|
HC OXALATE URINE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.06
|
| Rate for Payer: BCBS Complete |
$7.94
|
| Rate for Payer: BCBS MAPPO |
$14.45
|
| Rate for Payer: BCBS Trust/PPO |
$15.41
|
| Rate for Payer: BCN Commercial |
$15.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.45
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$7.56
|
| Rate for Payer: Mclaren Medicare |
$14.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.17
|
| Rate for Payer: Meridian Medicaid |
$15.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$13.73
|
| Rate for Payer: PACE SWMI |
$14.45
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$14.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.45
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health SBD |
$29.42
|
| Rate for Payer: Priority Health Tiered Network |
$11.56
|
| Rate for Payer: Railroad Medicare Medicare |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.45
|
| Rate for Payer: UHC Exchange |
$21.68
|
| Rate for Payer: UHC Medicaid |
$7.56
|
| Rate for Payer: UHCCP Medicaid |
$7.56
|
| Rate for Payer: VA VA |
$14.45
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.98
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Advantage |
$52.74
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PHP Commercial |
$64.05
|
| Rate for Payer: Priority Health SBD |
$47.47
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$75.35
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$67.81 |
| Rate for Payer: Aetna Commercial |
$64.05
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cash Price |
$60.28
|
| Rate for Payer: Cofinity Advantage |
$52.74
|
| Rate for Payer: Cofinity Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$67.81
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.05
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.51
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$64.05
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$47.47
|
| Rate for Payer: Priority Health Tiered Network |
$10.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.88
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: BCBS Complete |
$32.46
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$73.03 |
| Rate for Payer: Aetna Commercial |
$68.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.75
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Advantage |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$73.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.86
|
| Rate for Payer: PHP Commercial |
$68.98
|
| Rate for Payer: Priority Health SBD |
$51.12
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 OXYCODONE URINE.
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
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 OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$28.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: BCBS Complete |
$22.47
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health SBD |
$35.39
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$56.18
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.52
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Advantage |
$39.33
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.13
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: Priority Health SBD |
$35.39
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$1,348.39 |
| Rate for Payer: Aetna Commercial |
$1,273.48
|
| Rate for Payer: Aetna Medicare |
$749.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.84
|
| Rate for Payer: BCBS Complete |
$599.28
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Advantage |
$1,048.75
|
| Rate for Payer: Cofinity Commercial |
$1,288.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Healthscope Commercial |
$1,348.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,198.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: PHP Commercial |
$1,273.48
|
| Rate for Payer: Priority Health SBD |
$943.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.84
|
| Rate for Payer: UHC Core |
$780.57
|
| Rate for Payer: UHC Exchange |
$588.80
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,498.21
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$943.87 |
| Max. Negotiated Rate |
$1,348.39 |
| Rate for Payer: Aetna Commercial |
$1,273.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.84
|
| Rate for Payer: Cash Price |
$1,198.57
|
| Rate for Payer: Cofinity Advantage |
$1,048.75
|
| Rate for Payer: Cofinity Commercial |
$1,288.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,198.57
|
| Rate for Payer: Healthscope Commercial |
$1,348.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,273.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,123.66
|
| Rate for Payer: PHP Commercial |
$1,273.48
|
| Rate for Payer: Priority Health SBD |
$943.87
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$496.79 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$1,074.48
|
| Rate for Payer: Aetna Medicare |
$632.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.66
|
| Rate for Payer: BCBS Complete |
$505.64
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Advantage |
$884.86
|
| Rate for Payer: Cofinity Commercial |
$1,087.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Healthscope Commercial |
$1,137.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,011.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: PHP Commercial |
$1,074.48
|
| Rate for Payer: Priority Health SBD |
$796.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.66
|
| Rate for Payer: UHC Core |
$658.59
|
| Rate for Payer: UHC Exchange |
$496.79
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,264.09
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$796.38 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$1,074.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.66
|
| Rate for Payer: Cash Price |
$1,011.27
|
| Rate for Payer: Cofinity Advantage |
$884.86
|
| Rate for Payer: Cofinity Commercial |
$1,087.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.27
|
| Rate for Payer: Healthscope Commercial |
$1,137.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.07
|
| Rate for Payer: PHP Commercial |
$1,074.48
|
| Rate for Payer: Priority Health SBD |
$796.38
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,279.69
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$502.92 |
| Max. Negotiated Rate |
$1,151.72 |
| Rate for Payer: Aetna Commercial |
$1,087.74
|
| Rate for Payer: Aetna Medicare |
$639.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.80
|
| Rate for Payer: BCBS Complete |
$511.88
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cofinity Advantage |
$895.78
|
| Rate for Payer: Cofinity Commercial |
$1,100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Commercial |
$1,151.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,023.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.77
|
| Rate for Payer: PHP Commercial |
$1,087.74
|
| Rate for Payer: Priority Health SBD |
$806.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$831.80
|
| Rate for Payer: UHC Core |
$666.72
|
| Rate for Payer: UHC Exchange |
$502.92
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,279.69
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$806.20 |
| Max. Negotiated Rate |
$1,151.72 |
| Rate for Payer: Aetna Commercial |
$1,087.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.80
