|
HC BERMUDA GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200119
|
|
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 BERMUDA GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200119
|
|
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
|
|
|
HC BETA 2 GLYCOPROTEIN I CMPT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BETA 2 GLYCOPROTEIN I CMPT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGA M A
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200444
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGA M A
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200444
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200459
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200459
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG M A
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG M A
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200140
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGM M A
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC BETA 2 GLYCOPROTEIN I IGM M A
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200443
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGA
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$43.25 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGA
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200143
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC BETA 2 GP1 AB IGG
|
Facility
|
IP
|
$42.35
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200142
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$38.12 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.53
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$38.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.00
|
| Rate for Payer: PHP Commercial |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.64
|
| Rate for Payer: Priority Health SBD |
$26.68
|
|
|
HC BETA 2 GP1 AB IGG
|
Facility
|
OP
|
$42.35
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200142
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$43.25 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$38.12
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.00
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$36.00
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.64
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$26.68
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GP1 AB IGM
|
Facility
|
IP
|
$50.39
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.35 |
| Rate for Payer: Aetna Commercial |
$42.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.75
|
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Cofinity Commercial |
$35.27
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$45.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.83
|
| Rate for Payer: PHP Commercial |
$42.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.27
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
HC BETA 2 GP1 AB IGM
|
Facility
|
OP
|
$50.39
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200141
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.35 |
| Rate for Payer: Aetna Commercial |
$42.83
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Cash Price |
$40.31
|
| Rate for Payer: Cofinity Commercial |
$35.27
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.35
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.83
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$42.83
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.27
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$31.75
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
IP
|
$41.82
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.35 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health SBD |
$26.35
|
|
|
HC BETA-2 MICROGLOBULIN
|
Facility
|
OP
|
$41.82
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
30100115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$37.64 |
| Rate for Payer: Aetna Commercial |
$35.55
|
| Rate for Payer: Aetna Medicare |
$16.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.22
|
| Rate for Payer: BCBS Complete |
$9.29
|
| Rate for Payer: BCBS MAPPO |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Medicare Advantage |
$16.18
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cash Price |
$33.46
|
| Rate for Payer: Cofinity Commercial |
$35.97
|
| Rate for Payer: Cofinity Commercial |
$29.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$37.64
|
| Rate for Payer: Mclaren Medicaid |
$8.85
|
| Rate for Payer: Mclaren Medicare |
$16.18
|
| Rate for Payer: Meridian Medicaid |
$9.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.55
|
| Rate for Payer: PACE Medicare |
$15.37
|
| Rate for Payer: PACE SWMI |
$16.18
|
| Rate for Payer: PHP Commercial |
$35.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.27
|
| Rate for Payer: Priority Health Medicare |
$16.18
|
| Rate for Payer: Priority Health SBD |
$26.35
|
| Rate for Payer: Railroad Medicare Medicare |
$16.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.42
|
| Rate for Payer: UHC Core |
$27.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.18
|
| Rate for Payer: UHC Exchange |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$16.67
|
| Rate for Payer: VA VA |
$16.18
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.69
|
| Rate for Payer: BCBS MAPPO |
$8.17
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$8.17
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$4.47
|
| Rate for Payer: Mclaren Medicare |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$4.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$7.76
|
| Rate for Payer: PACE SWMI |
$8.17
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$8.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$8.17
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Core |
$13.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.17
|
| Rate for Payer: UHC Exchange |
$8.17
|
| Rate for Payer: UHC Medicare Advantage |
$8.42
|
| Rate for Payer: VA VA |
$8.17
|
|
|
HC BETA HYDROXY BUTYRATE KETONE
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
30100068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health SBD |
$17.55
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
OP
|
$600.76
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$540.68 |
| Rate for Payer: Aetna Commercial |
$510.65
|
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Cash Price |
$480.61
|
| Rate for Payer: Cash Price |
$480.61
|
| Rate for Payer: Cofinity Commercial |
$420.53
|
| Rate for Payer: Cofinity Commercial |
$516.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Healthscope Commercial |
$540.68
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.65
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Commercial |
$510.65
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.53
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health SBD |
$378.48
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$55.67
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
HC BILATERAL INJECT CARPAL TUNNEL
|
Facility
|
IP
|
$600.76
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$378.48 |
| Max. Negotiated Rate |
$540.68 |
| Rate for Payer: Aetna Commercial |
$510.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.49
|
| Rate for Payer: Cash Price |
$480.61
|
| Rate for Payer: Cofinity Commercial |
$420.53
|
| Rate for Payer: Cofinity Commercial |
$516.65
|
| Rate for Payer: Healthscope Commercial |
$540.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$510.65
|
| Rate for Payer: PHP Commercial |
$510.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.53
|
| Rate for Payer: Priority Health SBD |
$378.48
|
|
|
HC BILATERAL MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100048
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.12 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Aetna Commercial |
$615.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.60
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$622.64
|
| Rate for Payer: Cofinity Commercial |
$506.80
|
| Rate for Payer: Healthscope Commercial |
$651.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$615.40
|
| Rate for Payer: PHP Commercial |
$615.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$506.80
|
| Rate for Payer: Priority Health SBD |
$456.12
|
|
