|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.19 |
| Max. Negotiated Rate |
$530.45 |
| Rate for Payer: Aetna Commercial |
$425.00
|
| Rate for Payer: Aetna Medicare |
$184.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.64
|
| Rate for Payer: BCBS Complete |
$101.85
|
| Rate for Payer: BCBS MAPPO |
$177.31
|
| Rate for Payer: BCBS Trust/PPO |
$455.93
|
| Rate for Payer: BCN Medicare Advantage |
$177.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$430.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.31
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Mclaren Medicaid |
$96.99
|
| Rate for Payer: Mclaren Medicare |
$177.31
|
| Rate for Payer: Meridian Medicaid |
$101.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.00
|
| Rate for Payer: PACE Medicare |
$168.44
|
| Rate for Payer: PACE SWMI |
$177.31
|
| Rate for Payer: PHP Commercial |
$425.00
|
| Rate for Payer: PHP Medicare Advantage |
$177.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$530.45
|
| Rate for Payer: Priority Health Medicare |
$177.31
|
| Rate for Payer: Priority Health Narrow Network |
$424.36
|
| Rate for Payer: Priority Health SBD |
$315.00
|
| Rate for Payer: Railroad Medicare Medicare |
$177.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.31
|
| Rate for Payer: UHC Exchange |
$82.19
|
| Rate for Payer: UHC Medicare Advantage |
$182.63
|
| Rate for Payer: VA VA |
$177.31
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$425.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$325.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$350.00
|
| Rate for Payer: Cofinity Commercial |
$430.00
|
| Rate for Payer: Healthscope Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.00
|
| Rate for Payer: PHP Commercial |
$425.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
| Rate for Payer: Priority Health SBD |
$315.00
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$1,020.22
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$642.74 |
| Max. Negotiated Rate |
$918.20 |
| Rate for Payer: Aetna Commercial |
$867.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.14
|
| Rate for Payer: Cash Price |
$816.18
|
| Rate for Payer: Cofinity Commercial |
$714.15
|
| Rate for Payer: Cofinity Commercial |
$877.39
|
| Rate for Payer: Healthscope Commercial |
$918.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.19
|
| Rate for Payer: PHP Commercial |
$867.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.15
|
| Rate for Payer: Priority Health SBD |
$642.74
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$1,020.22
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$408.09 |
| Max. Negotiated Rate |
$918.20 |
| Rate for Payer: Aetna Commercial |
$867.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.14
|
| Rate for Payer: BCBS Complete |
$408.09
|
| Rate for Payer: Cash Price |
$816.18
|
| Rate for Payer: Cofinity Commercial |
$714.15
|
| Rate for Payer: Cofinity Commercial |
$877.39
|
| Rate for Payer: Healthscope Commercial |
$918.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.19
|
| Rate for Payer: PHP Commercial |
$867.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.15
|
| Rate for Payer: Priority Health SBD |
$642.74
|
|
|
HC ANOSCOPY
|
Facility
|
IP
|
$159.73
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.63 |
| Max. Negotiated Rate |
$143.76 |
| Rate for Payer: Aetna Commercial |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.82
|
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Cofinity Commercial |
$111.81
|
| Rate for Payer: Cofinity Commercial |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$143.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.77
|
| Rate for Payer: PHP Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.81
|
| Rate for Payer: Priority Health SBD |
$100.63
|
|
|
HC ANOSCOPY
|
Facility
|
OP
|
$159.73
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$143.76 |
| Rate for Payer: Aetna Commercial |
$135.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.82
|
| Rate for Payer: BCBS Complete |
$63.89
|
| Rate for Payer: Cash Price |
$127.78
|
| Rate for Payer: Cofinity Commercial |
$111.81
|
| Rate for Payer: Cofinity Commercial |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$143.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.77
|
| Rate for Payer: PHP Commercial |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.81
|
| Rate for Payer: Priority Health SBD |
$100.63
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$147.32
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$52.61
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$92.81
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$40.60
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$147.32
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.81 |
| Max. Negotiated Rate |
$132.59 |
| Rate for Payer: Aetna Commercial |
$125.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.76
|
| Rate for Payer: Cash Price |
$117.86
|
| Rate for Payer: Cofinity Commercial |
$103.12
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Healthscope Commercial |
$132.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.22
|
| Rate for Payer: PHP Commercial |
$125.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.12
|
| Rate for Payer: Priority Health SBD |
$92.81
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
OP
|
$1,536.46
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$1,382.81 |
| Rate for Payer: Aetna Commercial |
$1,305.99
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$66.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cofinity Commercial |
$1,321.36
|
| Rate for Payer: Cofinity Commercial |
$1,075.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$1,382.81
