|
HC DUOGLIDE CATHETER
|
Facility
|
OP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.99 |
| Max. Negotiated Rate |
$573.72 |
| Rate for Payer: Aetna Commercial |
$541.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.36
|
| Rate for Payer: BCBS Complete |
$254.99
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$446.23
|
| Rate for Payer: Cofinity Commercial |
$548.22
|
| Rate for Payer: Healthscope Commercial |
$573.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: PHP Commercial |
$541.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: Priority Health SBD |
$401.61
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
IP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.61 |
| Max. Negotiated Rate |
$573.72 |
| Rate for Payer: Aetna Commercial |
$541.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.36
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$446.23
|
| Rate for Payer: Cofinity Commercial |
$548.22
|
| Rate for Payer: Healthscope Commercial |
$573.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: PHP Commercial |
$541.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: Priority Health SBD |
$401.61
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$806.18
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$567.98
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$663.92
|
| Rate for Payer: Cofinity Commercial |
$815.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$853.60
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$806.18
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health SBD |
$597.52
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$144.40
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$597.52 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$806.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.49
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$815.67
|
| Rate for Payer: Cofinity Commercial |
$663.92
|
| Rate for Payer: Healthscope Commercial |
$853.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: PHP Commercial |
$806.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: Priority Health SBD |
$597.52
|
|
|
HC DUST MITE DF IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUST MITE DF IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC DUST MITE DP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DUST MITE DP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
OP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.39 |
| Max. Negotiated Rate |
$690.76 |
| Rate for Payer: Aetna Commercial |
$652.38
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.28
|
| Rate for Payer: BCBS Complete |
$56.19
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCBS Trust/PPO |
$61.78
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$660.06
|
| Rate for Payer: Cofinity Commercial |
$537.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Healthscope Commercial |
$690.76
|
| Rate for Payer: Mclaren Medicaid |
$53.51
|
| Rate for Payer: Mclaren Medicare |
$97.82
|
| Rate for Payer: Meridian Medicaid |
$56.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: PACE Medicare |
$92.93
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Commercial |
$652.38
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Medicare |
$97.82
|
| Rate for Payer: Priority Health Narrow Network |
$271.18
|
| Rate for Payer: Priority Health SBD |
$483.53
|
| Rate for Payer: Railroad Medicare Medicare |
$97.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$52.39
|
| Rate for Payer: UHC Medicare Advantage |
$100.75
|
| Rate for Payer: VA VA |
$97.82
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
IP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$483.53 |
| Max. Negotiated Rate |
$690.76 |
| Rate for Payer: Aetna Commercial |
$652.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.88
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$537.26
|
| Rate for Payer: Cofinity Commercial |
$660.06
|
| Rate for Payer: Healthscope Commercial |
$690.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: PHP Commercial |
$652.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: Priority Health SBD |
$483.53
|
|
|
HC E72 MOUSE URINE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC E72 MOUSE URINE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC EAKIN SEAL 2"
|
Facility
|
IP
|
$12.29
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.74 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.99
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$10.57
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.45
|
| Rate for Payer: PHP Commercial |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$7.74
|
|
|
HC EAKIN SEAL 2"
|
Facility
|
OP
|
$12.29
|
|
| Hospital Charge Code |
27100013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.99
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: Cash Price |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$10.57
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Healthscope Commercial |
$11.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.45
|
| Rate for Payer: PHP Commercial |
$10.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$7.74
|
|
|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$30.83 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$15.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Core |
$30.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EBV ANTIBODY PANEL CMPT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200508
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
OP
|
$36.29
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$32.66 |
| Rate for Payer: Aetna Commercial |
$30.85
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$32.66
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$8.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.85
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$30.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.40
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health SBD |
$22.86
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.35
|
| Rate for Payer: UHC Core |
$26.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Exchange |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.75
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EBV ANTIBODY PANEL, S
|
Facility
|
IP
|
$36.29
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200507
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$32.66 |
| Rate for Payer: Aetna Commercial |
$30.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.59
|
| Rate for Payer: Cash Price |
$29.03
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$32.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.85
|
| Rate for Payer: PHP Commercial |
$30.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.40
|
| Rate for Payer: Priority Health SBD |
$22.86
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC EBV HETEROPHILE AB
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86309
|
| Hospital Charge Code |
30000169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$173.33 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$26.09
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
HC ECG 1-3 LEADS TRACING ONLY
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 93041
|
| Hospital Charge Code |
73000003
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$192.86 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$591.02
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$192.86
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC ECHO, 2D, DOPPLER, COLOR FLOW
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
48300001
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,240.47 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
|
|
HC ECHO COMPLETE W/DEFINITY
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
HCPCS C8929
|
| Hospital Charge Code |
48300003
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$1,997.47 |
| Rate for Payer: Aetna Commercial |
$1,673.65
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$773.42
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cash Price |
$1,575.20
|
| Rate for Payer: Cofinity Commercial |
$1,693.34
|
| Rate for Payer: Cofinity Commercial |
$1,378.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,772.10
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,673.65
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,673.65
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,378.30
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health SBD |
$1,240.47
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$1,361.54
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
