|
HC BARRX 360 EXPRESS CATH BALLOON
|
Facility
|
IP
|
$5,720.86
|
|
| Hospital Charge Code |
27200286
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,604.14 |
| Max. Negotiated Rate |
$5,148.77 |
| Rate for Payer: Aetna Commercial |
$4,862.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,718.56
|
| Rate for Payer: Cash Price |
$4,576.69
|
| Rate for Payer: Cofinity Commercial |
$4,004.60
|
| Rate for Payer: Cofinity Commercial |
$4,919.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,004.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,576.69
|
| Rate for Payer: Healthscope Commercial |
$5,148.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,862.73
|
| Rate for Payer: PHP Commercial |
$4,862.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.56
|
| Rate for Payer: Priority Health SBD |
$3,604.14
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,350.88
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,741.05 |
| Max. Negotiated Rate |
$3,915.79 |
| Rate for Payer: Aetna Commercial |
$3,698.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,828.07
|
| Rate for Payer: Cash Price |
$3,480.70
|
| Rate for Payer: Cofinity Commercial |
$3,045.62
|
| Rate for Payer: Cofinity Commercial |
$3,741.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,045.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.70
|
| Rate for Payer: Healthscope Commercial |
$3,915.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,698.25
|
| Rate for Payer: PHP Commercial |
$3,698.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.07
|
| Rate for Payer: Priority Health SBD |
$2,741.05
|
|
|
HC BARRX 90 RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,350.88
|
|
| Hospital Charge Code |
27200287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.35 |
| Max. Negotiated Rate |
$3,915.79 |
| Rate for Payer: Aetna Commercial |
$3,698.25
|
| Rate for Payer: Aetna Medicare |
$2,175.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,828.07
|
| Rate for Payer: BCBS Complete |
$1,740.35
|
| Rate for Payer: Cash Price |
$3,480.70
|
| Rate for Payer: Cofinity Commercial |
$3,045.62
|
| Rate for Payer: Cofinity Commercial |
$3,741.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,045.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,480.70
|
| Rate for Payer: Healthscope Commercial |
$3,915.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,698.25
|
| Rate for Payer: PHP Commercial |
$3,698.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.07
|
| Rate for Payer: Priority Health SBD |
$2,741.05
|
|
|
HC BARRX RFA
|
Facility
|
IP
|
$2,044.39
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,287.97 |
| Max. Negotiated Rate |
$1,839.95 |
| Rate for Payer: Aetna Commercial |
$1,737.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.85
|
| Rate for Payer: Cash Price |
$1,635.51
|
| Rate for Payer: Cofinity Commercial |
$1,431.07
|
| Rate for Payer: Cofinity Commercial |
$1,758.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,431.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.51
|
| Rate for Payer: Healthscope Commercial |
$1,839.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.73
|
| Rate for Payer: PHP Commercial |
$1,737.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.85
|
| Rate for Payer: Priority Health SBD |
$1,287.97
|
|
|
HC BARRX RFA
|
Facility
|
OP
|
$2,044.39
|
|
| Hospital Charge Code |
36000101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$817.76 |
| Max. Negotiated Rate |
$1,839.95 |
| Rate for Payer: Aetna Commercial |
$1,737.73
|
| Rate for Payer: Aetna Medicare |
$1,022.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.85
|
| Rate for Payer: BCBS Complete |
$817.76
|
| Rate for Payer: Cash Price |
$1,635.51
|
| Rate for Payer: Cofinity Commercial |
$1,431.07
|
| Rate for Payer: Cofinity Commercial |
$1,758.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,431.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,635.51
|
| Rate for Payer: Healthscope Commercial |
$1,839.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,737.73
|
| Rate for Payer: PHP Commercial |
$1,737.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.85
|
| Rate for Payer: Priority Health SBD |
$1,287.97
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
OP
|
$4,420.13
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,768.05 |
| Max. Negotiated Rate |
$3,978.12 |
| Rate for Payer: Aetna Commercial |
$3,757.11
|
| Rate for Payer: Aetna Medicare |
$2,210.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,873.08
|
| Rate for Payer: BCBS Complete |
$1,768.05
|
| Rate for Payer: Cash Price |
$3,536.10
|
| Rate for Payer: Cofinity Commercial |
$3,094.09
|
| Rate for Payer: Cofinity Commercial |
$3,801.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,094.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,536.10
|
| Rate for Payer: Healthscope Commercial |
$3,978.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,757.11
|
| Rate for Payer: PHP Commercial |
$3,757.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,873.08
|
| Rate for Payer: Priority Health SBD |
$2,784.68
|
|
|
HC BARRX ULTRA LONG RFA FOCAL CATHETER
|
Facility
|
IP
|
$4,420.13
|
|
| Hospital Charge Code |
27200288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,784.68 |
| Max. Negotiated Rate |
$3,978.12 |
| Rate for Payer: Aetna Commercial |
$3,757.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,873.08
|
| Rate for Payer: Cash Price |
$3,536.10
|
| Rate for Payer: Cofinity Commercial |
$3,094.09
|
| Rate for Payer: Cofinity Commercial |
$3,801.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,094.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,536.10
|
| Rate for Payer: Healthscope Commercial |
$3,978.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,757.11
|
| Rate for Payer: PHP Commercial |
