|
HC CHROMOSOME ANALYSIS HEMATOLOGIAL
|
Facility
|
OP
|
$224.88
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$214.68 |
| Rate for Payer: Aetna Commercial |
$191.15
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.69
|
| Rate for Payer: BCBS Complete |
$82.57
|
| Rate for Payer: BCBS MAPPO |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$112.56
|
| Rate for Payer: BCN Medicare Advantage |
$143.75
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: Cofinity Commercial |
$193.40
|
| Rate for Payer: Cofinity Commercial |
$157.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.75
|
| Rate for Payer: Healthscope Commercial |
$202.39
|
| Rate for Payer: Mclaren Medicaid |
$78.63
|
| Rate for Payer: Mclaren Medicare |
$143.75
|
| Rate for Payer: Meridian Medicaid |
$82.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.15
|
| Rate for Payer: PACE Medicare |
$136.56
|
| Rate for Payer: PACE SWMI |
$143.75
|
| Rate for Payer: PHP Commercial |
$191.15
|
| Rate for Payer: PHP Medicare Advantage |
$143.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.42
|
| Rate for Payer: Priority Health Medicare |
$143.75
|
| Rate for Payer: Priority Health SBD |
$141.67
|
| Rate for Payer: Railroad Medicare Medicare |
$143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.50
|
| Rate for Payer: UHC Core |
$214.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.75
|
| Rate for Payer: UHC Exchange |
$143.75
|
| Rate for Payer: UHC Medicare Advantage |
$148.06
|
| Rate for Payer: VA VA |
$143.75
|
|
|
HC CHROMOSOME ANALYSIS HEMATOLOGIAL
|
Facility
|
IP
|
$224.88
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000017
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$141.67 |
| Max. Negotiated Rate |
$202.39 |
| Rate for Payer: Aetna Commercial |
$191.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.17
|
| Rate for Payer: Cash Price |
$179.90
|
| Rate for Payer: Cofinity Commercial |
$157.42
|
| Rate for Payer: Cofinity Commercial |
$193.40
|
| Rate for Payer: Healthscope Commercial |
$202.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.15
|
| Rate for Payer: PHP Commercial |
$191.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.42
|
| Rate for Payer: Priority Health SBD |
$141.67
|
|
|
HC CHROMOSOME ANALYSIS MARROW
|
Facility
|
IP
|
$225.75
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cofinity Commercial |
$194.14
|
| Rate for Payer: Cofinity Commercial |
$158.02
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.89
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.02
|
| Rate for Payer: Priority Health SBD |
$142.22
|
|
|
HC CHROMOSOME ANALYSIS MARROW
|
Facility
|
OP
|
$225.75
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
31000016
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$214.68 |
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.69
|
| Rate for Payer: BCBS Complete |
$82.57
|
| Rate for Payer: BCBS MAPPO |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$112.56
|
| Rate for Payer: BCN Medicare Advantage |
$143.75
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cofinity Commercial |
$194.14
|
| Rate for Payer: Cofinity Commercial |
$158.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.75
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Mclaren Medicaid |
$78.63
|
| Rate for Payer: Mclaren Medicare |
$143.75
|
| Rate for Payer: Meridian Medicaid |
$82.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$150.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.89
|
| Rate for Payer: PACE Medicare |
$136.56
|
| Rate for Payer: PACE SWMI |
$143.75
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Medicare Advantage |
$143.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.02
|
| Rate for Payer: Priority Health Medicare |
$143.75
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Railroad Medicare Medicare |
$143.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.50
|
| Rate for Payer: UHC Core |
$214.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.75
|
| Rate for Payer: UHC Exchange |
$143.75
|
| Rate for Payer: UHC Medicare Advantage |
$148.06
|
| Rate for Payer: VA VA |
$143.75
|
|
|
HC CHROMOSOME CELL COUNT 15 TO 20
|
Facility
|
OP
|
$198.90
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
31000019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna Medicare |
$130.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.86
|
| Rate for Payer: BCBS Complete |
$72.08
|
| Rate for Payer: BCBS MAPPO |
$125.49
|
| Rate for Payer: BCBS Trust/PPO |
$98.27
|
| Rate for Payer: BCN Medicare Advantage |
$125.49
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Cofinity Commercial |
$139.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.49
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Mclaren Medicaid |
$68.64
|
| Rate for Payer: Mclaren Medicare |
$125.49
|