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cofinity Advantage |
$895.78
|
| Rate for Payer: Cofinity Commercial |
$1,100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,023.75
|
| Rate for Payer: Healthscope Commercial |
$1,151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$959.77
|
| Rate for Payer: PHP Commercial |
$1,087.74
|
| Rate for Payer: Priority Health SBD |
$806.20
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,940.52
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,482.53 |
| Max. Negotiated Rate |
$3,546.47 |
| Rate for Payer: Aetna Commercial |
$3,349.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,561.34
|
| Rate for Payer: Cash Price |
$3,152.42
|
| Rate for Payer: Cofinity Advantage |
$2,758.36
|
| Rate for Payer: Cofinity Commercial |
$3,388.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,152.42
|
| Rate for Payer: Healthscope Commercial |
$3,546.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,349.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,955.39
|
| Rate for Payer: PHP Commercial |
$3,349.44
|
| Rate for Payer: Priority Health SBD |
$2,482.53
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,940.52
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,548.62 |
| Max. Negotiated Rate |
$3,546.47 |
| Rate for Payer: Aetna Commercial |
$3,349.44
|
| Rate for Payer: Aetna Medicare |
$1,970.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,561.34
|
| Rate for Payer: BCBS Complete |
$1,576.21
|
| Rate for Payer: Cash Price |
$3,152.42
|
| Rate for Payer: Cofinity Advantage |
$2,758.36
|
| Rate for Payer: Cofinity Commercial |
$3,388.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,152.42
|
| Rate for Payer: Healthscope Commercial |
$3,546.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,152.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,349.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,955.39
|
| Rate for Payer: PHP Commercial |
$3,349.44
|
| Rate for Payer: Priority Health SBD |
$2,482.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,561.34
|
| Rate for Payer: UHC Core |
$2,053.01
|
| Rate for Payer: UHC Exchange |
$1,548.62
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
IP
|
$818.25
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$515.50 |
| Max. Negotiated Rate |
$736.42 |
| Rate for Payer: Aetna Commercial |
$695.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.86
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cofinity Advantage |
$572.77
|
| Rate for Payer: Cofinity Commercial |
$703.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.60
|
| Rate for Payer: Healthscope Commercial |
$736.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.69
|
| Rate for Payer: PHP Commercial |
$695.51
|
| Rate for Payer: Priority Health SBD |
$515.50
|
|
|
HC OXYTOCIN CHALLENGE TEST
|
Facility
|
OP
|
$818.25
|
|
|
Service Code
|
CPT 59020
|
| Hospital Charge Code |
92000003
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$736.42 |
| Rate for Payer: Aetna Commercial |
$695.51
|
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$33.15
|
| Rate for Payer: BCN Commercial |
$33.15
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cofinity Advantage |
$572.77
|
| Rate for Payer: Cofinity Commercial |
$703.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$654.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Healthscope Commercial |
$736.42
|
| Rate for Payer: Mclaren Medicaid |
$105.35
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$695.51
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.69
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Commercial |
$695.51
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health SBD |
$515.50
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.86
|
| Rate for Payer: UHC Core |
$426.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Exchange |
$321.57
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
HC OYSTER IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC OYSTER IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200053
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC PACEMAKER AVEIR LEADLESS DUAL CHAMBER
|
Facility
|
OP
|
$87,549.66
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$78,794.69 |
| Rate for Payer: Aetna Commercial |
$74,417.21
|
| Rate for Payer: Aetna Medicare |
$43,774.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,907.28
|
| Rate for Payer: BCBS Complete |
$35,019.86
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$70,039.73
|
| Rate for Payer: Cash Price |
$70,039.73
|
| Rate for Payer: Cofinity Advantage |
$61,284.76
|
| Rate for Payer: Cofinity Commercial |
$75,292.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,039.73
|
| Rate for Payer: Healthscope Commercial |
$78,794.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70,039.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74,417.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,662.24
|
| Rate for Payer: PHP Commercial |
$74,417.21
|
| Rate for Payer: Priority Health SBD |
$55,156.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,907.28
|
| Rate for Payer: UHC Core |
$45,613.37
|
| Rate for Payer: UHC Exchange |
$34,407.02
|
|
|
HC PACEMAKER AVEIR LEADLESS DUAL CHAMBER
|
Facility
|
IP
|
$87,549.66
|
|
|
Service Code
|
HCPCS C1605
|
| Hospital Charge Code |
27500014
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$55,156.29 |
| Max. Negotiated Rate |
$78,794.69 |
| Rate for Payer: Aetna Commercial |
$74,417.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56,907.28
|
| Rate for Payer: Cash Price |
$70,039.73
|
| Rate for Payer: Cofinity Advantage |
$61,284.76
|
| Rate for Payer: Cofinity Commercial |
$75,292.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70,039.73
|
| Rate for Payer: Healthscope Commercial |
$78,794.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74,417.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65,662.24
|
| Rate for Payer: PHP Commercial |
$74,417.21
|
| Rate for Payer: Priority Health SBD |
$55,156.29
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
IP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$5,009.76 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Advantage |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,964.00
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
|
|
HC PACEMAKER DUAL CHAMBER LVL 7
|
Facility
|
OP
|
$7,952.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
27500354
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,125.14 |
| Max. Negotiated Rate |
$7,156.80 |
| Rate for Payer: Aetna Commercial |
$6,759.20
|
| Rate for Payer: Aetna Medicare |
$3,976.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,168.80
|
| Rate for Payer: BCBS Complete |
$3,180.80
|
| Rate for Payer: Cash Price |
$6,361.60
|
| Rate for Payer: Cofinity Advantage |
$5,566.40
|
| Rate for Payer: Cofinity Commercial |
$6,838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,361.60
|
| Rate for Payer: Healthscope Commercial |
$7,156.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,361.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,759.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,964.00
|
| Rate for Payer: PHP Commercial |
$6,759.20
|
| Rate for Payer: Priority Health SBD |
$5,009.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,168.80
|
| Rate for Payer: UHC Core |
$4,142.99
|
| Rate for Payer: UHC Exchange |
$3,125.14
|
|
