|
HC IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
IP
|
$333.42
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$210.05 |
| Max. Negotiated Rate |
$300.08 |
| Rate for Payer: Aetna Commercial |
$283.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.72
|
| Rate for Payer: Cash Price |
$266.74
|
| Rate for Payer: Cofinity Commercial |
$233.39
|
| Rate for Payer: Cofinity Commercial |
$286.74
|
| Rate for Payer: Healthscope Commercial |
$300.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.41
|
| Rate for Payer: PHP Commercial |
$283.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.39
|
| Rate for Payer: Priority Health SBD |
$210.05
|
|
|
HC IMMUNOHISTOCHEMISTY MULTIPLEX STAINS
|
Facility
|
OP
|
$333.42
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
31000117
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.36 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$283.41
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$161.34
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$266.74
|
| Rate for Payer: Cash Price |
$266.74
|
| Rate for Payer: Cofinity Commercial |
$286.74
|
| Rate for Payer: Cofinity Commercial |
$233.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$300.08
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.41
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$283.41
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$210.05
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.93
|
| Rate for Payer: UHC Core |
$92.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$169.94
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC IMPELLA LVAD
|
Facility
|
OP
|
$45,321.17
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18,128.47 |
| Max. Negotiated Rate |
$40,789.05 |
| Rate for Payer: Aetna Commercial |
$38,522.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,458.76
|
| Rate for Payer: BCBS Complete |
$18,128.47
|
| Rate for Payer: Cash Price |
$36,256.94
|
| Rate for Payer: Cofinity Commercial |
$31,724.82
|
| Rate for Payer: Cofinity Commercial |
$38,976.21
|
| Rate for Payer: Healthscope Commercial |
$40,789.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,522.99
|
| Rate for Payer: PHP Commercial |
$38,522.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,724.82
|
| Rate for Payer: Priority Health SBD |
$28,552.34
|
|
|
HC IMPELLA LVAD
|
Facility
|
IP
|
$45,321.17
|
|
| Hospital Charge Code |
27200132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28,552.34 |
| Max. Negotiated Rate |
$40,789.05 |
| Rate for Payer: Aetna Commercial |
$38,522.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29,458.76
|
| Rate for Payer: Cash Price |
$36,256.94
|
| Rate for Payer: Cofinity Commercial |
$31,724.82
|
| Rate for Payer: Cofinity Commercial |
$38,976.21
|
| Rate for Payer: Healthscope Commercial |
$40,789.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38,522.99
|
| Rate for Payer: PHP Commercial |
$38,522.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31,724.82
|
| Rate for Payer: Priority Health SBD |
$28,552.34
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
IP
|
$332.79
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.66 |
| Max. Negotiated Rate |
$299.51 |
| Rate for Payer: Aetna Commercial |
$282.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.31
|
| Rate for Payer: Cash Price |
$266.23
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Cofinity Commercial |
$286.20
|
| Rate for Payer: Healthscope Commercial |
$299.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.87
|
| Rate for Payer: PHP Commercial |
$282.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.95
|
| Rate for Payer: Priority Health SBD |
$209.66
|
|
|
HC IMPELLA MONITORING KIT
|
Facility
|
OP
|
$332.79
|
|
| Hospital Charge Code |
27200133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$299.51 |
| Rate for Payer: Aetna Commercial |
$282.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.31
|
| Rate for Payer: BCBS Complete |
$133.12
|
| Rate for Payer: Cash Price |
$266.23
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Cofinity Commercial |
$286.20
|
| Rate for Payer: Healthscope Commercial |
$299.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.87
|
| Rate for Payer: PHP Commercial |
$282.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.95
|
| Rate for Payer: Priority Health SBD |
$209.66
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
IP
|
$2,873.12
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,810.07 |
| Max. Negotiated Rate |
$2,585.81 |
| Rate for Payer: Aetna Commercial |
$2,442.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.53
|
| Rate for Payer: Cash Price |
