|
HC SICKLE CELL TEST
|
Facility
|
OP
|
$31.94
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
30500061
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$28.75 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.89
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$5.51
|
| Rate for Payer: BCBS Trust/PPO |
$5.87
|
| Rate for Payer: BCN Commercial |
$5.87
|
| Rate for Payer: BCN Medicare Advantage |
$5.51
|
| Rate for Payer: Cash Price |
$25.55
|
| Rate for Payer: Cash Price |
$25.55
|
| Rate for Payer: Cofinity Advantage |
$22.36
|
| Rate for Payer: Cofinity Commercial |
$27.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.51
|
| Rate for Payer: Healthscope Commercial |
$28.75
|
| Rate for Payer: Mclaren Medicaid |
$2.88
|
| Rate for Payer: Mclaren Medicare |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: Meridian Medicaid |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.15
|
| Rate for Payer: Nomi Health Commercial |
$8.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.95
|
| Rate for Payer: PACE Medicare |
$5.23
|
| Rate for Payer: PACE SWMI |
$5.51
|
| Rate for Payer: PHP Commercial |
$27.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.51
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health SBD |
$20.12
|
| Rate for Payer: Priority Health Tiered Network |
$4.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.27
|
| Rate for Payer: UHC Core |
$8.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.51
|
| Rate for Payer: UHC Exchange |
$8.27
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$5.51
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
OP
|
$1,185.73
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.99 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Commercial |
$1,007.87
|
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$685.19
|
| Rate for Payer: BCN Commercial |
$685.19
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Advantage |
$830.01
|
| Rate for Payer: Cofinity Commercial |
$1,019.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$1,067.16
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,007.87
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health SBD |
$747.01
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.72
|
| Rate for Payer: UHC Core |
$617.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$465.99
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
HC SIGMOIDOSCOPY FLX DX W/COLL SPEC BR/WA
|
Facility
|
IP
|
$1,185.73
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
76100186
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$747.01 |
| Max. Negotiated Rate |
$1,067.16 |
| Rate for Payer: Aetna Commercial |
$1,007.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.72
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Advantage |
$830.01
|
| Rate for Payer: Cofinity Commercial |
$1,019.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Healthscope Commercial |
$1,067.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PHP Commercial |
$1,007.87
|
| Rate for Payer: Priority Health SBD |
$747.01
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
OP
|
$2,673.54
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,069.42 |
| Max. Negotiated Rate |
$2,406.19 |
| Rate for Payer: Aetna Commercial |
$2,272.51
|
| Rate for Payer: Aetna Medicare |
$1,336.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,737.80
|
| Rate for Payer: BCBS Complete |
$1,069.42
|
| Rate for Payer: Cash Price |
$2,138.83
|
| Rate for Payer: Cofinity Advantage |
$1,871.48
|
| Rate for Payer: Cofinity Commercial |
$2,299.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.83
|
| Rate for Payer: Healthscope Commercial |
$2,406.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,138.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,272.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,005.15
|
| Rate for Payer: PHP Commercial |
$2,272.51
|
| Rate for Payer: Priority Health SBD |
$1,684.33
|
|
|
HC SIGMOIDOSCOPY W EUS EXAM
|
Facility
|
IP
|
$2,673.54
|
|
| Hospital Charge Code |
36000082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,684.33 |
| Max. Negotiated Rate |
$2,406.19 |
| Rate for Payer: Aetna Commercial |
$2,272.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,737.80
|
| Rate for Payer: Cash Price |
$2,138.83
|
| Rate for Payer: Cofinity Advantage |
$1,871.48
|
| Rate for Payer: Cofinity Commercial |
$2,299.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,138.83
|
| Rate for Payer: Healthscope Commercial |
$2,406.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,272.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,005.15
|
| Rate for Payer: PHP Commercial |
$2,272.51
|
| Rate for Payer: Priority Health SBD |
$1,684.33
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$1,290.13
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$812.78 |
| Max. Negotiated Rate |
$1,161.12 |
| Rate for Payer: Aetna Commercial |
$1,096.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.58
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cofinity Advantage |
$903.09
|
| Rate for Payer: Cofinity Commercial |
$1,109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.10
|
| Rate for Payer: Healthscope Commercial |
$1,161.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.60
|
| Rate for Payer: PHP Commercial |
$1,096.61
|
| Rate for Payer: Priority Health SBD |
$812.78
|
|
|
HC SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$1,290.13
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
36000111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Commercial |
$1,096.61
|
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$855.72
|
| Rate for Payer: BCN Commercial |
$855.72
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cash Price |
$1,032.10
|
| Rate for Payer: Cofinity Advantage |
$903.09
|
| Rate for Payer: Cofinity Commercial |
$1,109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,032.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$1,161.12