$3,757.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,873.08
|
| Rate for Payer: Priority Health SBD |
$2,784.68
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
IP
|
$16.66
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$14.99 |
| Rate for Payer: Aetna Commercial |
$14.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.83
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$14.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.33
|
| Rate for Payer: Healthscope Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.16
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.83
|
| Rate for Payer: Priority Health SBD |
$10.50
|
|
|
HC BARTONELLA HENSELAE CMPT
|
Facility
|
OP
|
$16.66
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200227
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$15.27 |
| Rate for Payer: Aetna Commercial |
$14.16
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cash Price |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$14.33
|
| Rate for Payer: Cofinity Commercial |
$11.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$14.99
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.16
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.47
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$8.38
|
| Rate for Payer: Priority Health SBD |
$10.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.73
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
IP
|
$17.69
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: Priority Health SBD |
$11.14
|
|
|
HC BARTONELLA HENSELAE IGG IGM
|
Facility
|
OP
|
$17.69
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
30200228
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$15.92 |
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.72
|
| Rate for Payer: BCBS Complete |
$5.73
|
| Rate for Payer: BCBS MAPPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCN Commercial |
$9.02
|
| Rate for Payer: BCN Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$5.46
|
| Rate for Payer: Mclaren Medicare |
$10.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: PACE Medicare |
$9.67
|
| Rate for Payer: PACE SWMI |
$10.18
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: PHP Medicare Advantage |
$10.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.47
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$8.38
|
| Rate for Payer: Priority Health SBD |
$11.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.18
|
| Rate for Payer: UHC Medicare Advantage |
$10.18
|
| Rate for Payer: UHCCP Medicaid |
$5.73
|
| Rate for Payer: VA VA |
$10.18
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.58
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS MAPPO |
$8.46
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: BCN Medicare Advantage |
$8.46
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.46
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Mclaren Medicaid |
$4.53
|
| Rate for Payer: Mclaren Medicare |
$8.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.88
|
| Rate for Payer: Meridian Medicaid |
$4.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: PACE Medicare |
$8.04
|
| Rate for Payer: PACE SWMI |
$8.46
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$8.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Medicare |
$8.46
|
| Rate for Payer: Priority Health Narrow Network |
$6.96
|
| Rate for Payer: Priority Health SBD |
$20.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.46
|
| Rate for Payer: UHC Medicare Advantage |
$8.46
|
| Rate for Payer: UHCCP Medicaid |
$4.76
|
| Rate for Payer: VA VA |
$8.46
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$31.84
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
30100010
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health SBD |
$20.06
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
IP
|
$94.78
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Aetna Commercial |
$80.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.61
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cofinity Commercial |
$66.35
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.82
|
| Rate for Payer: Healthscope Commercial |
$85.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.56
|
| Rate for Payer: PHP Commercial |
$80.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health SBD |
$59.71
|
|
|
HC BASIC METABOLIC W ION CALCIUM
|
Facility
|
OP
|
$94.78
|
|
|
Service Code
|
CPT 80047
|
| Hospital Charge Code |
30100009
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Aetna Commercial |
$80.56
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.73
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cash Price |
$75.82
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$66.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$85.30
|
| Rate for Payer: Mclaren Medicaid |
$7.36
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$7.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.56
|
| Rate for Payer: Nomi Health Commercial |
$20.60
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$80.56
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health Narrow Network |
$10.98
|
| Rate for Payer: Priority Health SBD |
$59.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Medicare Advantage |
$13.73
|
| Rate for Payer: UHCCP Medicaid |
$7.73
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
IP
|
$431.77
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$272.02 |
| Max. Negotiated Rate |
$388.59 |
| Rate for Payer: Aetna Commercial |
$367.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.65
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$302.24
|
| Rate for Payer: Cofinity Commercial |
$371.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Healthscope Commercial |
$388.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: PHP Commercial |
