|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
OP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$200.09 |
| Rate for Payer: Aetna Commercial |
$164.11
|
| Rate for Payer: Aetna Medicare |
$127.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: BCBS Complete |
$70.20
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCBS Trust/PPO |
$95.71
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$166.04
|
| Rate for Payer: Cofinity Commercial |
$135.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$173.76
|
| Rate for Payer: Mclaren Medicaid |
$66.85
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Medicaid |
$70.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$164.11
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health SBD |
$121.63
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Core |
$200.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.22
|
| Rate for Payer: UHC Exchange |
$122.22
|
| Rate for Payer: UHC Medicare Advantage |
$125.89
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
IP
|
$193.07
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$121.63 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$164.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.50
|
| Rate for Payer: Cash Price |
$154.46
|
| Rate for Payer: Cofinity Commercial |
$135.15
|
| Rate for Payer: Cofinity Commercial |
$166.04
|
| Rate for Payer: Healthscope Commercial |
$173.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.11
|
| Rate for Payer: PHP Commercial |
$164.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.15
|
| Rate for Payer: Priority Health SBD |
$121.63
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| 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 CELIAC DISEASE CASCADE
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
OP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| 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 |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| 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 CELIAC PLEXUS BLOCK
|
Facility
|
IP
|
$1,187.52
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.14 |
| Max. Negotiated Rate |
$1,068.77 |
| Rate for Payer: Aetna Commercial |
$1,009.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.89
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cofinity Commercial |
$831.26
|
| Rate for Payer: Cofinity Commercial |
$1,021.27
|
| Rate for Payer: Healthscope Commercial |
$1,068.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.39
|
| Rate for Payer: PHP Commercial |
$1,009.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.26
|
| Rate for Payer: Priority Health SBD |
$748.14
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
OP
|
$1,187.52
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Commercial |
$1,009.39
|
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$650.58
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cash Price |
$950.02
|
| Rate for Payer: Cofinity Commercial |
$1,021.27
|
| Rate for Payer: Cofinity Commercial |
$831.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Healthscope Commercial |
$1,068.77
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,009.39
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Commercial |
$1,009.39
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$831.26
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Priority Health SBD |
$748.14
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.57
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$92.34
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health SBD |
$105.84
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.58
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS MAPPO |
$12.46
|
| Rate for Payer: BCBS Trust/PPO |
$9.76
|
| Rate for Payer: BCN Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.46
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Mclaren Medicaid |
$6.82
|
| Rate for Payer: Mclaren Medicare |
$12.46
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PACE Medicare |
$11.84
|
| Rate for Payer: PACE SWMI |
$12.46
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: PHP Medicare Advantage |
$12.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: Railroad Medicare Medicare |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.95
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.46
|
| Rate for Payer: UHC Exchange |
$12.46
|
| Rate for Payer: UHC Medicare Advantage |
$12.83
|
| Rate for Payer: VA VA |
$12.46
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
IP
|
$90.40
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health SBD |
$56.95
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
OP
|
$90.40
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$81.36 |
| Rate for Payer: Aetna Commercial |
$76.84
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.00
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cash Price |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$77.74
|
| Rate for Payer: Cofinity Commercial |
$63.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$81.36
|
| Rate for Payer: Mclaren Medicaid |
$3.06
|
| Rate for Payer: Mclaren Medicare |
$5.60
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.84
|
| Rate for Payer: PACE Medicare |
$5.32
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PHP Commercial |
$76.84
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.28
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health SBD |
$56.95
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.72
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.60
|
| Rate for Payer: UHC Exchange |
$5.60
|
| Rate for Payer: UHC Medicare Advantage |
$5.77
|
