|
HC DNA DOUBLE STRANDED AB
|
Facility
|
OP
|
$28.98
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.18
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS MAPPO |
$13.74
|
| Rate for Payer: BCBS Trust/PPO |
$14.66
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.74
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Mclaren Medicaid |
$7.19
|
| Rate for Payer: Mclaren Medicare |
$13.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.43
|
| Rate for Payer: Meridian Medicaid |
$14.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PACE Medicare |
$13.05
|
| Rate for Payer: PACE SWMI |
$13.74
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: PHP Medicare Advantage |
$13.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.74
|
| Rate for Payer: Priority Health Medicare |
$13.74
|
| Rate for Payer: Priority Health SBD |
$18.26
|
| Rate for Payer: Priority Health Tiered Network |
$10.99
|
| Rate for Payer: Railroad Medicare Medicare |
$13.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.61
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.74
|
| Rate for Payer: UHC Exchange |
$20.61
|
| Rate for Payer: UHC Medicaid |
$7.19
|
| Rate for Payer: UHCCP Medicaid |
$7.19
|
| Rate for Payer: VA VA |
$13.74
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
IP
|
$28.98
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$26.08 |
| Rate for Payer: Aetna Commercial |
$24.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.84
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Advantage |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.73
|
| Rate for Payer: PHP Commercial |
$24.63
|
| Rate for Payer: Priority Health SBD |
$18.26
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
IP
|
$79.43
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$71.49 |
| Rate for Payer: Aetna Commercial |
$67.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.63
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Advantage |
$55.60
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Healthscope Commercial |
$71.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.57
|
| Rate for Payer: PHP Commercial |
$67.52
|
| Rate for Payer: Priority Health SBD |
$50.04
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
OP
|
$79.43
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$67.52
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.99
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$54.58
|
| Rate for Payer: BCN Commercial |
$54.58
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cash Price |
$63.54
|
| Rate for Payer: Cofinity Advantage |
$55.60
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$71.49
|
| Rate for Payer: Mclaren Medicaid |
$26.77
|
| Rate for Payer: Mclaren Medicare |
$51.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: Meridian Medicaid |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.52
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.57
|
| Rate for Payer: PACE Medicare |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$67.52
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$51.19
|
| Rate for Payer: Priority Health SBD |
$50.04
|
| Rate for Payer: Priority Health Tiered Network |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.79
|
| Rate for Payer: UHC Core |
$76.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.19
|
| Rate for Payer: UHC Exchange |
$76.79
|
| Rate for Payer: UHC Medicaid |
$26.77
|
| Rate for Payer: UHCCP Medicaid |
$26.77
|
| Rate for Payer: VA VA |
$51.19
|
|
|
HC DOG IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC DOG IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
OP
|
$449.41
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.34 |
| Max. Negotiated Rate |
$404.47 |
| Rate for Payer: Aetna Commercial |
$382.00
|
| Rate for Payer: Aetna Medicare |
$224.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.12
|
| Rate for Payer: BCBS Complete |
$179.76
|
| Rate for Payer: BCBS Trust/PPO |
$87.34
|
| Rate for Payer: BCN Commercial |
$87.34
|
| Rate for Payer: Cash Price |
$359.53
|
| Rate for Payer: Cash Price |
$359.53
|
| Rate for Payer: Cofinity Advantage |
$314.59
|
| Rate for Payer: Cofinity Commercial |
$386.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.53
|
| Rate for Payer: Healthscope Commercial |
$404.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$359.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.06
|
| Rate for Payer: PHP Commercial |
$382.00
|
| Rate for Payer: Priority Health SBD |
$283.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.12
|
| Rate for Payer: UHC Core |
$234.14
|
| Rate for Payer: UHC Exchange |
$176.62
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
IP
|
$449.41
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$283.13 |
| Max. Negotiated Rate |
$404.47 |
| Rate for Payer: Aetna Commercial |
$382.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.12
|
| Rate for Payer: Cash Price |
$359.53
|
| Rate for Payer: Cofinity Advantage |
$314.59
|
| Rate for Payer: Cofinity Commercial |
$386.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.53
|
| Rate for Payer: Healthscope Commercial |
$404.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.06
|
| Rate for Payer: PHP Commercial |
$382.00
|
| Rate for Payer: Priority Health SBD |
$283.13
|
|
|
HC DOXYCYCLINE HYCLATE 100 MG
|
Facility
|
IP
|
$230.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$207.21 |
| Rate for Payer: Aetna Commercial |
$195.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.65
|
| Rate for Payer: Cash Price |
$184.18
|
| Rate for Payer: Cofinity Advantage |
$161.16
|
| Rate for Payer: Cofinity Commercial |
$198.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.18
|
| Rate for Payer: Healthscope Commercial |
$207.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.67
|
| Rate for Payer: PHP Commercial |
$195.70
|
| Rate for Payer: Priority Health SBD |
$145.04
|
|
|
HC DOXYCYCLINE HYCLATE 100 MG
|
Facility
|
OP
|
$230.23
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.09 |
| Max. Negotiated Rate |
$207.21 |
| Rate for Payer: Aetna Commercial |
$195.70
|
| Rate for Payer: Aetna Medicare |
$115.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.65
|
| Rate for Payer: BCBS Complete |
$92.09
|
| Rate for Payer: Cash Price |
$184.18
|
| Rate for Payer: Cofinity Advantage |
$161.16
|
| Rate for Payer: Cofinity Commercial |
$198.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.18
|
| Rate for Payer: Healthscope Commercial |
$207.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.67
|
| Rate for Payer: PHP Commercial |
$195.70
|
| Rate for Payer: Priority Health SBD |
