|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
IP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.96 |
| Max. Negotiated Rate |
$179.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health SBD |
$125.96
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
OP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$344.04 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Medicare |
$127.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: BCBS Complete |
$68.79
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Mclaren Medicaid |
$65.51
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: Meridian Medicaid |
$68.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health SBD |
$125.96
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.22
|
| Rate for Payer: UHC Medicare Advantage |
$122.22
|
| Rate for Payer: UHCCP Medicaid |
$68.81
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.46 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.46 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
IP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.10 |
| Max. Negotiated Rate |
$1,090.14 |
| Rate for Payer: Aetna Commercial |
$1,029.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.33
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$1,041.69
|
| Rate for Payer: Cofinity Commercial |
$847.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Healthscope Commercial |
$1,090.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: PHP Commercial |
$1,029.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: Priority Health SBD |
$763.10
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
OP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$465.40 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna Commercial |
$1,029.58
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$847.89
|
| Rate for Payer: Cofinity Commercial |
$1,041.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$1,090.14
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$1,029.58
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$763.10
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
| Rate for Payer: VA VA |
$868.28
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.38
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.66
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health SBD |
$107.96
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
OP
|
$171.36
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna Medicare |
$12.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.57
|
| Rate for Payer: BCBS Complete |
$7.01
|
| Rate for Payer: BCBS MAPPO |
$12.46
|
| Rate for Payer: BCN Medicare Advantage |
$12.46
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.46
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Mclaren Medicaid |
$6.68
|
| Rate for Payer: Mclaren Medicare |
$12.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.08
|
| Rate for Payer: Meridian Medicaid |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.66
|
| Rate for Payer: PACE Medicare |
$11.84
|
| Rate for Payer: PACE SWMI |
$12.46
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: PHP Medicare Advantage |
$12.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health Medicare |
$12.46
|
| Rate for Payer: Priority Health SBD |
$107.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.46
|
| Rate for Payer: UHC Medicare Advantage |
$12.46
|
| Rate for Payer: UHCCP Medicaid |
$7.01
|
| Rate for Payer: VA VA |
$12.46
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
OP
|
$92.21
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| 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 |
$3.15
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Mclaren Medicaid |
$3.00
|
| 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 |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PACE Medicare |
$5.32
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health SBD |
$58.09
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.60
|
| Rate for Payer: UHC Medicare Advantage |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$3.15
|
| Rate for Payer: VA VA |
$5.60
|
|
|
HC CELL COUNT/DIFF MISC FLUID
|
Facility
|
IP
|
$92.21
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
30500067
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$78.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.94
|
| Rate for Payer: Cash Price |
$73.77
|
| Rate for Payer: Cofinity Commercial |
$64.55
|
| Rate for Payer: Cofinity Commercial |
$79.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.77
|
| Rate for Payer: Healthscope Commercial |
$82.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.38
|
| Rate for Payer: PHP Commercial |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.94
|
| Rate for Payer: Priority Health SBD |
$58.09
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
OP
|
$262.96
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.82 |
| Max. Negotiated Rate |
$382.43 |
| Rate for Payer: Aetna Commercial |
$223.52
|
| Rate for Payer: Aetna Medicare |
$141.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.92
|
| 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 |
$76.46
|
| Rate for Payer: BCBS MAPPO |
$135.86
|
| Rate for Payer: BCN Medicare Advantage |
$135.86
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cofinity Commercial |
$226.15
|
| Rate for Payer: Cofinity Commercial |
$184.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$236.66
|
| Rate for Payer: Mclaren Medicaid |
$72.82
|
| 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 |
$76.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.52
|
| Rate for Payer: PACE Medicare |
$129.07
|
| Rate for Payer: PACE SWMI |
$135.86
|
| Rate for Payer: PHP Commercial |
$223.52
|
| Rate for Payer: PHP Medicare Advantage |
$135.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.92
|
| Rate for Payer: Priority Health Medicare |
$135.86
|
| Rate for Payer: Priority Health SBD |
$165.66
|
| Rate for Payer: Railroad Medicare Medicare |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.86
|
| Rate for Payer: UHC Medicare Advantage |
$135.86
|
| Rate for Payer: UHCCP Medicaid |
$76.49
|
| Rate for Payer: VA VA |
$135.86
|
|
|
HC CELL FUNCTION ASSAY W/STIM
|
Facility
|
IP
|
$262.96
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
30200502
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$165.66 |
| Max. Negotiated Rate |
$236.66 |
| Rate for Payer: Aetna Commercial |
$223.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.92
|
| Rate for Payer: Cash Price |
$210.37
|
| Rate for Payer: Cofinity Commercial |
$184.07
|
| Rate for Payer: Cofinity Commercial |
$226.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.37
