|
HC PACKED CELLS DIRECT
|
Facility
|
OP
|
$841.79
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000058
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$757.61 |
| Rate for Payer: Aetna Commercial |
$715.52
|
| Rate for Payer: Aetna Medicare |
$187.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$225.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$225.43
|
| Rate for Payer: BCBS Complete |
$99.04
|
| Rate for Payer: BCBS MAPPO |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$505.91
|
| Rate for Payer: BCN Commercial |
$505.91
|
| Rate for Payer: BCN Medicare Advantage |
$180.34
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cash Price |
$673.43
|
| Rate for Payer: Cofinity Advantage |
$589.25
|
| Rate for Payer: Cofinity Commercial |
$723.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.34
|
| Rate for Payer: Healthscope Commercial |
$757.61
|
| Rate for Payer: Mclaren Medicaid |
$94.32
|
| Rate for Payer: Mclaren Medicare |
$180.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.36
|
| Rate for Payer: Meridian Medicaid |
$189.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.52
|
| Rate for Payer: Nomi Health Commercial |
$541.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$631.34
|
| Rate for Payer: PACE Medicare |
$171.32
|
| Rate for Payer: PACE SWMI |
$180.34
|
| Rate for Payer: PHP Commercial |
$715.52
|
| Rate for Payer: PHP Medicare Advantage |
$180.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$583.21
|
| Rate for Payer: Priority Health Medicare |
$180.34
|
| Rate for Payer: Priority Health SBD |
$530.33
|
| Rate for Payer: Priority Health Tiered Network |
$466.57
|
| Rate for Payer: Railroad Medicare Medicare |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.16
|
| Rate for Payer: UHC Core |
$438.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.34
|
| Rate for Payer: UHC Exchange |
$330.82
|
| Rate for Payer: UHC Medicaid |
$94.32
|
| Rate for Payer: UHCCP Medicaid |
$94.32
|
| Rate for Payer: VA VA |
$180.34
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$135.38 |
| Max. Negotiated Rate |
$1,154.01 |
| Rate for Payer: Aetna Commercial |
$1,089.90
|
| Rate for Payer: Aetna Medicare |
$269.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.56
|
| Rate for Payer: BCBS Complete |
$142.16
|
| Rate for Payer: BCBS MAPPO |
$258.85
|
| Rate for Payer: BCBS Trust/PPO |
$711.05
|
| Rate for Payer: BCN Commercial |
$711.05
|
| Rate for Payer: BCN Medicare Advantage |
$258.85
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Advantage |
$897.56
|
| Rate for Payer: Cofinity Commercial |
$1,102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.85
|
| Rate for Payer: Healthscope Commercial |
$1,154.01
|
| Rate for Payer: Mclaren Medicaid |
$135.38
|
| Rate for Payer: Mclaren Medicare |
$258.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.79
|
| Rate for Payer: Meridian Medicaid |
$271.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$284.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Nomi Health Commercial |
$776.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: PACE Medicare |
$245.91
|
| Rate for Payer: PACE SWMI |
$258.85
|
| Rate for Payer: PHP Commercial |
$1,089.90
|
| Rate for Payer: PHP Medicare Advantage |
$258.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$837.08
|
| Rate for Payer: Priority Health Medicare |
$258.85
|
| Rate for Payer: Priority Health SBD |
$807.80
|
| Rate for Payer: Priority Health Tiered Network |
$669.66
|
| Rate for Payer: Railroad Medicare Medicare |
$258.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.45
|
| Rate for Payer: UHC Core |
$668.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$258.85
|
| Rate for Payer: UHC Exchange |
$503.92
|
| Rate for Payer: UHC Medicaid |
$135.38
|
| Rate for Payer: UHCCP Medicaid |
$135.38
|
| Rate for Payer: VA VA |
$258.85
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,282.23
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$807.80 |
| Max. Negotiated Rate |
$1,154.01 |
| Rate for Payer: Aetna Commercial |
$1,089.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.45
|
| Rate for Payer: Cash Price |
$1,025.78
|
| Rate for Payer: Cofinity Advantage |
$897.56
|
| Rate for Payer: Cofinity Commercial |
$1,102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,025.78
|
| Rate for Payer: Healthscope Commercial |
$1,154.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,089.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.67
|
| Rate for Payer: PHP Commercial |
$1,089.90
|
| Rate for Payer: Priority Health SBD |
$807.80
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$99.88
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.92
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Advantage |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: Priority Health SBD |
$62.92
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$99.88
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: Aetna Medicare |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.92
|
| Rate for Payer: BCBS Complete |
$39.95
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Advantage |
$69.92
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.91
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: Priority Health SBD |
$62.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.92
|
| Rate for Payer: UHC Core |
$52.04
|
| Rate for Payer: UHC Exchange |
$39.25
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$702.27
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$275.99 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$596.93
|
| Rate for Payer: Aetna Medicare |
$351.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.48
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: Cash Price |
$561.82
|
| Rate for Payer: Cofinity Advantage |
$491.59
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.82
|
| Rate for Payer: Healthscope Commercial |