$145.04
|
|
|
HC DOXYCYCLINE HYCLATE 1MG
|
Facility
|
IP
|
$230.23
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
63600269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$207.21 |
| Rate for Payer: Aetna Commercial |
$195.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.65
|
| Rate for Payer: Cash Price |
$184.18
|
| Rate for Payer: Cofinity Advantage |
$161.16
|
| Rate for Payer: Cofinity Commercial |
$198.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.18
|
| Rate for Payer: Healthscope Commercial |
$207.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.67
|
| Rate for Payer: PHP Commercial |
$195.70
|
| Rate for Payer: Priority Health SBD |
$145.04
|
|
|
HC DOXYCYCLINE HYCLATE 1MG
|
Facility
|
OP
|
$230.23
|
|
|
Service Code
|
HCPCS J1271
|
| Hospital Charge Code |
63600269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$207.21 |
| Rate for Payer: Aetna Commercial |
$195.70
|
| Rate for Payer: Aetna Medicare |
$115.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.65
|
| Rate for Payer: BCBS Complete |
$92.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$184.18
|
| Rate for Payer: Cash Price |
$184.18
|
| Rate for Payer: Cofinity Advantage |
$161.16
|
| Rate for Payer: Cofinity Commercial |
$198.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.18
|
| Rate for Payer: Healthscope Commercial |
$207.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.67
|
| Rate for Payer: PHP Commercial |
$195.70
|
| Rate for Payer: Priority Health SBD |
$145.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Core |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
|
|
HC DPPX AB CBA, S
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC DPPX AB CBA, S
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Advantage |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
|
HC DPPX AB IFA, S
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC DPPX AB IFA, S
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC DRAINAGE ABSC CST HEMAT DENTOALVEOLAR STRUX
|
Facility
|
OP
|
$378.42
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Commercial |
$321.66
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$95.73
|
| Rate for Payer: BCN Commercial |
$95.73
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$302.74
|
| Rate for Payer: Cash Price |
$302.74
|
| Rate for Payer: Cash Price |
$302.74
|
| Rate for Payer: Cofinity Advantage |
$264.89
|
| Rate for Payer: Cofinity Commercial |
$325.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$340.58
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.66
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.81
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$321.66
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$238.40
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.97
|
| Rate for Payer: UHC Core |
$197.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$148.72
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC DRAINAGE ABSC CST HEMAT DENTOALVEOLAR STRUX
|
Facility
|
IP
|
$378.42
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
76100529
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.40 |
| Max. Negotiated Rate |
$340.58 |
| Rate for Payer: Aetna Commercial |
$321.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.97
|
| Rate for Payer: Cash Price |
$302.74
|
| Rate for Payer: Cofinity Advantage |
$264.89
|
| Rate for Payer: Cofinity Commercial |
$325.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.74
|
| Rate for Payer: Healthscope Commercial |
$340.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.81
|
| Rate for Payer: PHP Commercial |
$321.66
|
| Rate for Payer: Priority Health SBD |
$238.40
|
|
|
HC DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
OP
|
$653.51
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Commercial |
$555.48
|
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$195.24
|
| Rate for Payer: BCN Commercial |
$195.24
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Cash Price |
$522.81
|
| Rate for Payer: Cash Price |
$522.81
|
| Rate for Payer: Cash Price |
$522.81
|
| Rate for Payer: Cofinity Advantage |
$457.46
|
| Rate for Payer: Cofinity Commercial |
$562.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$588.16
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.48
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.13
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Commercial |
$555.48
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health SBD |
$411.71
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.78
|
| Rate for Payer: UHC Core |
$340.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Exchange |
$256.83
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
HC DRAINAGE ABSCESS PALATE UVULA
|
Facility
|
IP
|
$653.51
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
76100559
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$411.71 |
| Max. Negotiated Rate |
$588.16 |
| Rate for Payer: Aetna Commercial |
$555.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.78
|
| Rate for Payer: Cash Price |
$522.81
|
| Rate for Payer: Cofinity Advantage |
$457.46
|
| Rate for Payer: Cofinity Commercial |
$562.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$522.81
|
| Rate for Payer: Healthscope Commercial |
$588.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.13
|
| Rate for Payer: PHP Commercial |
$555.48
|
| Rate for Payer: Priority Health SBD |
$411.71
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health SBD |
$13.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.20
|
| Rate for Payer: UHC Core |
$11.38
|
| Rate for Payer: UHC Exchange |
$8.59
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health SBD |
$13.77
|
|
|
HC DRAINAGE CATHETER LVL 15
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Aetna Commercial |
$1,351.50
|
| Rate for Payer: Aetna Medicare |
$795.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.50
|
| Rate for Payer: BCBS Complete |
$636.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Advantage |
$1,113.00
|
| Rate for Payer: Cofinity Commercial |
$1,367.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.00
|
| Rate for Payer: Healthscope Commercial |
$1,431.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,272.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,351.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,192.50
|
| Rate for Payer: PHP Commercial |
$1,351.50
|
| Rate for Payer: Priority Health SBD |
$1,001.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.50
|
| Rate for Payer: UHC Core |
$828.39
|
| Rate for Payer: UHC Exchange |
$624.87
|
|
