|
HC URINE ALCOHOL SCRN
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health SBD |
$58.39
|
|
|
HC URINE ALCOHOL SCRN
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$58.39
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URINE AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30100569
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$19.53
|
|
|
HC URINE AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30100569
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health SBD |
$19.53
|
| Rate for Payer: UHC Core |
$25.38
|
|
|
HC URINE CULTURE
|
Facility
|
IP
|
$39.29
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
30600080
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$35.36 |
| Rate for Payer: Aetna Commercial |
$33.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.54
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Cofinity Commercial |
$33.79
|
| Rate for Payer: Healthscope Commercial |
$35.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.40
|
| Rate for Payer: PHP Commercial |
$33.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: Priority Health SBD |
$24.75
|
|
|
HC URINE CULTURE
|
Facility
|
OP
|
$39.29
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
30600080
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$35.36 |
| Rate for Payer: Aetna Commercial |
$33.40
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$6.32
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cofinity Commercial |
$33.79
|
| Rate for Payer: Cofinity Commercial |
$27.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$35.36
|
| Rate for Payer: Mclaren Medicaid |
$4.41
|
| Rate for Payer: Mclaren Medicare |
$8.07
|
| Rate for Payer: Meridian Medicaid |
$4.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.40
|
| Rate for Payer: PACE Medicare |
$7.67
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$33.40
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health SBD |
$24.75
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$13.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.07
|
| Rate for Payer: UHC Exchange |
$8.07
|
| Rate for Payer: UHC Medicare Advantage |
$8.31
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC URINE DRUG SCREEN 80306
|
Facility
|
IP
|
$24.77
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$22.29 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.10
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.05
|
| Rate for Payer: PHP Commercial |
$21.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health SBD |
$15.61
|
|
|
HC URINE DRUG SCREEN 80306
|
Facility
|
OP
|
$24.77
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$21.05
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.42
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$21.30
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.14
|
| Rate for Payer: Meridian Medicaid |
$9.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.05
|
| Rate for Payer: PACE Medicare |
$16.28
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$21.05
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Railroad Medicare Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.57
|
| Rate for Payer: UHC Core |
$23.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Exchange |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.65
|
| Rate for Payer: VA VA |
$17.14
|
|
|
HC URINE PHENCYCLIDINE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
30100386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
|
|
HC URINE PHENCYCLIDINE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
30100386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.30
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$43.40
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health SBD |
$39.06
|
| Rate for Payer: UHC Core |
$24.98
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30700005
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.95
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$6.74
|
| Rate for Payer: BCCCP Commercial |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$4.71
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Medicaid |
$4.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.33
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Exchange |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.87
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30700005
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC URINE PRESUMPTIVE ID
|
Facility
|
IP
|
$63.80
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health SBD |
$40.19
|
|
|
HC URINE PRESUMPTIVE ID
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.11
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS MAPPO |
$8.09
|
| Rate for Payer: BCBS Trust/PPO |
$6.34
|
| Rate for Payer: BCN Medicare Advantage |
$8.09
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Mclaren Medicaid |
$4.43
|
| Rate for Payer: Mclaren Medicare |
$8.09
|
| Rate for Payer: Meridian Medicaid |
$4.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.23
|
| Rate for Payer: PACE Medicare |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.09
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Medicare Advantage |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health Medicare |
$8.09
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Railroad Medicare Medicare |
$8.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.09
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$8.33
|
| Rate for Payer: VA VA |
$8.09
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| 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 |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$1.19
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Medicaid |
$1.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.60
|
| Rate for Payer: UHC Core |
$3.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.24
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
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 URIN MDMA
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health SBD |
$58.39
|
|
|
HC URIN MDMA
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Cofinity Commercial |
$64.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$58.39
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN COTININE.
|
Facility
|
IP
|
$99.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Cofinity Commercial |
$85.96
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.96
|
| Rate for Payer: PHP Commercial |
$84.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC URN COTININE.
|
Facility
|
OP
|
$99.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$84.96
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cash Price |
$79.96
|
| Rate for Payer: Cofinity Commercial |
$85.96
|
| Rate for Payer: Cofinity Commercial |
$69.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.96
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$84.96
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.96
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN MDMA
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC URN MDMA
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| 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 |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN TRICYCLIC
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC URN TRICYCLIC
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| 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 |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$6.89
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.12
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
IP
|
$1,925.25
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.91 |
| Max. Negotiated Rate |
$1,732.72 |
| Rate for Payer: Aetna Commercial |
$1,636.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.41
|
| Rate for Payer: Cash Price |
$1,540.20
|
| Rate for Payer: Cofinity Commercial |
$1,347.68
|
| Rate for Payer: Cofinity Commercial |
$1,655.72
|
| Rate for Payer: Healthscope Commercial |
$1,732.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,636.46
|
| Rate for Payer: PHP Commercial |
$1,636.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,347.68
|
| Rate for Payer: Priority Health SBD |
$1,212.91
|
|
