|
HC ADALIMUMAB AB, S
|
Facility
|
IP
|
$210.16
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$189.14 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.60
|
| Rate for Payer: Cash Price |
$168.13
|
| Rate for Payer: Cofinity Advantage |
$147.11
|
| Rate for Payer: Cofinity Commercial |
$180.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.13
|
| Rate for Payer: Healthscope Commercial |
$189.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.62
|
| Rate for Payer: PHP Commercial |
$178.64
|
| Rate for Payer: Priority Health SBD |
$132.40
|
|
|
HC ADALIMUMAB, S
|
Facility
|
IP
|
$306.92
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
30100704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$276.23 |
| Rate for Payer: Aetna Commercial |
$260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.50
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Advantage |
$214.84
|
| Rate for Payer: Cofinity Commercial |
$263.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Healthscope Commercial |
$276.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: PHP Commercial |
$260.88
|
| Rate for Payer: Priority Health SBD |
$193.36
|
|
|
HC ADALIMUMAB, S
|
Facility
|
OP
|
$306.92
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
30100704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$276.23 |
| Rate for Payer: Aetna Commercial |
$260.88
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$41.13
|
| Rate for Payer: BCN Commercial |
$41.13
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cash Price |
$245.54
|
| Rate for Payer: Cofinity Advantage |
$214.84
|
| Rate for Payer: Cofinity Commercial |
$263.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$276.23
|
| Rate for Payer: Mclaren Medicaid |
$20.17
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.88
|
| Rate for Payer: Nomi Health Commercial |
$57.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.19
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$260.88
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.57
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$193.36
|
| Rate for Payer: Priority Health Tiered Network |
$30.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.86
|
| Rate for Payer: UHC Core |
$57.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$57.86
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC ADAMTS13 ACTIVITY AND INHIBITOR PROFILE, PLASMA
|
Facility
|
OP
|
$163.97
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$147.57 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$16.95
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.91
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cofinity Advantage |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$141.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$147.57
|
| Rate for Payer: Mclaren Medicaid |
$16.14
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.37
|
| Rate for Payer: Nomi Health Commercial |
$46.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.98
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$139.37
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.86
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$103.30
|
| Rate for Payer: Priority Health Tiered Network |
$24.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.29
|
| Rate for Payer: UHC Core |
$46.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.86
|
| Rate for Payer: UHC Exchange |
$46.29
|
| Rate for Payer: UHC Medicaid |
$16.14
|
| Rate for Payer: UHCCP Medicaid |
$16.14
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC ADAMTS13 ACTIVITY AND INHIBITOR PROFILE, PLASMA
|
Facility
|
IP
|
$163.97
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$147.57 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.58
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cofinity Advantage |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$141.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.18
|
| Rate for Payer: Healthscope Commercial |
$147.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.98
|
| Rate for Payer: PHP Commercial |
$139.37
|
| Rate for Payer: Priority Health SBD |
$103.30
|
|
|
HC ADAMTS 13 ANTIBODY
|
Facility
|
IP
|
$184.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$165.74 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.70
|
| Rate for Payer: Cash Price |
$147.32
|
| Rate for Payer: Cofinity Advantage |
$128.91
|
| Rate for Payer: Cofinity Commercial |
$158.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.32
|
| Rate for Payer: Healthscope Commercial |
$165.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.11
|
| Rate for Payer: PHP Commercial |
$156.53
|
| Rate for Payer: Priority Health SBD |
$116.01
|
|
|
HC ADAMTS 13 ANTIBODY
|
Facility
|
OP
|
$184.15
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$165.74 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$147.32
|
| Rate for Payer: Cash Price |
$147.32
|
| Rate for Payer: Cofinity Advantage |
$128.91
|
| Rate for Payer: Cofinity Commercial |
$158.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$165.74
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.53
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.11
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$156.53
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$116.01
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC ADAMTS 13 INHIBITOR
|
Facility
|
IP
|
$154.94
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30000055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.61 |
| Max. Negotiated Rate |
$139.45 |
| Rate for Payer: Aetna Commercial |
$131.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.71
|
| Rate for Payer: Cash Price |
$123.95
|
| Rate for Payer: Cofinity Advantage |
$108.46
|
| Rate for Payer: Cofinity Commercial |
$133.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.95
|
| Rate for Payer: Healthscope Commercial |
$139.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.20
|
| Rate for Payer: PHP Commercial |
$131.70
|
| Rate for Payer: Priority Health SBD |
$97.61
|
|
|
HC ADAMTS 13 INHIBITOR
|
Facility
|
OP
|
$154.94
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30000055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$139.45 |
| Rate for Payer: Aetna Commercial |
$131.70
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$123.95
|
| Rate for Payer: Cash Price |
$123.95
|
| Rate for Payer: Cofinity Advantage |
$108.46
|
| Rate for Payer: Cofinity Commercial |