| Rate for Payer: Meridian Medicaid |
$72.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.06
|
| Rate for Payer: PACE Medicare |
$119.22
|
| Rate for Payer: PACE SWMI |
$125.49
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: PHP Medicare Advantage |
$125.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health Medicare |
$125.49
|
| Rate for Payer: Priority Health SBD |
$125.31
|
| Rate for Payer: Railroad Medicare Medicare |
$125.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.59
|
| Rate for Payer: UHC Core |
$211.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.49
|
| Rate for Payer: UHC Exchange |
$125.49
|
| Rate for Payer: UHC Medicare Advantage |
$129.25
|
| Rate for Payer: VA VA |
$125.49
|
|
|
HC CHROMOSOME CELL COUNT 15 TO 20
|
Facility
|
IP
|
$198.90
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
31000019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.31 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna Commercial |
$169.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.28
|
| Rate for Payer: Cash Price |
$159.12
|
| Rate for Payer: Cofinity Commercial |
$171.05
|
| Rate for Payer: Cofinity Commercial |
$139.23
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.06
|
| Rate for Payer: PHP Commercial |
$169.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health SBD |
$125.31
|
|
|
HC CHROMOSOME CULTURE
|
Facility
|
OP
|
$298.86
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.21 |
| Max. Negotiated Rate |
$268.97 |
| Rate for Payer: Aetna Commercial |
$254.03
|
| Rate for Payer: Aetna Medicare |
$156.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.88
|
| Rate for Payer: BCBS Complete |
$86.33
|
| Rate for Payer: BCBS MAPPO |
$150.30
|
| Rate for Payer: BCBS Trust/PPO |
$117.70
|
| Rate for Payer: BCN Medicare Advantage |
$150.30
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cofinity Commercial |
$257.02
|
| Rate for Payer: Cofinity Commercial |
$209.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.30
|
| Rate for Payer: Healthscope Commercial |
$268.97
|
| Rate for Payer: Mclaren Medicaid |
$82.21
|
| Rate for Payer: Mclaren Medicare |
$150.30
|
| Rate for Payer: Meridian Medicaid |
$86.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$157.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.03
|
| Rate for Payer: PACE Medicare |
$142.78
|
| Rate for Payer: PACE SWMI |
$150.30
|
| Rate for Payer: PHP Commercial |
$254.03
|
| Rate for Payer: PHP Medicare Advantage |
$150.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.20
|
| Rate for Payer: Priority Health Medicare |
$150.30
|
| Rate for Payer: Priority Health SBD |
$188.28
|
| Rate for Payer: Railroad Medicare Medicare |
$150.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.36
|
| Rate for Payer: UHC Core |
$250.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.30
|
| Rate for Payer: UHC Exchange |
$150.30
|
| Rate for Payer: UHC Medicare Advantage |
$154.81
|
| Rate for Payer: VA VA |
$150.30
|
|
|
HC CHROMOSOME CULTURE
|
Facility
|
IP
|
$298.86
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$188.28 |
| Max. Negotiated Rate |
$268.97 |
| Rate for Payer: Aetna Commercial |
$254.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.26
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cofinity Commercial |
$209.20
|
| Rate for Payer: Cofinity Commercial |
$257.02
|
| Rate for Payer: Healthscope Commercial |
$268.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.03
|
| Rate for Payer: PHP Commercial |
$254.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.20
|
| Rate for Payer: Priority Health SBD |
$188.28
|
|
|
HC CIRCUMCISION
|
Facility
|
OP
|
$2,710.48
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,084.19 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: BCBS Complete |
$1,084.19
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
|
|
HC CIRCUMCISION
|
Facility
|
IP
|
$2,710.48
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
IP
|
$2,661.82
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,676.95 |
| Max. Negotiated Rate |
$2,395.64 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
OP
|
$2,661.82
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.32 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Commercial |
$2,262.55
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$602.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cash Price |
$2,129.46
|
| Rate for Payer: Cofinity Commercial |
$1,863.27
|
| Rate for Payer: Cofinity Commercial |
$2,289.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,395.64
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,262.55
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,262.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Priority Health SBD |
$1,676.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$93.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
