer: PHP Commercial |
$3,873.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,501.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,197.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,189.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,375.08
|
| Rate for Payer: Priority Health Medicare |
$9,501.44
|
| Rate for Payer: Priority Health Narrow Network |
$25,900.06
|
| Rate for Payer: Priority Health SBD |
$2,870.70
|
| Rate for Payer: Railroad Medicare Medicare |
$9,501.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.92
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,501.44
|
| Rate for Payer: UHC Exchange |
$490.84
|
| Rate for Payer: UHC Medicare Advantage |
$9,786.48
|
| Rate for Payer: VA VA |
$9,501.44
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health SBD |
$24.36
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Mclaren Medicare |
$5.56
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.86
|
| Rate for Payer: PACE Medicare |
$5.28
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health Medicare |
$5.56
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$8.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$5.73
|
| Rate for Payer: VA VA |
$5.56
|
|
|
HC UREAPLASMA PCR
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.63
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.99
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$53.09
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.78
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.63
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.99
|
| Rate for Payer: Priority Health SBD |
$53.09
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
OP
|
$58.77
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$52.89
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.95
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$49.95
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.14
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$37.03
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
IP
|
$58.77
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.20
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Healthscope Commercial |
$52.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.95
|
| Rate for Payer: PHP Commercial |
$49.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.14
|
| Rate for Payer: Priority Health SBD |
$37.03
|
|
|
HC URETERAL DILITATION CATH
|
Facility
|
IP
|
$349.74
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
27200077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.34 |
| Max. Negotiated Rate |
$314.77 |
| Rate for Payer: Aetna Commercial |
$297.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.33
|
| Rate for Payer: Cash Price |
$279.79
|
| Rate for Payer: Cofinity Commercial |
$244.82
|
| Rate for Payer: Cofinity Commercial |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$314.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.28
|
| Rate for Payer: PHP Commercial |
$297.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.82
|
| Rate for Payer: Priority Health SBD |
$220.34
|
|
|
HC URETERAL DILITATION CATH
|
Facility
|
OP
|
$349.74
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
27200077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$314.77 |
| Rate for Payer: Aetna Commercial |
$297.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.33
|
| Rate for Payer: BCBS Complete |
$139.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$279.79
|
| Rate for Payer: Cash Price |
$279.79
|
| Rate for Payer: Cofinity Commercial |
$244.82
|
| Rate for Payer: Cofinity Commercial |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$314.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.28
|
| Rate for Payer: PHP Commercial |
$297.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.82
|
| Rate for Payer: Priority Health SBD |
$220.34
|
|
|
HC URIC ACID OTHER SOURCE
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
30100453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.35
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.08
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.08
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$4.83
|
| Rate for Payer: PACE SWMI |
$5.08
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$5.08
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.10
|
| Rate for Payer: UHC Core |
$8.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.08
|
| Rate for Payer: UHC Exchange |
$5.08
|
| Rate for Payer: UHC Medicare Advantage |
$5.23
|
| Rate for Payer: VA VA |
$5.08
|
|
|
HC URIC ACID OTHER SOURCE
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
30100453
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC URIC ACID SERUM
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
30100452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$2.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC Core |
$7.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC URIC ACID SERUM
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
30100452
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC URINALYSIS
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
30700001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC URINALYSIS
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
30700001
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.96
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS MAPPO |
$3.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$1.73
|
| Rate for Payer: Mclaren Medicare |
$3.17
|
| Rate for Payer: Meridian Medicaid |
$1.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.01
|
| Rate for Payer: PACE SWMI |
$3.17
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$3.17
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$5.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.17
|
| Rate for Payer: UHC Exchange |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$3.27
|
| Rate for Payer: VA VA |
$3.17
|
|
|
HC URINALYSIS, DIPSTICK ONLY
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.29
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.76
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Mclaren Medicaid |
$1.23
|
| Rate for Payer: Mclaren Medicare |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health SBD |
$13.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$3.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Exchange |
$2.25
|
| Rate for Payer: UHC Medicare Advantage |
$2.32
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC URINALYSIS, DIPSTICK ONLY
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700002
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health SBD |
$13.10
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC URINALYSIS, MICROSCOPIC ONLY
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
30700004
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.81
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$1.67
|
| Rate for Payer: Mclaren Medicare |
$3.05
|
| Rate for Payer: Meridian Medicaid |
$1.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.66
|
| Rate for Payer: UHC Core |
$5.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UHC Medicare Advantage |
$3.14
|
| Rate for Payer: VA VA |
$3.05
|
|
|
HC URINARY 1 PIECE POUCH
|
Facility
|
OP
|
$13.78
|
|
| Hospital Charge Code |
27000167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.96
|
| Rate for Payer: BCBS Complete |
$5.51
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$11.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.71
|
| Rate for Payer: PHP Commercial |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health SBD |
$8.68
|
|
|
HC URINARY 1 PIECE POUCH
|
Facility
|
IP
|
$13.78
|
|
| Hospital Charge Code |
27000167
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.96
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cofinity Commercial |
$11.85
|
| Rate for Payer: Cofinity Commercial |
$9.65
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.71
|
| Rate for Payer: PHP Commercial |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health SBD |
$8.68
|
|