$133.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$139.45
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.70
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.20
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$131.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$97.61
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
OP
|
$163.97
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$147.57 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$16.95
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$32.91
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cofinity Advantage |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$141.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$147.57
|
| Rate for Payer: Mclaren Medicaid |
$16.14
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.37
|
| Rate for Payer: Nomi Health Commercial |
$46.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.98
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$139.37
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.86
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$103.30
|
| Rate for Payer: Priority Health Tiered Network |
$24.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.29
|
| Rate for Payer: UHC Core |
$46.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.86
|
| Rate for Payer: UHC Exchange |
$46.29
|
| Rate for Payer: UHC Medicaid |
$16.14
|
| Rate for Payer: UHCCP Medicaid |
$16.14
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
IP
|
$163.97
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$147.57 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.58
|
| Rate for Payer: Cash Price |
$131.18
|
| Rate for Payer: Cofinity Advantage |
$114.78
|
| Rate for Payer: Cofinity Commercial |
$141.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.18
|
| Rate for Payer: Healthscope Commercial |
$147.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.98
|
| Rate for Payer: PHP Commercial |
$139.37
|
| Rate for Payer: Priority Health SBD |
$103.30
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
OP
|
$9.04
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cofinity Advantage |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.23
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.78
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: Priority Health SBD |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$4.71
|
| Rate for Payer: UHC Exchange |
$3.55
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
IP
|
$9.04
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.88
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cofinity Advantage |
$6.33
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.23
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.78
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: Priority Health SBD |
$5.70
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
OP
|
$93.64
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$48.79
|
| Rate for Payer: UHC Exchange |
$36.80
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
IP
|
$93.64
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.48
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.11
|
| Rate for Payer: UHC Core |
$6.50
|
| Rate for Payer: UHC Exchange |
$4.90
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.48
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Advantage |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.36
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health SBD |
$7.86
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,720.43 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$330.14 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$4,540.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$330.14
|
| Rate for Payer: BCN Commercial |
$330.14
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$331.62 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna Medicare |
$4,540.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: BCBS Complete |
$3,632.02
|
| Rate for Payer: BCBS Trust/PPO |
$331.62
|
| Rate for Payer: BCN Commercial |
$331.62
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,264.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$9,080.04
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,720.43 |
| Max. Negotiated Rate |
$8,172.04 |
| Rate for Payer: Aetna Commercial |
$7,718.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,902.03
|
| Rate for Payer: Cash Price |
$7,264.03
|
| Rate for Payer: Cofinity Advantage |
$6,356.03
|
| Rate for Payer: Cofinity Commercial |
$7,808.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,264.03
|
| Rate for Payer: Healthscope Commercial |
$8,172.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,718.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,810.03
|
| Rate for Payer: PHP Commercial |
$7,718.03
|
| Rate for Payer: Priority Health SBD |
$5,720.43
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
|
|
HC ADDL DOSE TC99M DOM PROD NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS C9176
|
| Hospital Charge Code |
34300041
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.50
|
| Rate for Payer: BCBS Complete |
$5.49
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Mclaren Medicaid |
$5.23
|
| Rate for Payer: Mclaren Medicare |
$10.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.50
|
| Rate for Payer: Meridian Medicaid |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$30.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PACE Medicare |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.54
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: Priority Health Tiered Network |
$25.23
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.50
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.00
|
| Rate for Payer: UHC Exchange |
$16.50
|
| Rate for Payer: UHC Medicaid |
$5.23
|
| Rate for Payer: UHCCP Medicaid |
$5.23
|
| Rate for Payer: VA VA |
$10.00
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$27.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: BCBS Complete |
$22.28
|
| Rate for Payer: BCBS Trust/PPO |
$14.22
|
| Rate for Payer: BCN Commercial |
$14.22
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.86
|
| Rate for Payer: UHC Core |
$27.86
|
| Rate for Payer: UHC Exchange |
$27.86
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.21
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Advantage |
$39.00
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: Priority Health SBD |
$35.10
|
|
