|
HC ADAMTS 13 INHIBITOR
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30000055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.73
|
| 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 |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Cofinity Commercial |
$106.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.73
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$95.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
OP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.49
|
| 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 |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| 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 |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$101.27
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$17.37
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
IP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$101.27 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.49
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health SBD |
$101.27
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
OP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$4.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.58
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
IP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.76
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.58
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
IP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
OP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.96
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health SBD |
$7.71
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,608.26 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,560.80 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$4,451.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,560.80 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$4,451.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,608.26 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.50
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$38.23
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health SBD |
$34.41
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.50
|
| 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 |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$10.00
|
| Rate for Payer: BCN Medicare Advantage |
$10.00
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Cofinity Commercial |
$38.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.00
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Mclaren Medicaid |
$5.36
|
| 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 |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: PACE Medicare |
$9.50
|
| Rate for Payer: PACE SWMI |
$10.00
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$10.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.00
|
| Rate for Payer: Priority Health SBD |
$34.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.00
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
| Rate for Payer: UHCCP Medicaid |
$5.63
|
| Rate for Payer: VA VA |
$10.00
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| 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 |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| 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 |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$88.58
|
| Rate for Payer: Cofinity Commercial |
$72.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$92.70
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$87.55
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$64.89
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.89 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.95
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$72.10
|
| Rate for Payer: Cofinity Commercial |
$88.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Healthscope Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: PHP Commercial |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health SBD |
$64.89
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: Aetna Medicare |
$13.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.29
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: Priority Health SBD |
$16.76
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$26.60
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$22.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.29
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.61
|
| Rate for Payer: PHP Commercial |
$22.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.29
|
| Rate for Payer: Priority Health SBD |
$16.76
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$50.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: BCBS Complete |
$40.78
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Cofinity Commercial |
$71.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: UHC Core |
$75.45
|
| Rate for Payer: UHC Exchange |
$75.45
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$368.85 |
| Max. Negotiated Rate |
$526.93 |
| Rate for Payer: Aetna Commercial |
$497.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.56
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$409.84
|
| Rate for Payer: Cofinity Commercial |
$503.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Healthscope Commercial |
$526.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: PHP Commercial |
$497.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: Priority Health SBD |
$368.85
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$585.48
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$106.32 |
| Max. Negotiated Rate |
$558.36 |
| Rate for Payer: Aetna Commercial |
$497.66
|
| Rate for Payer: Aetna Medicare |
$206.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.95
|
| Rate for Payer: BCBS Complete |
$111.64
|
| Rate for Payer: BCBS MAPPO |
$198.36
|
| Rate for Payer: BCN Medicare Advantage |
$198.36
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cash Price |
$468.38
|
| Rate for Payer: Cofinity Commercial |
$503.51
|
| Rate for Payer: Cofinity Commercial |
$409.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.36
|
| Rate for Payer: Healthscope Commercial |
$526.93
|
| Rate for Payer: Mclaren Medicaid |
$106.32
|
| Rate for Payer: Mclaren Medicare |
$198.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.28
|
| Rate for Payer: Meridian Medicaid |
$111.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.66
|
| Rate for Payer: PACE Medicare |
$188.44
|
| Rate for Payer: PACE SWMI |
$198.36
|
| Rate for Payer: PHP Commercial |
$497.66
|
| Rate for Payer: PHP Medicare Advantage |
$198.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.56
|
| Rate for Payer: Priority Health Medicare |
$198.36
|
| Rate for Payer: Priority Health SBD |
$368.85
|
| Rate for Payer: Railroad Medicare Medicare |
$198.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.36
|
| Rate for Payer: UHC Core |
$433.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.36
|
| Rate for Payer: UHC Exchange |
$433.26
|
| Rate for Payer: UHC Medicare Advantage |
$198.36
|
| Rate for Payer: UHCCP Medicaid |
$111.68
|
| Rate for Payer: VA VA |
$198.36
|
|