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,096.61
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$967.60
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,096.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health SBD |
$812.78
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.58
|
| Rate for Payer: UHC Core |
$672.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$507.02
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
IP
|
$257.93
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$232.14 |
| Rate for Payer: Aetna Commercial |
$219.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.65
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cofinity Advantage |
$180.55
|
| Rate for Payer: Cofinity Commercial |
$221.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.34
|
| Rate for Payer: Healthscope Commercial |
$232.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.45
|
| Rate for Payer: PHP Commercial |
$219.24
|
| Rate for Payer: Priority Health SBD |
$162.50
|
|
|
HC SIGNAL AVERAGE EKG
|
Facility
|
OP
|
$257.93
|
|
|
Service Code
|
CPT 93278
|
| Hospital Charge Code |
73100004
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$232.14 |
| Rate for Payer: Aetna Commercial |
$219.24
|
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$85.86
|
| Rate for Payer: BCN Commercial |
$85.86
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cash Price |
$206.34
|
| Rate for Payer: Cofinity Advantage |
$180.55
|
| Rate for Payer: Cofinity Commercial |
$221.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Healthscope Commercial |
$232.14
|
| Rate for Payer: Mclaren Medicaid |
$30.74
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.24
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.45
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Commercial |
$219.24
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health SBD |
$162.50
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.65
|
| Rate for Payer: UHC Core |
$134.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Exchange |
$101.37
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC SILICA CLOTTING TIME ASSAY
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
30500099
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$3.30
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.41
|
| Rate for Payer: BCN Commercial |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$3.14
|
| Rate for Payer: Mclaren Medicare |
$6.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.01
|
| Rate for Payer: Priority Health Medicare |
$6.01
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$4.81
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.02
|
| Rate for Payer: UHC Core |
$9.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.01
|
| Rate for Payer: UHC Exchange |
$9.02
|
| Rate for Payer: UHC Medicaid |
$3.14
|
| Rate for Payer: UHCCP Medicaid |
$3.14
|
| Rate for Payer: VA VA |
$6.01
|
|
|
HC SILVADENE 400 GM
|
Facility
|
OP
|
$258.59
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.63 |
| Max. Negotiated Rate |
$232.73 |
| Rate for Payer: Aetna Commercial |
$219.80
|
| Rate for Payer: Aetna Medicare |
$129.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.08
|
| Rate for Payer: BCBS Complete |
$103.44
|
| Rate for Payer: Cash Price |
$206.87
|
| Rate for Payer: Cofinity Advantage |
$181.01
|
| Rate for Payer: Cofinity Commercial |
$222.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.87
|
| Rate for Payer: Healthscope Commercial |
$232.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.94
|
| Rate for Payer: PHP Commercial |
$219.80
|
| Rate for Payer: Priority Health SBD |
$162.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.08
|
| Rate for Payer: UHC Core |
$134.73
|
| Rate for Payer: UHC Exchange |
$101.63
|
|
|
HC SILVADENE 400 GM
|
Facility
|
IP
|
$258.59
|
|
| Hospital Charge Code |
27100016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.91 |
| Max. Negotiated Rate |
$232.73 |
| Rate for Payer: Aetna Commercial |
$219.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.08
|
| Rate for Payer: Cash Price |
$206.87
|
| Rate for Payer: Cofinity Advantage |
$181.01
|
| Rate for Payer: Cofinity Commercial |
$222.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.87
|
| Rate for Payer: Healthscope Commercial |
$232.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.94
|
| Rate for Payer: PHP Commercial |
$219.80
|
| Rate for Payer: Priority Health SBD |
$162.91
|
|
|
HC SILVADENE 85 GM
|
Facility
|
OP
|
$106.71
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.94 |
| Max. Negotiated Rate |
$96.04 |
| Rate for Payer: Aetna Commercial |
$90.70
|
| Rate for Payer: Aetna Medicare |
$53.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: BCBS Complete |
$42.68
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cofinity Advantage |
$74.70
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.37
|
| Rate for Payer: Healthscope Commercial |
$96.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: PHP Commercial |
$90.70
|
| Rate for Payer: Priority Health SBD |
$67.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.36
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: UHC Exchange |
$41.94
|
|
|
HC SILVADENE 85 GM
|
Facility
|
IP
|
$106.71
|
|
| Hospital Charge Code |
27100017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.23 |
| Max. Negotiated Rate |
$96.04 |
| Rate for Payer: Aetna Commercial |
$90.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: Cash Price |
$85.37
|
| Rate for Payer: Cofinity Advantage |
$74.70
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.37
|
| Rate for Payer: Healthscope Commercial |
$96.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.03
|
| Rate for Payer: PHP Commercial |
$90.70
|
| Rate for Payer: Priority Health SBD |
$67.23
|
|
|
HC SILVER 4X4
|
Facility
|
IP
|
$66.72
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$60.05 |
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.37
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Advantage |
