|
HC CRE
|
Facility
|
IP
|
$1,424.73
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27200104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$897.58 |
| 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: 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
|
|
|
HC C REACTIVE PROTEIN
|
Facility
|
OP
|
$60.40
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC C REACTIVE PROTEIN
|
Facility
|
IP
|
$60.40
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200137
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.05 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health SBD |
$38.05
|
|
|
HC CREATE TEAR SAC DRAIN
|
Facility
|
IP
|
$5,057.16
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,186.01 |
| Max. Negotiated Rate |
$4,551.44 |
| Rate for Payer: Aetna Commercial |
$4,298.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,287.15
|
| Rate for Payer: Cash Price |
$4,045.73
|
| Rate for Payer: Cofinity Commercial |
$4,349.16
|
| Rate for Payer: Cofinity Commercial |
$3,540.01
|
| Rate for Payer: Healthscope Commercial |
$4,551.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,298.59
|
| Rate for Payer: PHP Commercial |
$4,298.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,540.01
|
| Rate for Payer: Priority Health SBD |
$3,186.01
|
|
|
HC CREATE TEAR SAC DRAIN
|
Facility
|
OP
|
$5,057.16
|
|
|
Service Code
|
CPT 68720
|
| Hospital Charge Code |
76100308
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$790.44 |
| Max. Negotiated Rate |
$10,481.39 |
| Rate for Payer: Aetna Commercial |
$4,298.59
|
| Rate for Payer: Aetna Medicare |
$3,577.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,287.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,300.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,300.35
|
| Rate for Payer: BCBS Complete |
$1,976.10
|
| Rate for Payer: BCBS MAPPO |
$3,440.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,440.28
|
| Rate for Payer: Cash Price |
$4,045.73
|
| Rate for Payer: Cash Price |
$4,045.73
|
| Rate for Payer: Cofinity Commercial |
$4,349.16
|
| Rate for Payer: Cofinity Commercial |
$3,540.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,440.28
|
| Rate for Payer: Healthscope Commercial |
$4,551.44
|
| Rate for Payer: Mclaren Medicaid |
$1,881.83
|
| Rate for Payer: Mclaren Medicare |
$3,440.28
|
| Rate for Payer: Meridian Medicaid |
$1,976.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,612.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,956.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,298.59
|
| Rate for Payer: PACE Medicare |
$3,268.27
|
| Rate for Payer: PACE SWMI |
$3,440.28
|
| Rate for Payer: PHP Commercial |
$4,298.59
|
| Rate for Payer: PHP Medicare Advantage |
$3,440.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,881.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,540.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,481.39
|
| Rate for Payer: Priority Health Medicare |
$3,440.28
|
| Rate for Payer: Priority Health Narrow Network |
$8,385.11
|
| Rate for Payer: Priority Health SBD |
$3,186.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,440.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,440.28
|
| Rate for Payer: UHC Exchange |
$790.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,543.49
|
| Rate for Payer: VA VA |
$3,440.28
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC CREATININE CLEARANCE
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82575
|
| Hospital Charge Code |
30100182
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.82
|
| Rate for Payer: BCBS Complete |
$5.43
|
| Rate for Payer: BCBS MAPPO |
$9.46
|
| Rate for Payer: BCBS Trust/PPO |
$7.41
|
| Rate for Payer: BCN Medicare Advantage |
$9.46
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.46
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$5.17
|
| Rate for Payer: Mclaren Medicare |
$9.46
|
| Rate for Payer: Meridian Medicaid |
$5.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$8.99
|
| Rate for Payer: PACE SWMI |
$9.46
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$9.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$9.46
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.35
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.46
|
| Rate for Payer: UHC Exchange |
$9.46
|
| Rate for Payer: UHC Medicare Advantage |
$9.74
|
| Rate for Payer: VA VA |
$9.46
|
|
|
HC CREATININE SERUM
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
Hospital Revenue Code
|
301
|
| 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 CREATININE SERUM
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.14
|
| Rate for Payer: UHC Core |
$8.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Exchange |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC CREATININE URINE/OTHER SOURCE
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC CREATININE URINE/OTHER SOURCE
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100181
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
OP
|
$39.21
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$35.29 |
| Rate for Payer: Aetna Commercial |
$33.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.49
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Healthscope Commercial |
$35.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.33
|
| Rate for Payer: PHP Commercial |
$33.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.45
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
HC CRITIC AID 6.5 OZ
|
Facility
|
IP
|
$39.21
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$35.29 |
| Rate for Payer: Aetna Commercial |
$33.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.49
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Healthscope Commercial |
$35.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.33
|
| Rate for Payer: PHP Commercial |
$33.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.45
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
HC CRITICAL CARE R&B
|
Facility
|
IP
|
$6,213.20
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$3,914.32 |
| Max. Negotiated Rate |
$5,591.88 |
| Rate for Payer: Aetna Commercial |
$5,281.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,038.58
|
| Rate for Payer: Cash Price |
$4,970.56
|
| Rate for Payer: Cofinity Commercial |
$4,349.24
|
| Rate for Payer: Cofinity Commercial |
$5,343.35
|
| Rate for Payer: Healthscope Commercial |
$5,591.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,281.22
|
| Rate for Payer: PHP Commercial |
$5,281.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,349.24
|
| Rate for Payer: Priority Health SBD |
$3,914.32
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.91 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health SBD |
$98.91
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna Commercial |
$133.45
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.17
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$135.02
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$141.30
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$133.45
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health SBD |
$98.91
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.05
|
| Rate for Payer: UHC Core |
$30.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.21
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UHC Medicare Advantage |
$30.09
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health SBD |
$97.65
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$108.50
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$97.65
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$114.03 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health SBD |
$114.03
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$153.85
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$155.66
|
| Rate for Payer: Cofinity Commercial |
$126.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.85
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$153.85
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.70
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$114.03
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$29.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health SBD |
$38.56
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Cofinity Commercial |
$42.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$38.56
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$90.07
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$81.06 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.55
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$63.05
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health SBD |
$56.74
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$90.07
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$189.98 |
| Rate for Payer: Aetna Commercial |
$76.56
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cash Price |
$72.06
|
| Rate for Payer: Cofinity Commercial |
$63.05
|
| Rate for Payer: Cofinity Commercial |
$77.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$81.06
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.56
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$76.56
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health SBD |
$56.74
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC Core |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$228.50
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$143.96 |
| Max. Negotiated Rate |
$205.65 |
| Rate for Payer: Aetna Commercial |
$194.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.52
|
| Rate for Payer: Cash Price |
$182.80
|
| Rate for Payer: Cofinity Commercial |
$159.95
|
| Rate for Payer: Cofinity Commercial |
$196.51
|
| Rate for Payer: Healthscope Commercial |
$205.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.22
|
| Rate for Payer: PHP Commercial |
$194.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.95
|
| Rate for Payer: Priority Health SBD |
$143.96
|
|