$2,298.50
|
| Rate for Payer: Cofinity Commercial |
$2,011.18
|
| Rate for Payer: Cofinity Commercial |
$2,470.88
|
| Rate for Payer: Healthscope Commercial |
$2,585.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,442.15
|
| Rate for Payer: PHP Commercial |
$2,442.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,011.18
|
| Rate for Payer: Priority Health SBD |
$1,810.07
|
|
|
HC IMPELLA REMOVAL
|
Facility
|
OP
|
$2,873.12
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
48100114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$180.09 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Commercial |
$2,442.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.53
|
| Rate for Payer: BCBS Complete |
$1,149.25
|
| Rate for Payer: BCBS Trust/PPO |
$411.24
|
| Rate for Payer: Cash Price |
$2,298.50
|
| Rate for Payer: Cash Price |
$2,298.50
|
| Rate for Payer: Cofinity Commercial |
$2,470.88
|
| Rate for Payer: Cofinity Commercial |
$2,011.18
|
| Rate for Payer: Healthscope Commercial |
$2,585.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,442.15
|
| Rate for Payer: PHP Commercial |
$2,442.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,011.18
|
| Rate for Payer: Priority Health SBD |
$1,810.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.10
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$180.09
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
IP
|
$6,081.01
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,831.04 |
| Max. Negotiated Rate |
$5,472.91 |
| Rate for Payer: Aetna Commercial |
$5,168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,952.66
|
| Rate for Payer: Cash Price |
$4,864.81
|
| Rate for Payer: Cofinity Commercial |
$4,256.71
|
| Rate for Payer: Cofinity Commercial |
$5,229.67
|
| Rate for Payer: Healthscope Commercial |
$5,472.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,168.86
|
| Rate for Payer: PHP Commercial |
$5,168.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,256.71
|
| Rate for Payer: Priority Health SBD |
$3,831.04
|
|
|
HC IMPLANTABLE PRESSURE SENSOR W ANGIO
|
Facility
|
OP
|
$6,081.01
|
|
|
Service Code
|
CPT 33289
|
| Hospital Charge Code |
48100105
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$320.57 |
| Max. Negotiated Rate |
$81,329.31 |
| Rate for Payer: Aetna Commercial |
$5,168.86
|
| Rate for Payer: Aetna Medicare |
$26,895.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,952.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,326.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,326.80
|
| Rate for Payer: BCBS Complete |
$14,854.81
|
| Rate for Payer: BCBS MAPPO |
$25,861.44
|
| Rate for Payer: BCN Medicare Advantage |
$25,861.44
|
| Rate for Payer: Cash Price |
$4,864.81
|
| Rate for Payer: Cash Price |
$4,864.81
|
| Rate for Payer: Cofinity Commercial |
$5,229.67
|
| Rate for Payer: Cofinity Commercial |
$4,256.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,861.44
|
| Rate for Payer: Healthscope Commercial |
$5,472.91
|
| Rate for Payer: Mclaren Medicaid |
$14,146.21
|
| Rate for Payer: Mclaren Medicare |
$25,861.44
|
| Rate for Payer: Meridian Medicaid |
$14,854.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,154.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,740.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,168.86
|
| Rate for Payer: PACE Medicare |
$24,568.37
|
| Rate for Payer: PACE SWMI |
$25,861.44
|
| Rate for Payer: PHP Commercial |
$5,168.86
|
| Rate for Payer: PHP Medicare Advantage |
$25,861.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,146.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,256.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,329.31
|
| Rate for Payer: Priority Health Medicare |
$25,861.44
|
| Rate for Payer: Priority Health Narrow Network |
$65,063.44
|
| Rate for Payer: Priority Health SBD |
$3,831.04
|
| Rate for Payer: Railroad Medicare Medicare |
$25,861.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.63
|
| Rate for Payer: UHC Core |
$15,010.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,861.44
|
| Rate for Payer: UHC Exchange |
$320.57
|
| Rate for Payer: UHC Medicare Advantage |
$26,637.28
|
| Rate for Payer: VA VA |
$25,861.44
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
OP
|
$70,725.38
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$63,652.84 |
| Rate for Payer: Aetna Commercial |
$60,116.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,971.50
|
| Rate for Payer: BCBS Complete |
$28,290.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$56,580.30
|
| Rate for Payer: Cash Price |
$56,580.30
|
| Rate for Payer: Cofinity Commercial |
$49,507.77
|
