|
HC ANTI THROMBIN III
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
30500035
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.81
|
| Rate for Payer: BCBS Complete |
$6.81
|
| Rate for Payer: BCBS MAPPO |
$11.85
|
| Rate for Payer: BCBS Trust/PPO |
$9.28
|
| Rate for Payer: BCN Medicare Advantage |
$11.85
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.85
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Mclaren Medicaid |
$6.48
|
| Rate for Payer: Mclaren Medicare |
$11.85
|
| Rate for Payer: Meridian Medicaid |
$6.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Medicare |
$11.26
|
| Rate for Payer: PACE SWMI |
$11.85
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$11.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health Medicare |
$11.85
|
| Rate for Payer: Priority Health SBD |
$30.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.22
|
| Rate for Payer: UHC Core |
$20.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.85
|
| Rate for Payer: UHC Exchange |
$11.85
|
| Rate for Payer: UHC Medicare Advantage |
$12.21
|
| Rate for Payer: VA VA |
$11.85
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
30500036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.51
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS MAPPO |
$10.81
|
| Rate for Payer: BCBS Trust/PPO |
$8.47
|
| Rate for Payer: BCN Medicare Advantage |
$10.81
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.81
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$5.91
|
| Rate for Payer: Mclaren Medicare |
$10.81
|
| Rate for Payer: Meridian Medicaid |
$6.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Medicare |
$10.27
|
| Rate for Payer: PACE SWMI |
$10.81
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$10.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health Medicare |
$10.81
|
| Rate for Payer: Priority Health SBD |
$37.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.97
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.81
|
| Rate for Payer: UHC Exchange |
$10.81
|
| Rate for Payer: UHC Medicare Advantage |
$11.13
|
| Rate for Payer: VA VA |
$10.81
|
|
|
HC ANTITHROMBIN III ANTIGEN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
30500036
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health SBD |
$37.80
|
|
|
HC ANTITRYPSIN GENOTYPE CMPT 1
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 81332
|
| Hospital Charge Code |
31000095
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$71.46 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$45.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.56
|
| Rate for Payer: BCBS Complete |
$25.07
|
| Rate for Payer: BCBS MAPPO |
$43.65
|
| Rate for Payer: BCBS Trust/PPO |
$34.18
|
| Rate for Payer: BCN Medicare Advantage |
$43.65
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.65
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$23.88
|
| Rate for Payer: Mclaren Medicare |
$43.65
|
| Rate for Payer: Meridian Medicaid |
$25.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$41.47
|
| Rate for Payer: PACE SWMI |
$43.65
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$43.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$43.65
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$43.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.38
|
| Rate for Payer: UHC Core |
$71.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.65
|
| Rate for Payer: UHC Exchange |
$43.65
|
| Rate for Payer: UHC Medicare Advantage |
$44.96
|
| Rate for Payer: VA VA |
$43.65
|
|
|
HC ANTITRYPSIN GENOTYPE CMPT 1
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 81332
|
| Hospital Charge Code |
31000095
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC AO GRAM W HEART CATH
|
Facility
|
IP
|
$717.35
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$451.93 |
| Max. Negotiated Rate |
$645.62 |
| Rate for Payer: Aetna Commercial |
$609.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.28
|
| Rate for Payer: Cash Price |
$573.88
|
| Rate for Payer: Cofinity Commercial |
$502.14
|
| Rate for Payer: Cofinity Commercial |
$616.92
|
| Rate for Payer: Healthscope Commercial |
$645.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$609.75
|
| Rate for Payer: PHP Commercial |
$609.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.14
|
| Rate for Payer: Priority Health SBD |
$451.93
|
|
|
HC AO GRAM W HEART CATH
|
Facility
|
OP
|
$717.35
|
|
|
Service Code
|
CPT 93567
|
| Hospital Charge Code |
48100026
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$609.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.28
|
| Rate for Payer: BCBS Complete |
$286.94
|
| Rate for Payer: BCBS Trust/PPO |
$373.33
|
| Rate for Payer: Cash Price |
$573.88
|
| Rate for Payer: Cash Price |
$573.88
|
| Rate for Payer: Cofinity Commercial |
$502.14
|
| Rate for Payer: Cofinity Commercial |
$616.92
|
| Rate for Payer: Healthscope Commercial |
$645.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$609.75
|
| Rate for Payer: PHP Commercial |
$609.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.14
|
| Rate for Payer: Priority Health SBD |
$451.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$36.02
|
|
|
HC AORTA ILIAC ULTRA COMPL
|
Facility
|
OP
|
$1,294.92
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
92100015
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.26 |
| Max. Negotiated Rate |
$1,165.43 |
| Rate for Payer: Aetna Commercial |
$1,100.68
|
| Rate for Payer: Aetna Medicare |
$226.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$272.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$272.54
|
| Rate for Payer: BCBS Complete |
$125.24
|
| Rate for Payer: BCBS MAPPO |
$218.03
|
| Rate for Payer: BCBS Trust/PPO |
$658.55
|
| Rate for Payer: BCN Medicare Advantage |
$218.03
|
| Rate for Payer: Cash Price |
$1,035.94
|
| Rate for Payer: Cash Price |
$1,035.94
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Cofinity Commercial |
$1,113.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.03
|
| Rate for Payer: Healthscope Commercial |
$1,165.43
|
| Rate for Payer: Mclaren Medicaid |
$119.26
|
| Rate for Payer: Mclaren Medicare |
$218.03
|
| Rate for Payer: Meridian Medicaid |
$125.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,100.68
|
| Rate for Payer: PACE Medicare |
$207.13
|
| Rate for Payer: PACE SWMI |
$218.03
|
| Rate for Payer: PHP Commercial |
$1,100.68
|
| Rate for Payer: PHP Medicare Advantage |
$218.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.44
|
| Rate for Payer: Priority Health Medicare |
$218.03
|
| Rate for Payer: Priority Health SBD |
$815.80
|
| Rate for Payer: Railroad Medicare Medicare |
$218.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$218.03
|
| Rate for Payer: UHC Exchange |
$177.15
|
| Rate for Payer: UHC Medicare Advantage |
$224.57
|
| Rate for Payer: VA VA |
$218.03
|
|
|
HC AORTA ILIAC ULTRA COMPL
|
Facility
|
IP
|
$1,294.92
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
92100015
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$815.80 |