$367.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health SBD |
$272.02
|
|
|
HC BASIC RAD DOSIMETRY
|
Facility
|
OP
|
$431.77
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
33300005
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$63.49 |
| Max. Negotiated Rate |
$408.86 |
| Rate for Payer: Aetna Commercial |
$367.00
|
| Rate for Payer: Aetna Medicare |
$135.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.61
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$130.09
|
| Rate for Payer: BCBS Trust/PPO |
$63.49
|
| Rate for Payer: BCN Commercial |
$63.49
|
| Rate for Payer: BCN Medicare Advantage |
$130.09
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cash Price |
$345.42
|
| Rate for Payer: Cofinity Commercial |
$371.32
|
| Rate for Payer: Cofinity Commercial |
$302.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.09
|
| Rate for Payer: Healthscope Commercial |
$388.59
|
| Rate for Payer: Mclaren Medicaid |
$69.73
|
| Rate for Payer: Mclaren Medicare |
$130.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.59
|
| Rate for Payer: Meridian Medicaid |
$73.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.00
|
| Rate for Payer: Nomi Health Commercial |
$390.27
|
| Rate for Payer: PACE Medicare |
$123.59
|
| Rate for Payer: PACE SWMI |
$130.09
|
| Rate for Payer: PHP Commercial |
$367.00
|
| Rate for Payer: PHP Medicare Advantage |
$130.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$408.86
|
| Rate for Payer: Priority Health Medicare |
$130.09
|
| Rate for Payer: Priority Health Narrow Network |
$327.09
|
| Rate for Payer: Priority Health SBD |
$272.02
|
| Rate for Payer: Railroad Medicare Medicare |
$130.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.09
|
| Rate for Payer: UHC Exchange |
$319.51
|
| Rate for Payer: UHC Medicare Advantage |
$130.09
|
| Rate for Payer: UHCCP Medicaid |
$73.24
|
| Rate for Payer: VA VA |
$130.09
|
|
|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
IP
|
$224.21
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.25 |
| Max. Negotiated Rate |
$201.79 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.74
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$156.95
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health SBD |
$141.25
|
|
|
HC BB-COMP-FRESH-FROZEN PLASMA EA
|
Facility
|
OP
|
$224.21
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
39000041
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$190.58
|
| Rate for Payer: Aetna Medicare |
$72.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.06
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$69.65
|
| Rate for Payer: BCBS Trust/PPO |
$201.20
|
| Rate for Payer: BCN Commercial |
$201.20
|
| Rate for Payer: BCN Medicare Advantage |
$69.65
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cash Price |
$179.37
|
| Rate for Payer: Cofinity Commercial |
$192.82
|
| Rate for Payer: Cofinity Commercial |
$156.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.65
|
| Rate for Payer: Healthscope Commercial |
$201.79
|
| Rate for Payer: Mclaren Medicaid |
$37.33
|
| Rate for Payer: Mclaren Medicare |
$69.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.13
|
| Rate for Payer: Meridian Medicaid |
$39.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.58
|
| Rate for Payer: Nomi Health Commercial |
$208.95
|
| Rate for Payer: PACE Medicare |
$66.17
|
| Rate for Payer: PACE SWMI |
$69.65
|
| Rate for Payer: PHP Commercial |
$190.58
|
| Rate for Payer: PHP Medicare Advantage |
$69.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.93
|
| Rate for Payer: Priority Health Medicare |
$69.65
|
| Rate for Payer: Priority Health Narrow Network |
$175.14
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: Railroad Medicare Medicare |
$69.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.65
|
| Rate for Payer: UHC Exchange |
$165.92
|
| Rate for Payer: UHC Medicare Advantage |
$69.65
|
| Rate for Payer: UHCCP Medicaid |
$39.21
|
| Rate for Payer: VA VA |
$69.65
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.95
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000042
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.65 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health SBD |
$59.65
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$18.97
|
| Rate for Payer: BCN Commercial |
$18.97
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$32.13
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$17.14
|
| Rate for Payer: Priority Health SBD |
$66.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$12.06
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC B CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.30
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health SBD |
$66.20
|
|
|
HC B CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.81
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Mclaren Medicaid |
$27.44
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$28.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health Narrow Network |
$40.95
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: UHCCP Medicaid |
$28.82
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC B CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$94.68
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000041
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.65 |
| Max. Negotiated Rate |
$85.21 |
| Rate for Payer: Aetna Commercial |
$80.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.54
|
| Rate for Payer: Cash Price |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$66.28
|
| Rate for Payer: Cofinity Commercial |
$81.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$85.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.48
|
| Rate for Payer: PHP Commercial |
$80.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.54
|
| Rate for Payer: Priority Health SBD |
$59.65
|
|
