|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$174.79
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$157.31 |
| Rate for Payer: Aetna Commercial |
$148.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.61
|
| Rate for Payer: Cash Price |
$139.83
|
| Rate for Payer: Cofinity Advantage |
$122.35
|
| Rate for Payer: Cofinity Commercial |
$150.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.83
|
| Rate for Payer: Healthscope Commercial |
$157.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.09
|
| Rate for Payer: PHP Commercial |
$148.57
|
| Rate for Payer: Priority Health SBD |
$110.12
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health SBD |
$59.25
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.00
|
| Rate for Payer: BCBS Complete |
$3.08
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$5.97
|
| Rate for Payer: BCN Commercial |
$5.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$2.93
|
| Rate for Payer: Mclaren Medicare |
$5.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.88
|
| Rate for Payer: Meridian Medicaid |
$5.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$8.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Medicare |
$5.32
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.60
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health Tiered Network |
$4.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.40
|
| Rate for Payer: UHC Core |
$8.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.60
|
| Rate for Payer: UHC Exchange |
$8.40
|
| Rate for Payer: UHC Medicaid |
$2.93
|
| Rate for Payer: UHCCP Medicaid |
$2.93
|
| Rate for Payer: VA VA |
$5.60
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
IP
|
$268.22
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$168.98 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Aetna Commercial |
$227.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.34
|
| Rate for Payer: Cash Price |
$214.58
|
| Rate for Payer: Cofinity Advantage |
$187.75
|
| Rate for Payer: Cofinity Commercial |
$230.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.58
|
| Rate for Payer: Healthscope Commercial |
$241.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.16
|
| Rate for Payer: PHP Commercial |
$227.99
|
| Rate for Payer: Priority Health SBD |
$168.98
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
OP
|
$268.22
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Aetna Commercial |
$227.99
|
| Rate for Payer: Aetna Medicare |
$141.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.82
|
| Rate for Payer: BCBS Complete |
$74.61
|
| Rate for Payer: BCBS MAPPO |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$135.86
|
| Rate for Payer: Cash Price |
$214.58
|
| Rate for Payer: Cash Price |
$214.58
|
| Rate for Payer: Cofinity Advantage |
$187.75
|
| Rate for Payer: Cofinity Commercial |
$230.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$241.40
|
| Rate for Payer: Mclaren Medicaid |
$71.05
|
| Rate for Payer: Mclaren Medicare |
$135.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.65
|
| Rate for Payer: Meridian Medicaid |
$142.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.99
|
| Rate for Payer: Nomi Health Commercial |
$203.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.16
|
| Rate for Payer: PACE Medicare |
$129.07
|
| Rate for Payer: PACE SWMI |
$135.86
|
| Rate for Payer: PHP Commercial |
$227.99
|
| Rate for Payer: PHP Medicare Advantage |
$135.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$135.86
|
| Rate for Payer: Priority Health Medicare |
$135.86
|
| Rate for Payer: Priority Health SBD |
$168.98
|
| Rate for Payer: Priority Health Tiered Network |
$108.69
|
| Rate for Payer: Railroad Medicare Medicare |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.79
|
| Rate for Payer: UHC Core |
$203.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.86
|
| Rate for Payer: UHC Exchange |
$203.79
|
| Rate for Payer: UHC Medicaid |
$71.05
|
| Rate for Payer: UHCCP Medicaid |
$71.05
|
| Rate for Payer: VA VA |
$135.86
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
IP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.36 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Advantage |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.14
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health SBD |
$93.36
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$133.37 |
| Rate for Payer: Aetna Commercial |
$125.96
|
| Rate for Payer: Aetna Medicare |
$74.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.32
|
| Rate for Payer: BCBS Complete |
$59.28
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Advantage |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.55
|
| Rate for Payer: Healthscope Commercial |
$133.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.14
|
| Rate for Payer: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health SBD |
$93.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.32
|
| Rate for Payer: UHC Core |
$77.21
|
| Rate for Payer: UHC Exchange |
$58.24
|
|
|
HC CENTRIFUGAL HEAD
|
Facility
|
OP
|
$414.48
|
|
| Hospital Charge Code |
27006714
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.89 |
| Max. Negotiated Rate |
$373.03 |
| Rate for Payer: Aetna Commercial |
$352.31
|
| Rate for Payer: Aetna Medicare |
$207.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.41
|
| Rate for Payer: BCBS Complete |
$165.79
|
| Rate for Payer: Cash Price |
$331.58
|
| Rate for Payer: Cofinity Advantage |
$290.14
|