$632.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.70
|
| Rate for Payer: PHP Commercial |
$596.93
|
| Rate for Payer: Priority Health SBD |
$442.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.48
|
| Rate for Payer: UHC Core |
$365.88
|
| Rate for Payer: UHC Exchange |
$275.99
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$702.27
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$442.43 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$596.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.48
|
| Rate for Payer: Cash Price |
$561.82
|
| Rate for Payer: Cofinity Advantage |
$491.59
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$561.82
|
| Rate for Payer: Healthscope Commercial |
$632.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$526.70
|
| Rate for Payer: PHP Commercial |
$596.93
|
| Rate for Payer: Priority Health SBD |
$442.43
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$209.12
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$82.18 |
| Max. Negotiated Rate |
$188.21 |
| Rate for Payer: Aetna Commercial |
$177.75
|
| Rate for Payer: Aetna Medicare |
$104.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.93
|
| Rate for Payer: BCBS Complete |
$83.65
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cofinity Advantage |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$179.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.30
|
| Rate for Payer: Healthscope Commercial |
$188.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$167.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.84
|
| Rate for Payer: PHP Commercial |
$177.75
|
| Rate for Payer: Priority Health SBD |
$131.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$108.95
|
| Rate for Payer: UHC Exchange |
$82.18
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$209.12
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.75 |
| Max. Negotiated Rate |
$188.21 |
| Rate for Payer: Aetna Commercial |
$177.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.93
|
| Rate for Payer: Cash Price |
$167.30
|
| Rate for Payer: Cofinity Advantage |
$146.38
|
| Rate for Payer: Cofinity Commercial |
$179.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.30
|
| Rate for Payer: Healthscope Commercial |
$188.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.84
|
| Rate for Payer: PHP Commercial |
$177.75
|
| Rate for Payer: Priority Health SBD |
$131.75
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$858.33
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$540.75 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$729.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.91
|
| Rate for Payer: Cash Price |
$686.66
|
| Rate for Payer: Cofinity Advantage |
$600.83
|
| Rate for Payer: Cofinity Commercial |
$738.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.66
|
| Rate for Payer: Healthscope Commercial |
$772.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.75
|
| Rate for Payer: PHP Commercial |
$729.58
|
| Rate for Payer: Priority Health SBD |
$540.75
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$858.33
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$337.32 |
| Max. Negotiated Rate |
$772.50 |
| Rate for Payer: Aetna Commercial |
$729.58
|
| Rate for Payer: Aetna Medicare |
$429.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.91
|
| Rate for Payer: BCBS Complete |
$343.33
|
| Rate for Payer: Cash Price |
$686.66
|
| Rate for Payer: Cofinity Advantage |
$600.83
|
| Rate for Payer: Cofinity Commercial |
$738.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$686.66
|
| Rate for Payer: Healthscope Commercial |
$772.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$729.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.75
|
| Rate for Payer: PHP Commercial |
$729.58
|
| Rate for Payer: Priority Health SBD |
$540.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$557.91
|
| Rate for Payer: UHC Core |
$447.19
|
| Rate for Payer: UHC Exchange |
$337.32
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$167.67
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$105.63 |
| Max. Negotiated Rate |
$150.90 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.99
|
| Rate for Payer: Cash Price |
$134.14
|
| Rate for Payer: Cofinity Advantage |
$117.37
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.14
|
| Rate for Payer: Healthscope Commercial |
$150.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.75
|
| Rate for Payer: PHP Commercial |
$142.52
|
| Rate for Payer: Priority Health SBD |
$105.63
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$167.67
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$150.90 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.99
|
| 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 |
$134.14
|
| Rate for Payer: Cash Price |
$134.14
|
| Rate for Payer: Cofinity Advantage |
$117.37
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$150.90
|
| 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 |
$142.52
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.75
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$142.52
|
| 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 |
$105.63
|
| 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 PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$75.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Advantage |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.84
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health SBD |
$95.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.66
|
| Rate for Payer: UHC Core |
$79.08
|
| Rate for Payer: UHC Exchange |
$59.65
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.66
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Advantage |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.84
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health SBD |
$95.63
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
OP
|
$942.09