| Rate for Payer: Cofinity Commercial |
$60,823.83
|
| Rate for Payer: Healthscope Commercial |
$63,652.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60,116.57
|
| Rate for Payer: PHP Commercial |
$60,116.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,507.77
|
| Rate for Payer: Priority Health SBD |
$44,556.99
|
|
|
HC IMPLANTABLE PRESSURE SENSOR WO LEAD
|
Facility
|
IP
|
$70,725.38
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27800103
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44,556.99 |
| Max. Negotiated Rate |
$63,652.84 |
| Rate for Payer: Aetna Commercial |
$60,116.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,971.50
|
| Rate for Payer: Cash Price |
$56,580.30
|
| Rate for Payer: Cofinity Commercial |
$49,507.77
|
| Rate for Payer: Cofinity Commercial |
$60,823.83
|
| Rate for Payer: Healthscope Commercial |
$63,652.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60,116.57
|
| Rate for Payer: PHP Commercial |
$60,116.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49,507.77
|
| Rate for Payer: Priority Health SBD |
$44,556.99
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
OP
|
$532.68
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$845.03 |
| Rate for Payer: Aetna Commercial |
$452.78
|
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCBS Trust/PPO |
$236.02
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cofinity Commercial |
$372.88
|
| Rate for Payer: Cofinity Commercial |
$458.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Healthscope Commercial |
$479.41
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.78
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Commercial |
$452.78
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.03
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health Narrow Network |
$676.02
|
| Rate for Payer: Priority Health SBD |
$335.59
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$54.03
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
HC IMPLANT HORMONE SUBCUTANEOUS
|
Facility
|
IP
|
$532.68
|
|
|
Service Code
|
CPT 11980
|
| Hospital Charge Code |
76100178
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$335.59 |
| Max. Negotiated Rate |
$479.41 |
| Rate for Payer: Aetna Commercial |
$452.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.24
|
| Rate for Payer: Cash Price |
$426.14
|
| Rate for Payer: Cofinity Commercial |
$372.88
|
| Rate for Payer: Cofinity Commercial |
$458.10
|
| Rate for Payer: Healthscope Commercial |
$479.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$452.78
|
| Rate for Payer: PHP Commercial |
$452.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.88
|
| Rate for Payer: Priority Health SBD |
$335.59
|
|
|
HC IMRT PLAN
|
Facility
|
IP
|
$7,327.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$4,616.01 |
| Max. Negotiated Rate |
$6,594.30 |
| Rate for Payer: Aetna Commercial |
$6,227.95
|
| Rate for Payer: Aetna Commercial |
$5,938.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,762.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,540.89
|
| Rate for Payer: Cash Price |
$5,861.60
|
| Rate for Payer: Cash Price |
$5,588.78
|
| Rate for Payer: Cofinity Commercial |
$6,301.22
|
| Rate for Payer: Cofinity Commercial |
$5,128.90
|
| Rate for Payer: Cofinity Commercial |
$6,007.94
|
| Rate for Payer: Cofinity Commercial |
$4,890.19
|
| Rate for Payer: Healthscope Commercial |
$6,594.30
|
| Rate for Payer: Healthscope Commercial |
$6,287.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,938.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,227.95
|
| Rate for Payer: PHP Commercial |
$6,227.95
|
| Rate for Payer: PHP Commercial |
$5,938.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,128.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,890.19
|
| Rate for Payer: Priority Health SBD |
$4,616.01
|
| Rate for Payer: Priority Health SBD |
$4,401.17
|
|
|
HC IMRT PLAN
|
Facility
|
OP
|
$7,327.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
33300006
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$674.41 |
| Max. Negotiated Rate |
$6,594.30 |
| Rate for Payer: Aetna Commercial |
$6,227.95
|
| Rate for Payer: Aetna Commercial |
$5,938.08
|
| Rate for Payer: Aetna Medicare |
$1,282.24
|
| Rate for Payer: Aetna Medicare |
$1,282.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,762.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,540.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.15
|
| Rate for Payer: BCBS Complete |
$708.19
|
| Rate for Payer: BCBS Complete |
$708.19
|
| Rate for Payer: BCBS MAPPO |
$1,232.92
|
| Rate for Payer: BCBS MAPPO |