$46.70
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: Priority Health SBD |
$42.03
|
|
|
HC SILVER 4X4
|
Facility
|
OP
|
$66.72
|
|
| Hospital Charge Code |
27000146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$60.05 |
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna Medicare |
$33.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.37
|
| Rate for Payer: BCBS Complete |
$26.69
|
| Rate for Payer: Cash Price |
$53.38
|
| Rate for Payer: Cofinity Advantage |
$46.70
|
| Rate for Payer: Cofinity Commercial |
$57.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.38
|
| Rate for Payer: Healthscope Commercial |
$60.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.04
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: Priority Health SBD |
$42.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.37
|
| Rate for Payer: UHC Core |
$34.76
|
| Rate for Payer: UHC Exchange |
$26.22
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
OP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,506.15 |
| Max. Negotiated Rate |
$8,029.34 |
| Rate for Payer: Aetna Commercial |
$7,583.27
|
| Rate for Payer: Aetna Medicare |
$4,460.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,798.97
|
| Rate for Payer: BCBS Complete |
$3,568.60
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Advantage |
$6,245.04
|
| Rate for Payer: Cofinity Commercial |
$7,672.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,029.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,137.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: PHP Commercial |
$7,583.27
|
| Rate for Payer: Priority Health SBD |
$5,620.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,798.97
|
| Rate for Payer: UHC Core |
$4,648.10
|
| Rate for Payer: UHC Exchange |
$3,506.15
|
|
|
HC SILVER HAWK CATHETER
|
Facility
|
IP
|
$8,921.49
|
|
|
Service Code
|
HCPCS C1888
|
| Hospital Charge Code |
27200070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,620.54 |
| Max. Negotiated Rate |
$8,029.34 |
| Rate for Payer: Aetna Commercial |
$7,583.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,798.97
|
| Rate for Payer: Cash Price |
$7,137.19
|
| Rate for Payer: Cofinity Advantage |
$6,245.04
|
| Rate for Payer: Cofinity Commercial |
$7,672.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,137.19
|
| Rate for Payer: Healthscope Commercial |
$8,029.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,583.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,691.12
|
| Rate for Payer: PHP Commercial |
$7,583.27
|
| Rate for Payer: Priority Health SBD |
$5,620.54
|
|
|
HC SILVER ROPE
|
Facility
|
IP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
|
|
HC SILVER ROPE
|
Facility
|
OP
|
$55.67
|
|
| Hospital Charge Code |
27000147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Aetna Commercial |
$47.32
|
| Rate for Payer: Aetna Medicare |
$27.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$38.97
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$50.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.75
|
| Rate for Payer: PHP Commercial |
$47.32
|
| Rate for Payer: Priority Health SBD |
$35.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.19
|
| Rate for Payer: UHC Core |
$29.00
|
| Rate for Payer: UHC Exchange |
$21.88
|
|
|
HC SIMIAN B AB
|
Facility
|
IP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.39
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$65.04
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Healthscope Commercial |
$83.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| Rate for Payer: PHP Commercial |
$78.97
|
| Rate for Payer: Priority Health SBD |
$58.53
|
|
|
HC SIMIAN B AB
|
Facility
|
OP
|
$92.91
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
30200333
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$83.62 |
| Rate for Payer: Aetna Commercial |
$78.97
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.73
|
| Rate for Payer: BCN Commercial |
$13.73
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cash Price |
$74.33
|
| Rate for Payer: Cofinity Advantage |
$65.04
|
| Rate for Payer: Cofinity Commercial |
$79.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$83.62
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: Meridian Medicaid |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.68
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$78.97
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.88
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$58.53
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.32
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.88
|
| Rate for Payer: UHC Exchange |
$19.32
|
| Rate for Payer: UHC Medicaid |
$6.74
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
IP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.07 |
| Max. Negotiated Rate |
$331.53 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: Priority Health SBD |
$232.07
|
|
|
HC SIMPLE CYSTOMETROGRAM
|
Facility
|
OP
|
$368.37
|
|
|
Service Code
|
CPT 51725
|
| Hospital Charge Code |
76100189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.26 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Commercial |
$313.11
|
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$92.26
|
| Rate for Payer: BCN Commercial |
$92.26
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cash Price |
$294.70
|
| Rate for Payer: Cofinity Advantage |
$257.86
|
| Rate for Payer: Cofinity Commercial |
$316.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Healthscope Commercial |
$331.53
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.11
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.28
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Commercial |
$313.11
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health SBD |
$232.07
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.44
|
| Rate for Payer: UHC Core |
$191.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Exchange |
$144.77
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