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$370.24 |
| Max. Negotiated Rate |
$847.88 |
| Rate for Payer: Aetna Commercial |
$800.78
|
| Rate for Payer: Aetna Medicare |
$471.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.36
|
| Rate for Payer: BCBS Complete |
$376.84
|
| Rate for Payer: Cash Price |
$753.67
|
| Rate for Payer: Cofinity Advantage |
$659.46
|
| Rate for Payer: Cofinity Commercial |
$810.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.67
|
| Rate for Payer: Healthscope Commercial |
$847.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$753.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.57
|
| Rate for Payer: PHP Commercial |
$800.78
|
| Rate for Payer: Priority Health SBD |
$593.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$612.36
|
| Rate for Payer: UHC Core |
$490.83
|
| Rate for Payer: UHC Exchange |
$370.24
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
IP
|
$942.09
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$593.52 |
| Max. Negotiated Rate |
$847.88 |
| Rate for Payer: Aetna Commercial |
$800.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.36
|
| Rate for Payer: Cash Price |
$753.67
|
| Rate for Payer: Cofinity Advantage |
$659.46
|
| Rate for Payer: Cofinity Commercial |
$810.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$753.67
|
| Rate for Payer: Healthscope Commercial |
$847.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$800.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$706.57
|
| Rate for Payer: PHP Commercial |
$800.78
|
| Rate for Payer: Priority Health SBD |
$593.52
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: BCBS Complete |
$3.56
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$6.91
|
| Rate for Payer: BCN Commercial |
$6.91
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Advantage |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Mclaren Medicaid |
$3.39
|
| Rate for Payer: Mclaren Medicare |
$6.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$6.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$9.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.50
|
| Rate for Payer: PACE Medicare |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.48
|
| Rate for Payer: Priority Health Medicare |
$6.48
|
| Rate for Payer: Priority Health SBD |
$43.26
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.72
|
| Rate for Payer: UHC Core |
$9.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicaid |
$3.39
|
| Rate for Payer: UHCCP Medicaid |
$3.39
|
| Rate for Payer: VA VA |
$6.48
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.26 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.64
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Advantage |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.50
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: Priority Health SBD |
$43.26
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.38 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health SBD |
$75.38
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
OP
|
$119.65
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Medicare |
$23.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.71
|
| Rate for Payer: BCBS Complete |
$12.62
|
| Rate for Payer: BCBS MAPPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Commercial |
$24.49
|
| Rate for Payer: BCN Medicare Advantage |
$22.97
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$22.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.12
|
| Rate for Payer: Meridian Medicaid |
$24.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Nomi Health Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PACE Medicare |
$21.82
|
| Rate for Payer: PACE SWMI |
$22.97
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$22.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.97
|
| Rate for Payer: Priority Health Medicare |
$22.97
|
| Rate for Payer: Priority Health SBD |
$75.38
|
| Rate for Payer: Priority Health Tiered Network |
$18.38
|
| Rate for Payer: Railroad Medicare Medicare |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.46
|
| Rate for Payer: UHC Core |
$34.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.97
|
| Rate for Payer: UHC Exchange |
$34.46
|
| Rate for Payer: UHC Medicaid |
$12.01
|
| Rate for Payer: UHCCP Medicaid |
$12.01
|
| Rate for Payer: VA VA |
$22.97
|
|
|
HC PANTOTHENIC ACID (B-5) BIOASSAY
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.32
|
| Rate for Payer: BCBS Complete |
$9.37
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Advantage |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Mclaren Medicaid |
$8.92
|
| Rate for Payer: Mclaren Medicare |
$17.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.91
|
| Rate for Payer: Meridian Medicaid |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.15
|
| Rate for Payer: PACE Medicare |
$16.21
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.06
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health SBD |
$70.69
|
| Rate for Payer: Priority Health Tiered Network |
$13.65
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.59
|
| Rate for Payer: UHC Core |
$25.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.06
|
| Rate for Payer: UHC Exchange |
$25.59
|
| Rate for Payer: UHC Medicaid |
$8.92
|
| Rate for Payer: UHCCP Medicaid |
$8.92
|
| Rate for Payer: VA VA |
$17.06
|
|
|
HC PANTOTHENIC ACID (B-5) BIOASSAY
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.69 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.93
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Advantage |
$78.54
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.15
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health SBD |
$70.69
|
|
|
HC PAPER WASP IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
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 PAPER WASP IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
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
|
|
