|
HC BENCE JONES PROTEIN
|
Facility
|
IP
|
$169.12
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.93
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$118.38
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health SBD |
$106.55
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$175.10
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health SBD |
$175.10
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$175.10
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health SBD |
$175.10
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.10 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health SBD |
$175.10
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$175.10
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health SBD |
$20.56
|
|
|
HC BENZO CONFIRMATION, U
|
Facility
|
OP
|
$30.64
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.92
|
| Rate for Payer: BCBS Complete |
$12.26
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.92
|
| Rate for Payer: Priority Health SBD |
$19.30
|
|
|
HC BENZO CONFIRMATION, U
|
Facility
|
IP
|
$30.64
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.30 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.92
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.92
|
| Rate for Payer: Priority Health SBD |
$19.30
|
|
|
HC BENZODIAZAPINE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC BENZODIAZAPINE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health SBD |
$64.05
|
|
|
HC BENZODIAZEPINE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30100594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.30 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$31.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
|
|
HC BENZODIAZEPINE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30100594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$44.27
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health SBD |
$39.84
|
|
|
HC BERMUDA GRASS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC BERMUDA GRASS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200119
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC BETA 2 GLYCOPROTEIN I CMPT
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$14.33
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I CMPT
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200139
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC BETA 2 GLYCOPROTEIN I IGA M A
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200444
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$14.33
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGA M A
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200444
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200459
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$71.64 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$13.64
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$25.45
|
| Rate for Payer: UHCCP Medicaid |
$14.33
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC BETA 2 GLYCOPROTEIN I IGG
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
30200459
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
