|
HC COVID 19 PCR
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
30600307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.09
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$77.11
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$61.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC COVID 19 PCR
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
HCPCS U0002
|
| Hospital Charge Code |
30600307
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.56
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$77.11
|
|
|
HC COVID ABBOTT ID NOW
|
Facility
|
IP
|
$147.90
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health SBD |
$93.18
|
|
|
HC COVID ABBOTT ID NOW
|
Facility
|
OP
|
$147.90
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600310
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.09
|
| Rate for Payer: BCCCP Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$93.18
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$61.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC COVID FLU AB RSV GENEMARKERS
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600316
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| 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 |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| 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 |
$212.42
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$212.42
|
| 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 |
$174.93
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| 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 COVID FLU AB RSV GENEMARKERS
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600316
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.42
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.93
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC COXIELLA BURNETTI ANTIBODIES
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$9.49
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$6.63
|
| Rate for Payer: Mclaren Medicare |
$12.12
|
| Rate for Payer: Meridian Medicaid |
$6.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PACE Medicare |
$11.51
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health Medicare |
$12.12
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.54
|
| Rate for Payer: UHC Core |
$20.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.12
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: VA VA |
$12.12
|
|
|
HC COXIELLA BURNETTI ANTIBODIES
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC COXIELLA BURNETTI ANTIBODY CMP
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCBS Trust/PPO |
$9.49
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Mclaren Medicaid |
$6.63
|
| Rate for Payer: Mclaren Medicare |
$12.12
|
| Rate for Payer: Meridian Medicaid |
$6.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PACE Medicare |
$11.51
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health Medicare |
$12.12
|
| Rate for Payer: Priority Health SBD |
$26.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.54
|
| Rate for Payer: UHC Core |
$20.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.12
|
| Rate for Payer: UHC Exchange |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: VA VA |
$12.12
|
|
|
HC COXIELLA BURNETTI ANTIBODY CMP
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200248
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.99 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.85
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.41
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.99
|
| Rate for Payer: Priority Health SBD |
$26.99
|
|
|
HC COXSACKIE A AB CMPT
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC COXSACKIE A AB CMPT
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200266
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC COXSACKIE B AB CMPT
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200265
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC COXSACKIE B AB CMPT
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200265
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$22.15 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.20
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$7.13
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$7.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.64
|
| Rate for Payer: UHC Core |
$22.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Exchange |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.42
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC C PEPTIDE LEVEL
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
30100464
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC C PEPTIDE LEVEL
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 84681
|
| Hospital Charge Code |
30100464
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$35.36 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Medicaid |
$11.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| Rate for Payer: UHC Core |
$35.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$21.43
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CPK
|
Facility
|
OP
|
$52.22
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
30100178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$44.39
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$41.78
|
| Rate for Payer: Cash Price |
$41.78
|
| Rate for Payer: Cofinity Commercial |
$44.91
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Mclaren Medicaid |
$3.56
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Medicaid |
$3.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.39
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$44.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health SBD |
$32.90
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.81
|
| Rate for Payer: UHC Core |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.51
|
| Rate for Payer: UHC Exchange |
$6.51
|
| Rate for Payer: UHC Medicare Advantage |
$6.71
|
| Rate for Payer: VA VA |
$6.51
|
|
|
HC CPK
|
Facility
|
IP
|
$52.22
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
30100178
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$44.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.94
|
| Rate for Payer: Cash Price |
$41.78
|
| Rate for Payer: Cofinity Commercial |
$36.55
|
| Rate for Payer: Cofinity Commercial |
$44.91
|
| Rate for Payer: Healthscope Commercial |
$47.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.39
|
| Rate for Payer: PHP Commercial |
$44.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.55
|
| Rate for Payer: Priority Health SBD |
$32.90
|
|
|
HC CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
IP
|
$404.21
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$254.65 |
| Max. Negotiated Rate |
$363.79 |
| Rate for Payer: Aetna Commercial |
$343.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.74
|
| Rate for Payer: Cash Price |
$323.37
|
| Rate for Payer: Cofinity Commercial |
$282.95
|
| Rate for Payer: Cofinity Commercial |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$363.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.58
|
| Rate for Payer: PHP Commercial |
$343.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.95
|
| Rate for Payer: Priority Health SBD |
$254.65
|
|
|
HC CPLX CHRNC CARE 1ST 60 MIN
|
Facility
|
OP
|
$404.21
|
|
|
Service Code
|
CPT 99487
|
| Hospital Charge Code |
51000108
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Aetna Commercial |
$343.58
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$323.37
|
| Rate for Payer: Cash Price |
$323.37
|
| Rate for Payer: Cofinity Commercial |
$282.95
|
| Rate for Payer: Cofinity Commercial |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$363.79
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.58
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$343.58
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.61
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health Narrow Network |
$333.29
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$87.75
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC CPR
|
Facility
|
IP
|
$960.79
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$605.30 |
| Max. Negotiated Rate |
$864.71 |
| Rate for Payer: Aetna Commercial |
$816.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.51
|
| Rate for Payer: Cash Price |
$768.63
|
| Rate for Payer: Cofinity Commercial |
$672.55
|
| Rate for Payer: Cofinity Commercial |
$826.28
|
| Rate for Payer: Healthscope Commercial |
$864.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$816.67
|
| Rate for Payer: PHP Commercial |
$816.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.55
|
| Rate for Payer: Priority Health SBD |
$605.30
|
|
|
HC CPR
|
Facility
|
OP
|
$960.79
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
45000018
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$864.71 |
| Rate for Payer: Aetna Commercial |
$816.67
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$175.07
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$768.63
|
| Rate for Payer: Cash Price |
$768.63
|
| Rate for Payer: Cofinity Commercial |
$826.28
|
| Rate for Payer: Cofinity Commercial |
$672.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$864.71
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$816.67
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$816.67
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.04
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$659.23
|
| Rate for Payer: Priority Health SBD |
$605.30
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$177.15
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC CRAB IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200037
|
|
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 CRAB IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200037
|
|
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 CRE
|
Facility
|
OP
|
$1,424.73
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,282.26 |
| Rate for Payer: Aetna Commercial |
$1,211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.07
|
| Rate for Payer: BCBS Complete |
$569.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$1,139.78
|
| Rate for Payer: Cash Price |
$1,139.78
|
| Rate for Payer: Cofinity Commercial |
$1,225.27
|
| Rate for Payer: Cofinity Commercial |
$997.31
|
| Rate for Payer: Healthscope Commercial |
$1,282.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.02
|
| Rate for Payer: PHP Commercial |
$1,211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.31
|
| Rate for Payer: Priority Health SBD |
$897.58
|
|