| Rate for Payer: Cofinity Commercial |
$356.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.58
|
| Rate for Payer: Healthscope Commercial |
$373.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.86
|
| Rate for Payer: PHP Commercial |
$352.31
|
| Rate for Payer: Priority Health SBD |
$261.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.41
|
| Rate for Payer: UHC Core |
$215.94
|
| Rate for Payer: UHC Exchange |
$162.89
|
|
|
HC CENTRIFUGAL HEAD
|
Facility
|
IP
|
$414.48
|
|
| Hospital Charge Code |
27006714
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$261.12 |
| Max. Negotiated Rate |
$373.03 |
| Rate for Payer: Aetna Commercial |
$352.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.41
|
| Rate for Payer: Cash Price |
$331.58
|
| Rate for Payer: Cofinity Advantage |
$290.14
|
| Rate for Payer: Cofinity Commercial |
$356.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.58
|
| Rate for Payer: Healthscope Commercial |
$373.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.86
|
| Rate for Payer: PHP Commercial |
$352.31
|
| Rate for Payer: Priority Health SBD |
$261.12
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
OP
|
$254.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna Medicare |
$127.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: BCBS Complete |
$101.96
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Advantage |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health SBD |
$160.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.45
|
| Rate for Payer: UHC Core |
$127.45
|
| Rate for Payer: UHC Exchange |
$127.45
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
IP
|
$254.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$160.59 |
| Max. Negotiated Rate |
$229.41 |
| Rate for Payer: Aetna Commercial |
$216.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.69
|
| Rate for Payer: Cash Price |
$203.92
|
| Rate for Payer: Cofinity Advantage |
$178.43
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.92
|
| Rate for Payer: Healthscope Commercial |
$229.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.18
|
| Rate for Payer: PHP Commercial |
$216.66
|
| Rate for Payer: Priority Health SBD |
$160.59
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
OP
|
$4,218.68
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,687.47 |
| Max. Negotiated Rate |
$3,796.81 |
| Rate for Payer: Aetna Commercial |
$3,585.88
|
| Rate for Payer: Aetna Medicare |
$2,109.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,742.14
|
| Rate for Payer: BCBS Complete |
$1,687.47
|
| Rate for Payer: Cash Price |
$3,374.94
|
| Rate for Payer: Cofinity Advantage |
$2,953.08
|
| Rate for Payer: Cofinity Commercial |
$3,628.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.94
|
| Rate for Payer: Healthscope Commercial |
$3,796.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,374.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,164.01
|
| Rate for Payer: PHP Commercial |
$3,585.88
|
| Rate for Payer: Priority Health SBD |
$2,657.77
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
IP
|
$4,218.68
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.77 |
| Max. Negotiated Rate |
$3,796.81 |
| Rate for Payer: Aetna Commercial |
$3,585.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,742.14
|
| Rate for Payer: Cash Price |
$3,374.94
|
| Rate for Payer: Cofinity Advantage |
$2,953.08
|
| Rate for Payer: Cofinity Commercial |
$3,628.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.94
|
| Rate for Payer: Healthscope Commercial |
$3,796.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,164.01
|
| Rate for Payer: PHP Commercial |
$3,585.88
|
| Rate for Payer: Priority Health SBD |
$2,657.77
|
|
|
HC CERETEC PER DOSE
|
Facility
|
OP
|
$2,102.21
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$840.88 |
| Max. Negotiated Rate |
$2,925.96 |
| Rate for Payer: Aetna Commercial |
$1,786.88
|
| Rate for Payer: Aetna Medicare |
$1,051.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.44
|
| Rate for Payer: BCBS Complete |
$840.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.61
|
| Rate for Payer: BCN Commercial |
$1,140.61
|
| Rate for Payer: Cash Price |
$1,681.77
|
| Rate for Payer: Cash Price |
$1,681.77
|
| Rate for Payer: Cofinity Advantage |
$1,471.55
|
| Rate for Payer: Cofinity Commercial |
$1,807.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,681.77
|
| Rate for Payer: Healthscope Commercial |
$1,891.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,681.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,786.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.66
|
| Rate for Payer: PHP Commercial |
$1,786.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,925.96
|
| Rate for Payer: Priority Health SBD |
$1,324.39
|
| Rate for Payer: Priority Health Tiered Network |
$2,340.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,530.72
|
| Rate for Payer: UHC Core |
$1,530.72
|
| Rate for Payer: UHC Exchange |
$1,530.72
|
|
|
HC CERETEC PER DOSE
|
Facility
|
IP
|
$2,102.21
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,324.39 |
| Max. Negotiated Rate |
$1,891.99 |
| Rate for Payer: Aetna Commercial |
$1,786.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.44
|
| Rate for Payer: Cash Price |
$1,681.77
|
| Rate for Payer: Cofinity Advantage |
$1,471.55
|
| Rate for Payer: Cofinity Commercial |
$1,807.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,681.77
|
| Rate for Payer: Healthscope Commercial |
