|
HC HERPES SIMPLEX IGG TYPE 2
|
Facility
|
IP
|
$71.85
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200283
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$64.66 |
| Rate for Payer: Aetna Commercial |
$61.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.70
|
| Rate for Payer: Cash Price |
$57.48
|
| Rate for Payer: Cofinity Commercial |
$50.30
|
| Rate for Payer: Cofinity Commercial |
$61.79
|
| Rate for Payer: Healthscope Commercial |
$64.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.07
|
| Rate for Payer: PHP Commercial |
$61.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.30
|
| Rate for Payer: Priority Health SBD |
$45.27
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC HERPES SIMPLEX IGM TYPE 1&2
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200278
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.75
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.56
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC HERPES SIMPLEX NON-SPECIFIC
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health SBD |
$24.42
|
|
|
HC HERPES SIMPLEX NON-SPECIFIC
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200277
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$24.42
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC HERPES SIMPLEX PCR
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health SBD |
$34.65
|
|
|
HC HERPES SIMPLEX PCR
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$47.30
|
| Rate for Payer: Cofinity Commercial |
$38.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$49.50
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.75
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$46.75
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$34.65
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS 1 (HSV-1)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS 1 (HSV-1)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600270
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HERPES SIMPLEX VIRUS CULTURE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
30600116
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$64.26 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health SBD |
$64.26
|
|
|
HC HERPES SIMPLEX VIRUS CULTURE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 87255
|
| Hospital Charge Code |
30600116
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$91.80 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: Aetna Medicare |
$35.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.32
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$33.86
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Medicare Advantage |
$33.86
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$87.72
|
| Rate for Payer: Cofinity Commercial |
$71.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.86
|
| Rate for Payer: Healthscope Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Mclaren Medicare |
$33.86
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.70
|
| Rate for Payer: PACE Medicare |
$32.17
|
| Rate for Payer: PACE SWMI |
$33.86
|
| Rate for Payer: PHP Commercial |
$86.70
|
| Rate for Payer: PHP Medicare Advantage |
$33.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health Medicare |
$33.86
|
| Rate for Payer: Priority Health SBD |
$64.26
|
| Rate for Payer: Railroad Medicare Medicare |
$33.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.63
|
| Rate for Payer: UHC Core |
$57.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.86
|
| Rate for Payer: UHC Exchange |
$33.86
|
| Rate for Payer: UHC Medicare Advantage |
$34.88
|
| Rate for Payer: VA VA |
$33.86
|
|
|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
IP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.93
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$33.31
|
| Rate for Payer: Cofinity Commercial |
$40.93
|
| Rate for Payer: Healthscope Commercial |
$42.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: PHP Commercial |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: Priority Health SBD |
$29.98
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
OP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$33.31
|
| Rate for Payer: Cofinity Commercial |
$40.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$42.83
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$40.45
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$29.98
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.52
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health SBD |
$11.16
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.94
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$11.78
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$10.60
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.94
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$11.78
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health SBD |
$10.60
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$10.11
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$10.11
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.12
|
| Rate for Payer: BCBS Complete |
$7.41
|
| Rate for Payer: BCBS MAPPO |
$12.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.90
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$7.06
|
| Rate for Payer: Mclaren Medicare |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$7.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Medicare |
$12.26
|
| Rate for Payer: PACE SWMI |
$12.90
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$12.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health Medicare |
$12.90
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.48
|
| Rate for Payer: UHC Core |
$21.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.90
|
| Rate for Payer: UHC Exchange |
$12.90
|
| Rate for Payer: UHC Medicare Advantage |
$13.29
|
| Rate for Payer: VA VA |
$12.90
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$82.41 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$82.41
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health SBD |
$26.04
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.87
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health SBD |
$26.04
|
|