|
| Rate for Payer: Healthscope Commercial |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.52
|
| Rate for Payer: PHP Commercial |
$223.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.92
|
| Rate for Payer: Priority Health SBD |
$165.66
|
|
|
HC CENTRAL LINE DRSG CHANGE
|
Facility
|
OP
|
$148.19
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000059
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.28 |
| 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: Cash Price |
$118.55
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.73
|
| 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: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health SBD |
$93.36
|
|
|
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 Commercial |
$103.73
|
| Rate for Payer: Cofinity Commercial |
$127.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.73
|
| 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: PHP Commercial |
$125.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.32
|
| Rate for Payer: Priority Health SBD |
$93.36
|
|
|
HC CENTROMERE AB
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC CENTROMERE AB
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200167
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| 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 |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC CEPHEID SARS-COV2/FLU A&B
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 0240U
|
| Hospital Charge Code |
30600317
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: BCBS Complete |
$99.96
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
OP
|
$4,135.96
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,654.38 |
| Max. Negotiated Rate |
$3,722.36 |
| Rate for Payer: Aetna Commercial |
$3,515.57
|
| Rate for Payer: Aetna Medicare |
$2,067.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.37
|
| Rate for Payer: BCBS Complete |
$1,654.38
|
| Rate for Payer: Cash Price |
$3,308.77
|
| Rate for Payer: Cofinity Commercial |
$2,895.17
|
| Rate for Payer: Cofinity Commercial |
$3,556.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,895.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,308.77
|
| Rate for Payer: Healthscope Commercial |
$3,722.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.57
|
| Rate for Payer: PHP Commercial |
$3,515.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.37
|
| Rate for Payer: Priority Health SBD |
$2,605.65
|
|
|
HC CERCLAGE (OB SURGERY)
|
Facility
|
IP
|
$4,135.96
|
|
| Hospital Charge Code |
36000017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,605.65 |
| Max. Negotiated Rate |
$3,722.36 |
| Rate for Payer: Aetna Commercial |
$3,515.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.37
|
| Rate for Payer: Cash Price |
$3,308.77
|
| Rate for Payer: Cofinity Commercial |
$2,895.17
|
| Rate for Payer: Cofinity Commercial |
$3,556.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,895.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,308.77
|
| Rate for Payer: Healthscope Commercial |
$3,722.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.57
|
| Rate for Payer: PHP Commercial |
$3,515.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.37
|
| Rate for Payer: Priority Health SBD |
$2,605.65
|
|
|
HC CERETEC PER DOSE
|
Facility
|
IP
|
$2,060.99
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,298.42 |
| Max. Negotiated Rate |
$1,854.89 |
| Rate for Payer: Aetna Commercial |
$1,751.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.64
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cofinity Commercial |
$1,442.69
|
| Rate for Payer: Cofinity Commercial |
$1,772.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,442.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,648.79
|
| Rate for Payer: Healthscope Commercial |
$1,854.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,751.84
|
| Rate for Payer: PHP Commercial |
$1,751.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.64
|
| Rate for Payer: Priority Health SBD |
$1,298.42
|
|
|
HC CERETEC PER DOSE
|
Facility
|
OP
|
$2,060.99
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
34300002
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$430.05 |
| Max. Negotiated Rate |
$2,258.51 |
| Rate for Payer: Aetna Commercial |
$1,751.84
|
| Rate for Payer: Aetna Medicare |
$834.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,339.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,002.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,002.92
|
| Rate for Payer: BCBS Complete |
$451.56
|
| Rate for Payer: BCBS MAPPO |
$802.34
|
| Rate for Payer: BCN Medicare Advantage |
$802.34
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cash Price |
$1,648.79
|
| Rate for Payer: Cofinity Commercial |
$1,772.45
|
| Rate for Payer: Cofinity Commercial |
$1,442.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,442.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,648.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.34
|
| Rate for Payer: Healthscope Commercial |
$1,854.89
|
| Rate for Payer: Mclaren Medicaid |
$430.05
|
| Rate for Payer: Mclaren Medicare |
$802.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.46
|
| Rate for Payer: Meridian Medicaid |
$451.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$922.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,751.84
|
| Rate for Payer: PACE Medicare |
$762.22
|
| Rate for Payer: PACE SWMI |
$802.34
|
| Rate for Payer: PHP Commercial |
$1,751.84
|
| Rate for Payer: PHP Medicare Advantage |
$802.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.64
|
| Rate for Payer: Priority Health Medicare |
$802.34
|
| Rate for Payer: Priority Health SBD |
$1,298.42
|
| Rate for Payer: Railroad Medicare Medicare |
$802.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,258.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$802.34
|
| Rate for Payer: UHC Medicare Advantage |
$802.34
|
| Rate for Payer: UHCCP Medicaid |
$451.72
|
| Rate for Payer: VA VA |
$802.34
|
|
|
HC CERTOLIZUMAB
|
Facility
|
IP
|
$166.26
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100675
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.74 |
| Max. Negotiated Rate |
$149.63 |
| Rate for Payer: Aetna Commercial |
$141.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.07
|
| Rate for Payer: Cash Price |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$116.38
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.01
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.32
|
| Rate for Payer: PHP Commercial |
$141.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.07
|
| Rate for Payer: Priority Health SBD |
$104.74
|
|