OP
|
$2,710.48
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.85 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$193.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
IP
|
$2,710.48
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,761.81
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$1,897.34
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health SBD |
$1,707.60
|
|
|
HC CITRIC ACID URINE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$47.26 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.75
|
| Rate for Payer: BCBS Complete |
$15.97
|
| Rate for Payer: BCBS MAPPO |
$27.80
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Medicare Advantage |
$27.80
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.80
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$15.21
|
| Rate for Payer: Mclaren Medicare |
$27.80
|
| Rate for Payer: Meridian Medicaid |
$15.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PACE Medicare |
$26.41
|
| Rate for Payer: PACE SWMI |
$27.80
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$27.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health Medicare |
$27.80
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.36
|
| Rate for Payer: UHC Core |
$47.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.80
|
| Rate for Payer: UHC Exchange |
$27.80
|
| Rate for Payer: UHC Medicare Advantage |
$28.63
|
| Rate for Payer: VA VA |
$27.80
|
|
|
HC CITRIC ACID URINE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.41
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC CK-MB FRACTION
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC CK-MB FRACTION
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$12.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.44
|
| Rate for Payer: BCBS Complete |
$6.63
|
| Rate for Payer: BCBS MAPPO |
$11.55
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$11.55
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.55
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Mclaren Medicare |
$11.55
|
| Rate for Payer: Meridian Medicaid |
$6.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PACE Medicare |
$10.97
|
| Rate for Payer: PACE SWMI |
$11.55
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$11.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health Medicare |
$11.55
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.86
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.55
|
| Rate for Payer: UHC Exchange |
$11.55
|
| Rate for Payer: UHC Medicare Advantage |
$11.90
|
| Rate for Payer: VA VA |
$11.55
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 CLADOSPORIUM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
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 CLAM IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
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 CLAM IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 CLIP FIX DEVICE ROTATABLE
|
Facility
|
IP
|
$775.77
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.74 |
| Max. Negotiated Rate |
$698.19 |
| Rate for Payer: Aetna Commercial |
$659.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.25
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$543.04
|
| Rate for Payer: Cofinity Commercial |
$667.16
|
| Rate for Payer: Healthscope Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.40
|
| Rate for Payer: PHP Commercial |
$659.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.04
|
| Rate for Payer: Priority Health SBD |
$488.74
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
OP
|
$775.77
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$698.19 |
| Rate for Payer: Aetna Commercial |
$659.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.25
|
| Rate for Payer: BCBS Complete |
$310.31
|
| Rate for Payer: Cash Price |
$620.62
|
| Rate for Payer: Cofinity Commercial |
$543.04
|
| Rate for Payer: Cofinity Commercial |
$667.16
|
| Rate for Payer: Healthscope Commercial |
$698.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$659.40
|
| Rate for Payer: PHP Commercial |
$659.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$543.04
|
| Rate for Payer: Priority Health SBD |
$488.74
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
IP
|
$344.39
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$216.97 |
| Max. Negotiated Rate |
$309.95 |
| Rate for Payer: Aetna Commercial |
$292.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.85
|
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$241.07
|
| Rate for Payer: Cofinity Commercial |
$296.18
|
| Rate for Payer: Healthscope Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$292.73
|
| Rate for Payer: PHP Commercial |
$292.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.07
|
| Rate for Payer: Priority Health SBD |
$216.97
|
|