$1,232.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,481.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,481.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.92
|
| Rate for Payer: Cash Price |
$5,861.60
|
| Rate for Payer: Cash Price |
$5,861.60
|
| Rate for Payer: Cash Price |
$5,588.78
|
| Rate for Payer: Cash Price |
$5,588.78
|
| Rate for Payer: Cofinity Commercial |
$6,007.94
|
| Rate for Payer: Cofinity Commercial |
$4,890.19
|
| Rate for Payer: Cofinity Commercial |
$6,301.22
|
| Rate for Payer: Cofinity Commercial |
$5,128.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.92
|
| Rate for Payer: Healthscope Commercial |
$6,594.30
|
| Rate for Payer: Healthscope Commercial |
$6,287.38
|
| Rate for Payer: Mclaren Medicaid |
$674.41
|
| Rate for Payer: Mclaren Medicaid |
$674.41
|
| Rate for Payer: Mclaren Medicare |
$1,232.92
|
| Rate for Payer: Mclaren Medicare |
$1,232.92
|
| Rate for Payer: Meridian Medicaid |
$708.19
|
| Rate for Payer: Meridian Medicaid |
$708.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,227.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,938.08
|
| Rate for Payer: PACE Medicare |
$1,171.27
|
| Rate for Payer: PACE Medicare |
$1,171.27
|
| Rate for Payer: PACE SWMI |
$1,232.92
|
| Rate for Payer: PACE SWMI |
$1,232.92
|
| Rate for Payer: PHP Commercial |
$5,938.08
|
| Rate for Payer: PHP Commercial |
$6,227.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,128.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,890.19
|
| Rate for Payer: Priority Health Medicare |
$1,232.92
|
| Rate for Payer: Priority Health Medicare |
$1,232.92
|
| Rate for Payer: Priority Health SBD |
$4,616.01
|
| Rate for Payer: Priority Health SBD |
$4,401.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,993.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,993.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.92
|
| Rate for Payer: UHC Exchange |
$1,812.72
|
| Rate for Payer: UHC Exchange |
$1,812.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.91
|
| Rate for Payer: VA VA |
$1,232.92
|
| Rate for Payer: VA VA |
$1,232.92
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
OP
|
$768.66
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$307.46 |
| Max. Negotiated Rate |
$691.79 |
| Rate for Payer: Aetna Commercial |
$653.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.63
|
| Rate for Payer: BCBS Complete |
$307.46
|
| Rate for Payer: BCBS Trust/PPO |
$331.80
|
| Rate for Payer: Cash Price |
$614.93
|
| Rate for Payer: Cash Price |
$614.93
|
| Rate for Payer: Cofinity Commercial |
$538.06
|
| Rate for Payer: Cofinity Commercial |
$661.05
|
| Rate for Payer: Healthscope Commercial |
$691.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$653.36
|
| Rate for Payer: PHP Commercial |
$653.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.06
|
| Rate for Payer: Priority Health SBD |
$484.26
|
|
|
HC IN 111 AUTOLOG WBC PER STUDY
|
Facility
|
IP
|
$768.66
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
34300013
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$484.26 |
| Max. Negotiated Rate |
$691.79 |
| Rate for Payer: Aetna Commercial |
$653.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.63
|
| Rate for Payer: Cash Price |
$614.93
|
| Rate for Payer: Cofinity Commercial |
$538.06
|
| Rate for Payer: Cofinity Commercial |
$661.05
|
| Rate for Payer: Healthscope Commercial |
$691.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$653.36
|
| Rate for Payer: PHP Commercial |
$653.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.06
|
| Rate for Payer: Priority Health SBD |
$484.26
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
OP
|
$5,305.42
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$2,122.17 |
| Max. Negotiated Rate |
$4,774.88 |
| Rate for Payer: Aetna Commercial |
$4,509.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.52
|
| Rate for Payer: BCBS Complete |
$2,122.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,081.46
|
| Rate for Payer: Cash Price |
$4,244.34
|
| Rate for Payer: Cash Price |
$4,244.34
|
| Rate for Payer: Cofinity Commercial |
$3,713.79
|
| Rate for Payer: Cofinity Commercial |
$4,562.66
|
| Rate for Payer: Healthscope Commercial |
$4,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,509.61
|
| Rate for Payer: PHP Commercial |
$4,509.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,713.79
|
| Rate for Payer: Priority Health SBD |
$3,342.41
|
|
|
HC IN 111 OCTEO PER STUDY UP TO 6 MCI
|
Facility
|
IP
|
$5,305.42
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
34300014
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$3,342.41 |
| Max. Negotiated Rate |
$4,774.88 |
| Rate for Payer: Aetna Commercial |
