|
HC IR VENOGRAM BIL
|
Facility
|
OP
|
$1,400.83
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
32000204
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.12 |
| Max. Negotiated Rate |
$4,378.42 |
| Rate for Payer: Aetna Commercial |
$1,190.71
|
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$108.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cash Price |
$1,120.66
|
| Rate for Payer: Cofinity Commercial |
$980.58
|
| Rate for Payer: Cofinity Commercial |
$1,204.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Healthscope Commercial |
$1,260.75
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,190.71
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Commercial |
$1,190.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$980.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,378.42
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,502.74
|
| Rate for Payer: Priority Health SBD |
$882.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
OP
|
$3,727.13
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$129.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,168.06
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,348.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$145.38
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
IP
|
$3,727.13
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,348.09 |
| Max. Negotiated Rate |
$3,354.42 |
| Rate for Payer: Aetna Commercial |
$3,168.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,422.63
|
| Rate for Payer: Cash Price |
$2,981.70
|
| Rate for Payer: Cofinity Commercial |
$2,608.99
|
| Rate for Payer: Cofinity Commercial |
$3,205.33
|
| Rate for Payer: Healthscope Commercial |
$3,354.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,168.06
|
| Rate for Payer: PHP Commercial |
$3,168.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,608.99
|
| Rate for Payer: Priority Health SBD |
$2,348.09
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
IP
|
$3,500.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,205.11 |
| Max. Negotiated Rate |
$3,150.15 |
| Rate for Payer: Aetna Commercial |
$2,975.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.11
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cofinity Commercial |
$3,010.15
|
| Rate for Payer: Cofinity Commercial |
$2,450.12
|
| Rate for Payer: Healthscope Commercial |
$3,150.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.14
|
| Rate for Payer: PHP Commercial |
$2,975.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.12
|
| Rate for Payer: Priority Health SBD |
$2,205.11
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
OP
|
$3,500.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.18 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Commercial |
$2,975.14
|
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$114.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cash Price |
$2,800.14
|
| Rate for Payer: Cofinity Commercial |
$3,010.15
|
| Rate for Payer: Cofinity Commercial |
$2,450.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Healthscope Commercial |
$3,150.15
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.14
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Commercial |
$2,975.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Priority Health SBD |
$2,205.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$117.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
IP
|
$1,184.66
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$746.34 |
| Max. Negotiated Rate |
$1,066.19 |
| Rate for Payer: Aetna Commercial |
$1,006.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.03
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cofinity Commercial |
$1,018.81
|
| Rate for Payer: Cofinity Commercial |
$829.26
|
| Rate for Payer: Healthscope Commercial |
$1,066.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.96
|
| Rate for Payer: PHP Commercial |
$1,006.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.26
|
| Rate for Payer: Priority Health SBD |
$746.34
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
OP
|
$1,184.66
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.52 |
| Max. Negotiated Rate |
$1,066.19 |
| Rate for Payer: Aetna Commercial |
$1,006.96
|
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$770.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$556.46
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cash Price |
$947.73
|
| Rate for Payer: Cofinity Commercial |
$829.26
|
| Rate for Payer: Cofinity Commercial |
$1,018.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Healthscope Commercial |
$1,066.19
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,006.96
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Commercial |
$1,006.96
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.26
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health SBD |
$746.34
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$100.52
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
OP
|
$158.20
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Aetna Commercial |
$134.47
|
| Rate for Payer: Aetna Medicare |
$35.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.42
|
| Rate for Payer: BCBS Complete |
$19.50
|
| Rate for Payer: BCBS MAPPO |
$33.94
|
| Rate for Payer: BCN Medicare Advantage |
$33.94
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cofinity Commercial |
$136.05
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.94
|
| Rate for Payer: Healthscope Commercial |
$142.38
|
| Rate for Payer: Mclaren Medicaid |
$18.57
|
| Rate for Payer: Mclaren Medicare |
$33.94
|
| Rate for Payer: Meridian Medicaid |
$19.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.47
|
| Rate for Payer: PACE Medicare |
$32.24
|
| Rate for Payer: PACE SWMI |
$33.94
|
| Rate for Payer: PHP Commercial |
$134.47
|
| Rate for Payer: PHP Medicare Advantage |
$33.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.74
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health SBD |
$99.67
|
| Rate for Payer: Railroad Medicare Medicare |
$33.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.73
|
| Rate for Payer: UHC Core |
$57.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.94
|
| Rate for Payer: UHC Exchange |
$33.94
|
| Rate for Payer: UHC Medicare Advantage |
$34.96
|
| Rate for Payer: VA VA |
$33.94
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
IP
|
$158.20
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Aetna Commercial |
$134.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.83
|
| Rate for Payer: Cash Price |
$126.56
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$136.05
|
| Rate for Payer: Healthscope Commercial |
$142.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.47
|
| Rate for Payer: PHP Commercial |
$134.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.74
|
| Rate for Payer: Priority Health SBD |
$99.67
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health SBD |
$34.06
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$464.37 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.37
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health Narrow Network |
$371.50
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$464.37 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$158.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.98
|
| Rate for Payer: BCBS Complete |
$87.30
|
| Rate for Payer: BCBS MAPPO |
$151.98
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$151.98
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.98
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$83.13
|
| Rate for Payer: Mclaren Medicare |
$151.98
|
| Rate for Payer: Meridian Medicaid |
$87.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$144.38
|
| Rate for Payer: PACE SWMI |
$151.98
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$151.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$464.37
|
| Rate for Payer: Priority Health Medicare |
$151.98
|
| Rate for Payer: Priority Health Narrow Network |
$371.50
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$151.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.98
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$156.54
|
| Rate for Payer: VA VA |
$151.98
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.40
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health SBD |
$98.28
|
| Rate for Payer: UHC Core |
$28.22
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.48
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.48
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$0.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.84
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.75
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.20
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.20
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.13
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.03
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.07
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1.03
|
|