| Rate for Payer: VA VA |
$5.60
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
IP
|
$257.80
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.41 |
| Max. Negotiated Rate |
$232.02 |
| Rate for Payer: Aetna Commercial |
$219.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.57
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$221.71
|
| Rate for Payer: Cofinity Commercial |
$180.46
|
| Rate for Payer: Healthscope Commercial |
$232.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.13
|
| Rate for Payer: PHP Commercial |
$219.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.46
|
| Rate for Payer: Priority Health SBD |
$162.41
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
OP
|
$257.80
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.32 |
| Max. Negotiated Rate |
$232.02 |
| Rate for Payer: Aetna Commercial |
$219.13
|
| Rate for Payer: Aetna Medicare |
$141.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.82
|
| Rate for Payer: BCBS Complete |
$78.04
|
| Rate for Payer: BCBS MAPPO |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$135.86
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cash Price |
$206.24
|
| Rate for Payer: Cofinity Commercial |
$221.71
|
| Rate for Payer: Cofinity Commercial |
$180.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$232.02
|
| Rate for Payer: Mclaren Medicaid |
$74.32
|
| Rate for Payer: Mclaren Medicare |
$135.86
|
| Rate for Payer: Meridian Medicaid |
$78.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.13
|
| Rate for Payer: PACE Medicare |
$129.07
|
| Rate for Payer: PACE SWMI |
$135.86
|
| Rate for Payer: PHP Commercial |
$219.13
|
| Rate for Payer: PHP Medicare Advantage |
$135.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.46
|
| Rate for Payer: Priority Health Medicare |
$135.86
|
| Rate for Payer: Priority Health SBD |
$162.41
|
| Rate for Payer: Railroad Medicare Medicare |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.03
|
| Rate for Payer: UHC Core |
$230.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.86
|
| Rate for Payer: UHC Exchange |
$135.86
|
| Rate for Payer: UHC Medicare Advantage |
$139.94
|
| Rate for Payer: VA VA |
$135.86
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health SBD |
$93.36
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$51.75
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.96
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.73
|
| Rate for Payer: Priority Health SBD |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Exchange |
$8.51
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$111.69
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Core |
$171.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
OP
|
$4,054.86
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,621.94 |
| Max. Negotiated Rate |
$3,649.37 |
| Rate for Payer: Aetna Commercial |
$3,446.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,635.66
|
| Rate for Payer: BCBS Complete |
$1,621.94
|
| Rate for Payer: Cash Price |
$3,243.89
|
| Rate for Payer: Cofinity Commercial |
$2,838.40
|
| Rate for Payer: Cofinity Commercial |
$3,487.18
|
| Rate for Payer: Healthscope Commercial |
$3,649.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,446.63
|
| Rate for Payer: PHP Commercial |
$3,446.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.40
|
| Rate for Payer: Priority Health SBD |
$2,554.56
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
IP
|
$4,054.86
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,554.56 |
| Max. Negotiated Rate |
$3,649.37 |
| Rate for Payer: Aetna Commercial |
$3,446.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,635.66
|
| Rate for Payer: Cash Price |
$3,243.89
|
| Rate for Payer: Cofinity Commercial |
$2,838.40
|
| Rate for Payer: Cofinity Commercial |
$3,487.18
|
| Rate for Payer: Healthscope Commercial |
$3,649.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,446.63
|
| Rate for Payer: PHP Commercial |
$3,446.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,838.40
|
| Rate for Payer: Priority Health SBD |
$2,554.56
|
|
|
HC CERETEC PER DOSE
|
Facility
|
OP
|
$2,020.58
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$808.23 |
| Max. Negotiated Rate |
$1,818.52 |
| Rate for Payer: Aetna Commercial |
$1,717.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.38
|
| Rate for Payer: BCBS Complete |
$808.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,173.58
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cofinity Commercial |
$1,414.41
|
| Rate for Payer: Cofinity Commercial |
$1,737.70
|
| Rate for Payer: Healthscope Commercial |
$1,818.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.49
|
| Rate for Payer: PHP Commercial |
$1,717.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.41
|
| Rate for Payer: Priority Health SBD |
$1,272.97
|
|
|
HC CERETEC PER DOSE
|
Facility
|
IP
|
$2,020.58
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,272.97 |
| Max. Negotiated Rate |
$1,818.52 |
| Rate for Payer: Aetna Commercial |
$1,717.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.38
|
| Rate for Payer: Cash Price |
$1,616.46
|
| Rate for Payer: Cofinity Commercial |
$1,414.41
|
| Rate for Payer: Cofinity Commercial |
$1,737.70
|
| Rate for Payer: Healthscope Commercial |
$1,818.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,717.49
|
| Rate for Payer: PHP Commercial |
$1,717.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,414.41
|
| Rate for Payer: Priority Health SBD |
$1,272.97
|
|
|
HC CERTOLIZUMAB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Cofinity Commercial |
$114.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$102.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