$4,509.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,448.52
|
| Rate for Payer: Cash Price |
$4,244.34
|
| Rate for Payer: Cofinity Commercial |
$3,713.79
|
| Rate for Payer: Cofinity Commercial |
$4,562.66
|
| Rate for Payer: Healthscope Commercial |
$4,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,509.61
|
| Rate for Payer: PHP Commercial |
$4,509.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,713.79
|
| Rate for Payer: Priority Health SBD |
$3,342.41
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
IP
|
$5,409.15
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,407.76 |
| Max. Negotiated Rate |
$4,868.24 |
| Rate for Payer: Aetna Commercial |
$4,597.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,515.95
|
| Rate for Payer: Cash Price |
$4,327.32
|
| Rate for Payer: Cofinity Commercial |
$3,786.40
|
| Rate for Payer: Cofinity Commercial |
$4,651.87
|
| Rate for Payer: Healthscope Commercial |
$4,868.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,597.78
|
| Rate for Payer: PHP Commercial |
$4,597.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.40
|
| Rate for Payer: Priority Health SBD |
$3,407.76
|
|
|
HC INCIS & DRAIN EPIDIDYMIS TESTIS &/OR SCROTUM
|
Facility
|
OP
|
$5,409.15
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
76100349
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.89 |
| Max. Negotiated Rate |
$5,575.00 |
| Rate for Payer: Aetna Commercial |
$4,597.78
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,515.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$831.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$4,327.32
|
| Rate for Payer: Cash Price |
$4,327.32
|
| Rate for Payer: Cofinity Commercial |
$4,651.87
|
| Rate for Payer: Cofinity Commercial |
$3,786.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$4,868.24
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,597.78
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$4,597.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,786.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,575.00
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,460.00
|
| Rate for Payer: Priority Health SBD |
$3,407.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$209.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$109.14
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$239.73 |
| Rate for Payer: Aetna Commercial |
$92.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.94
|
| Rate for Payer: BCBS Complete |
$43.66
|
| Rate for Payer: BCBS Trust/PPO |
$239.73
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Cofinity Commercial |
$76.40
|
| Rate for Payer: Cofinity Commercial |
$93.86
|
| Rate for Payer: Healthscope Commercial |
$98.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.77
|
| Rate for Payer: PHP Commercial |
$92.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.40
|
| Rate for Payer: Priority Health SBD |
$68.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.78
|
| Rate for Payer: UHC Exchange |
$29.80
|
|
|
HC INCISIONAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$109.14
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
76100153
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.76 |
| Max. Negotiated Rate |
$98.23 |
| Rate for Payer: Aetna Commercial |
$92.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.94
|
| Rate for Payer: Cash Price |
$87.31
|
| Rate for Payer: Cofinity Commercial |
$76.40
|
| Rate for Payer: Cofinity Commercial |
$93.86
|
| Rate for Payer: Healthscope Commercial |
$98.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.77
|
| Rate for Payer: PHP Commercial |
$92.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.40
|
| Rate for Payer: Priority Health SBD |
$68.76
|
|
|
HC INCISIONAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$480.42
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
76100152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Commercial |
$408.36
|
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$135.20
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Cash Price |
$384.34
|
| Rate for Payer: Cash Price |
$384.34
|
| Rate for Payer: Cofinity Commercial |
$413.16
|
| Rate for Payer: Cofinity Commercial |
$336.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Healthscope Commercial |
$432.38
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$408.36
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Commercial |
$408.36
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Priority Health SBD |
$302.66
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$55.01
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