| Max. Negotiated Rate |
$1,165.43 |
| Rate for Payer: Aetna Commercial |
$1,100.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.70
|
| Rate for Payer: Cash Price |
$1,035.94
|
| Rate for Payer: Cofinity Commercial |
$1,113.63
|
| Rate for Payer: Cofinity Commercial |
$906.44
|
| Rate for Payer: Healthscope Commercial |
$1,165.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,100.68
|
| Rate for Payer: PHP Commercial |
$1,100.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$906.44
|
| Rate for Payer: Priority Health SBD |
$815.80
|
|
|
HC AORTA ILIAC ULTRA LIMITD
|
Facility
|
IP
|
$800.53
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$504.33 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health SBD |
$504.33
|
|
|
HC AORTA ILIAC ULTRA LIMITD
|
Facility
|
OP
|
$800.53
|
|
|
Service Code
|
CPT 93979
|
| Hospital Charge Code |
92100016
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$720.48 |
| Rate for Payer: Aetna Commercial |
$680.45
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$434.43
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cash Price |
$640.42
|
| Rate for Payer: Cofinity Commercial |
$688.46
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$720.48
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$680.45
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$680.45
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.37
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$504.33
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$115.91
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC APHERESIS
|
Facility
|
OP
|
$2,505.38
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,002.15 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,002.15
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$1,753.77
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health SBD |
$1,578.39
|
|
|
HC APHERESIS
|
Facility
|
IP
|
$2,505.38
|
|
| Hospital Charge Code |
36000006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,578.39 |
| Max. Negotiated Rate |
$2,254.84 |
| Rate for Payer: Aetna Commercial |
$2,129.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cofinity Commercial |
$1,753.77
|
| Rate for Payer: Cofinity Commercial |
$2,154.63
|
| Rate for Payer: Healthscope Commercial |
$2,254.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,129.57
|
| Rate for Payer: PHP Commercial |
$2,129.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.77
|
| Rate for Payer: Priority Health SBD |
$1,578.39
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$129.14
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.66 |
| Max. Negotiated Rate |
$1,227.07 |
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.07
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health SBD |
$81.36
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$129.14
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
63600001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$116.23 |
| Rate for Payer: Aetna Commercial |
$109.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Cash Price |
$103.31
|
| Rate for Payer: Cofinity Commercial |
$111.06
|
| Rate for Payer: Cofinity Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$116.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.77
|
| Rate for Payer: PHP Commercial |
$109.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.40
|
| Rate for Payer: Priority Health SBD |
$81.36
|
|
|
HC APNEALINK PLUS
|
Facility
|
OP
|
$733.10
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$659.79 |
| Rate for Payer: Aetna Commercial |
$623.14
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$222.58
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cofinity Commercial |
$513.17
|
| Rate for Payer: Cofinity Commercial |
$630.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$659.79
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.14
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$623.14
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$461.85
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Exchange |
$92.67
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC APNEALINK PLUS
|
Facility
|
IP
|
$733.10
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$461.85 |
| Max. Negotiated Rate |
$659.79 |
| Rate for Payer: Aetna Commercial |
$623.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.52
|
| Rate for Payer: Cash Price |
$586.48
|
| Rate for Payer: Cofinity Commercial |
$513.17
|
| Rate for Payer: Cofinity Commercial |
$630.47
|
| Rate for Payer: Healthscope Commercial |
$659.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$623.14
|
| Rate for Payer: PHP Commercial |
$623.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.17
|
| Rate for Payer: Priority Health SBD |
$461.85
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$43.47
|
|
|
HC APOLIPOPROTEIN A1
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$12.11
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Mclaren Medicaid |
$11.54
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$43.47
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$26.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$21.72
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$12.11
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$11.54
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$31.49
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$26.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$21.72
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APOLIPOPROTEIN B
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100107
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.48
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.99
|
| Rate for Payer: Priority Health SBD |
$31.49
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health SBD |
$24.42
|
|
|
HC APOLIPOPROTEIN B LMPP
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
30100637
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.36
|
| Rate for Payer: BCBS Complete |
$12.11
|
| Rate for Payer: BCBS MAPPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.09
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Mclaren Medicaid |
$11.54
|
| Rate for Payer: Mclaren Medicare |
$21.09
|
| Rate for Payer: Meridian Medicaid |
$12.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Medicare |
$20.04
|
| Rate for Payer: PACE SWMI |
$21.09
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health Medicare |
$21.09
|
| Rate for Payer: Priority Health SBD |
$24.42
|
| Rate for Payer: Railroad Medicare Medicare |
$21.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.31
|
| Rate for Payer: UHC Core |
$26.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.09
|
| Rate for Payer: UHC Exchange |
$21.09
|
| Rate for Payer: UHC Medicare Advantage |
$21.72
|
| Rate for Payer: VA VA |
$21.09
|
|
|
HC APPLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC APPLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200072
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