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,305.99
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$1,305.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.52
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health SBD |
$967.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
IP
|
$1,536.46
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.97 |
| Max. Negotiated Rate |
$1,382.81 |
| Rate for Payer: Aetna Commercial |
$1,305.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.70
|
| Rate for Payer: Cash Price |
$1,229.17
|
| Rate for Payer: Cofinity Commercial |
$1,075.52
|
| Rate for Payer: Cofinity Commercial |
$1,321.36
|
| Rate for Payer: Healthscope Commercial |
$1,382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,305.99
|
| Rate for Payer: PHP Commercial |
$1,305.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.52
|
| Rate for Payer: Priority Health SBD |
$967.97
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
OP
|
$2,033.68
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$1,830.31 |
| Rate for Payer: Aetna Commercial |
$1,728.63
|
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$349.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cofinity Commercial |
$1,748.96
|
| Rate for Payer: Cofinity Commercial |
$1,423.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Healthscope Commercial |
$1,830.31
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.63
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Commercial |
$1,728.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.58
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health SBD |
$1,281.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$64.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
IP
|
$2,033.68
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,281.22 |
| Max. Negotiated Rate |
$1,830.31 |
| Rate for Payer: Aetna Commercial |
$1,728.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,321.89
|
| Rate for Payer: Cash Price |
$1,626.94
|
| Rate for Payer: Cofinity Commercial |
$1,423.58
|
| Rate for Payer: Cofinity Commercial |
$1,748.96
|
| Rate for Payer: Healthscope Commercial |
$1,830.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,728.63
|
| Rate for Payer: PHP Commercial |
$1,728.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,423.58
|
| Rate for Payer: Priority Health SBD |
$1,281.22
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
OP
|
$115.50
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Aetna Commercial |
$98.18
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Cofinity Commercial |
$80.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$103.95
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.18
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$98.18
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.85
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health SBD |
$72.76
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC Core |
$29.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
IP
|
$115.50
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Aetna Commercial |
$98.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.08
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cofinity Commercial |
$80.85
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.18
|
| Rate for Payer: PHP Commercial |
$98.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.85
|
| Rate for Payer: Priority Health SBD |
$72.76
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC ANTIBODY ELUTION
|
Facility
|
OP
|
$293.90
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$464.37 |
| Rate for Payer: Aetna Commercial |
$249.82
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$235.12
|
| Rate for Payer: Cash Price |
$235.12
|
| Rate for Payer: Cofinity Commercial |
$205.73
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$264.51
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.82
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$249.82
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.37
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health Narrow Network |
$371.50
|
| Rate for Payer: Priority Health SBD |
$185.16
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$29.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC ANTIBODY ELUTION
|
Facility
|
IP
|
$293.90
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
30200341
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$185.16 |
| Max. Negotiated Rate |
$264.51 |
| Rate for Payer: Aetna Commercial |
$249.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.04
|
| Rate for Payer: Cash Price |
$235.12
|
| Rate for Payer: Cofinity Commercial |
$252.75
|
| Rate for Payer: Cofinity Commercial |
$205.73
|
| Rate for Payer: Healthscope Commercial |
$264.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.82
|
| Rate for Payer: PHP Commercial |
$249.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.73
|
| Rate for Payer: Priority Health SBD |
$185.16
|
|
|
HC ANTIBODY IDENTIFICATION
|
Facility
|
OP
|
$209.10
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
30200342
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$177.74
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cash Price |
$167.28
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Cofinity Commercial |
$146.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$188.19
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.74
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$177.74
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$131.73
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC Core |
$29.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
