|
HC URINE AMPHETAMINE CONFIRM
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30100569
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.92
|
|
|
HC URINE AMPHETAMINE CONFIRM
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
30100569
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$15.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: BCBS Complete |
$12.65
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.92
|
|
|
HC URINE CULTURE
|
Facility
|
OP
|
$40.08
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
30600080
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.09
|
| Rate for Payer: BCBS Complete |
$4.54
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| Rate for Payer: Mclaren Medicare |
$8.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$4.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PACE Medicare |
$7.67
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health SBD |
$25.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.07
|
| Rate for Payer: UHC Medicare Advantage |
$8.07
|
| Rate for Payer: UHCCP Medicaid |
$4.54
|
| Rate for Payer: VA VA |
$8.07
|
|
|
HC URINE CULTURE
|
Facility
|
IP
|
$40.08
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
30600080
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.25 |
| Max. Negotiated Rate |
$36.07 |
| Rate for Payer: Aetna Commercial |
$34.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.05
|
| Rate for Payer: Cash Price |
$32.06
|
| Rate for Payer: Cofinity Commercial |
$28.06
|
| Rate for Payer: Cofinity Commercial |
$34.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$36.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.07
|
| Rate for Payer: PHP Commercial |
$34.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.05
|
| Rate for Payer: Priority Health SBD |
$25.25
|
|
|
HC URINE DRUG SCREEN 80306
|
Facility
|
OP
|
$25.27
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$48.25 |
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.43
|
| Rate for Payer: BCBS Complete |
$9.65
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Mclaren Medicaid |
$9.19
|
| Rate for Payer: Mclaren Medicare |
$17.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: Meridian Medicaid |
$9.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.48
|
| Rate for Payer: PACE Medicare |
$16.28
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$21.48
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.43
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: Priority Health SBD |
$15.92
|
| Rate for Payer: Railroad Medicare Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
| Rate for Payer: UHCCP Medicaid |
$9.65
|
| Rate for Payer: VA VA |
$17.14
|
|
|
HC URINE DRUG SCREEN 80306
|
Facility
|
IP
|
$25.27
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
30000145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.43
|
| Rate for Payer: Cash Price |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Cofinity Commercial |
$21.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$22.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.48
|
| Rate for Payer: PHP Commercial |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.43
|
| Rate for Payer: Priority Health SBD |
$15.92
|
|
|
HC URINE PHENCYCLIDINE
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
30100386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
|
|
HC URINE PHENCYCLIDINE
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
30100386
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30700005
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC URINE PREGNANCY TEST
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30700005
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$24.24 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$4.61
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$4.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$16.39
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UHCCP Medicaid |
$4.85
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC URINE PRESUMPTIVE ID
|
Facility
|
IP
|
$65.08
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna Commercial |
$55.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.30
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.06
|
| Rate for Payer: Healthscope Commercial |
$58.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.32
|
| Rate for Payer: PHP Commercial |
$55.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.30
|
| Rate for Payer: Priority Health SBD |
$41.00
|
|
|
HC URINE PRESUMPTIVE ID
|
Facility
|
OP
|
$65.08
|
|
|
Service Code
|
CPT 87088
|
| Hospital Charge Code |
30600081
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$58.57 |
| Rate for Payer: Aetna Commercial |
$55.32
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.11
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$8.09
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cash Price |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$55.97
|
| Rate for Payer: Cofinity Commercial |
$45.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$58.57
|
| Rate for Payer: Mclaren Medicaid |
$4.34
|
| Rate for Payer: Mclaren Medicare |
$8.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.49
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.32
|
| Rate for Payer: PACE Medicare |
$7.69
|
| Rate for Payer: PACE SWMI |
$8.09
|
| Rate for Payer: PHP Commercial |
$55.32
|
| Rate for Payer: PHP Medicare Advantage |
$8.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.30
|
| Rate for Payer: Priority Health Medicare |
$8.09
|
| Rate for Payer: Priority Health SBD |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$8.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$8.09
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: VA VA |
$8.09
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health SBD |
$24.36
|
|
|
HC URINE REDUCING SUBSTANCES
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30700003
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.71
|
| Rate for Payer: BCBS Complete |
$1.22
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$1.16
|
| Rate for Payer: Mclaren Medicare |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Meridian Medicaid |
$1.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PACE Medicare |
$2.06
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP Medicaid |
$1.22
|
| Rate for Payer: VA VA |
$2.17
|
|
|
HC URIN MDMA
|
Facility
|
IP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.55 |
| Max. Negotiated Rate |
$85.08 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health SBD |
$59.55
|
|
|
HC URIN MDMA
|
Facility
|
OP
|
$94.53
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$80.35
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.44
|
| 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 |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cash Price |
$75.62
|
| Rate for Payer: Cofinity Commercial |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$66.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$85.08
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.35
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$80.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.44
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$59.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN COTININE.
|
Facility
|
IP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.75 |
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$71.36
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC URN COTININE.
|
Facility
|
OP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100647
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| 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 |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Cofinity Commercial |
$71.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| 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 |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC URN MDMA
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC URN MDMA
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN TRICYCLIC
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Cofinity Commercial |
$33.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC URN TRICYCLIC
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
OP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$785.50 |
| Max. Negotiated Rate |
$1,767.38 |
| Rate for Payer: Aetna Commercial |
$1,669.20
|
| Rate for Payer: Aetna Medicare |
$981.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.44
|
| Rate for Payer: BCBS Complete |
$785.50
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,374.63
|
| Rate for Payer: Cofinity Commercial |
$1,688.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,767.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: PHP Commercial |
$1,669.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: Priority Health SBD |
$1,237.17
|
|
|
HC UROLIFT PER DEVICE
|
Facility
|
IP
|
$1,963.76
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
27800129
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.17 |
| Max. Negotiated Rate |
$1,767.38 |
| Rate for Payer: Aetna Commercial |
$1,669.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.44
|
| Rate for Payer: Cash Price |
$1,571.01
|
| Rate for Payer: Cofinity Commercial |
$1,374.63
|
| Rate for Payer: Cofinity Commercial |
$1,688.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,374.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,571.01
|
| Rate for Payer: Healthscope Commercial |
$1,767.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,669.20
|
| Rate for Payer: PHP Commercial |
$1,669.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.44
|
| Rate for Payer: Priority Health SBD |
$1,237.17
|
|
|
HC UROSTOMY ADAPTOR TUBE
|
Facility
|
IP
|
$16.37
|
|
| Hospital Charge Code |
27000168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Cofinity Commercial |
$14.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.91
|
| Rate for Payer: PHP Commercial |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.64
|
| Rate for Payer: Priority Health SBD |
$10.31
|
|