$1,891.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,786.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.66
|
| Rate for Payer: PHP Commercial |
$1,786.88
|
| Rate for Payer: Priority Health SBD |
$1,324.39
|
|
|
HC CERTOLIZUMAB
|
Facility
|
OP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Advantage |
$118.71
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$106.84
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC CERTOLIZUMAB
|
Facility
|
IP
|
$169.59
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.84 |
| Max. Negotiated Rate |
$152.63 |
| Rate for Payer: Aetna Commercial |
$144.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.23
|
| Rate for Payer: Cash Price |
$135.67
|
| Rate for Payer: Cofinity Advantage |
$118.71
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.67
|
| Rate for Payer: Healthscope Commercial |
$152.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.19
|
| Rate for Payer: PHP Commercial |
$144.15
|
| Rate for Payer: Priority Health SBD |
$106.84
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
OP
|
$133.17
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Advantage |
$93.22
|
| Rate for Payer: Cofinity Commercial |
$114.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$119.85
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.88
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$113.19
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$83.90
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CERTOLIZUMAB CMPT
|
Facility
|
IP
|
$133.17
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100676
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.90 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Aetna Commercial |
$113.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.56
|
| Rate for Payer: Cash Price |
$106.54
|
| Rate for Payer: Cofinity Advantage |
$93.22
|
| Rate for Payer: Cofinity Commercial |
$114.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.54
|
| Rate for Payer: Healthscope Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.88
|
| Rate for Payer: PHP Commercial |
$113.19
|
| Rate for Payer: Priority Health SBD |
$83.90
|
|
|
HC CERULOPLASMIN
|
Facility
|
IP
|
$43.51
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: Priority Health SBD |
$27.41
|
|
|
HC CERULOPLASMIN
|
Facility
|
OP
|
$43.51
|
|
|
Service Code
|
CPT 82390
|
| Hospital Charge Code |
30100140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$39.16 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$11.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.43
|
| Rate for Payer: BCBS Complete |
$5.90
|
| Rate for Payer: BCBS MAPPO |
$10.74
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: BCN Commercial |
$11.46
|
| Rate for Payer: BCN Medicare Advantage |
$10.74
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cash Price |
$34.81
|
| Rate for Payer: Cofinity Advantage |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$37.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.74
|
| Rate for Payer: Healthscope Commercial |
$39.16
|
| Rate for Payer: Mclaren Medicaid |
$5.62
|
| Rate for Payer: Mclaren Medicare |
$10.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.28
|
| Rate for Payer: Meridian Medicaid |
$11.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.98
|
| Rate for Payer: Nomi Health Commercial |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.63
|
| Rate for Payer: PACE Medicare |
$10.20
|
| Rate for Payer: PACE SWMI |
$10.74
|
| Rate for Payer: PHP Commercial |
$36.98
|
| Rate for Payer: PHP Medicare Advantage |
$10.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10.74
|
| Rate for Payer: Priority Health Medicare |
$10.74
|
| Rate for Payer: Priority Health SBD |
$27.41
|
| Rate for Payer: Priority Health Tiered Network |
$8.59
|
| Rate for Payer: Railroad Medicare Medicare |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.11
|
| Rate for Payer: UHC Core |
$16.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.74
|
| Rate for Payer: UHC Exchange |
$16.11
|
| Rate for Payer: UHC Medicaid |
$5.62
|
| Rate for Payer: UHCCP Medicaid |
$5.62
|
| Rate for Payer: VA VA |
$10.74
|
|
|
HC CERVILENZ
|
Facility
|
IP
|
$174.10
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.68 |
| Max. Negotiated Rate |
$156.69 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.17
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Advantage |
$121.87
|
| Rate for Payer: Cofinity Commercial |
$149.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Healthscope Commercial |
$156.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.99
|
| Rate for Payer: Priority Health SBD |
$109.68
|
|
|
HC CERVILENZ
|
Facility
|
OP
|
$174.10
|
|
| Hospital Charge Code |
27200171
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.42 |
| Max. Negotiated Rate |
$156.69 |
| Rate for Payer: Aetna Commercial |
$147.99
|
| Rate for Payer: Aetna Medicare |
$87.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.17
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: Cash Price |
$139.28
|
| Rate for Payer: Cofinity Advantage |
$121.87
|
| Rate for Payer: Cofinity Commercial |
$149.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.28
|
| Rate for Payer: Healthscope Commercial |
$156.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.57
|
| Rate for Payer: PHP Commercial |
$147.99
|
| Rate for Payer: Priority Health SBD |
$109.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.17
|
| Rate for Payer: UHC Core |
$90.71
|
| Rate for Payer: UHC Exchange |
$68.42
|
|
