|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
OP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$1,168.97 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.26
|
| Rate for Payer: BCBS Complete |
$519.54
|
| Rate for Payer: BCBS Trust/PPO |
$691.58
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.02
|
| Rate for Payer: Healthscope Commercial |
$1,168.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: PHP Commercial |
$1,104.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: Priority Health SBD |
$818.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$67.45
|
|
|
HC IVUS EA ADDL NON CORONARY VESSEL
|
Facility
|
IP
|
$1,298.86
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
36100484
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$818.28 |
| Max. Negotiated Rate |
$1,168.97 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.26
|
| Rate for Payer: Cash Price |
$1,039.09
|
| Rate for Payer: Cofinity Commercial |
$1,117.02
|
| Rate for Payer: Cofinity Commercial |
$909.20
|
| Rate for Payer: Healthscope Commercial |
$1,168.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,104.03
|
| Rate for Payer: PHP Commercial |
$1,104.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.20
|
| Rate for Payer: Priority Health SBD |
$818.28
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
IP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,837.75 |
| Max. Negotiated Rate |
$6,911.07 |
| Rate for Payer: Aetna Commercial |
$6,527.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,991.33
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$6,603.91
|
| Rate for Payer: Cofinity Commercial |
$5,375.28
|
| Rate for Payer: Healthscope Commercial |
$6,911.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: PHP Commercial |
$6,527.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: Priority Health SBD |
$4,837.75
|
|
|
HC IVUS NON CORONARY INITIAL
|
Facility
|
OP
|
$7,678.97
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
36100483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$6,911.07 |
| Rate for Payer: Aetna Commercial |
$6,527.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,991.33
|
| Rate for Payer: BCBS Complete |
$3,071.59
|
| Rate for Payer: BCBS Trust/PPO |
$4,687.12
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cash Price |
$6,143.18
|
| Rate for Payer: Cofinity Commercial |
$5,375.28
|
| Rate for Payer: Cofinity Commercial |
$6,603.91
|
| Rate for Payer: Healthscope Commercial |
$6,911.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,527.12
|
| Rate for Payer: PHP Commercial |
$6,527.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,375.28
|
| Rate for Payer: Priority Health SBD |
$4,837.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.29
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$84.81
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
OP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$507.34 |
| Max. Negotiated Rate |
$1,351.94 |
| Rate for Payer: Aetna Commercial |
$1,276.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.40
|
| Rate for Payer: BCBS Complete |
$600.86
|
| Rate for Payer: BCBS Trust/PPO |
$507.34
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,051.51
|
| Rate for Payer: Cofinity Commercial |
$1,291.86
|
| Rate for Payer: Healthscope Commercial |
$1,351.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: PHP Commercial |
$1,276.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: Priority Health SBD |
$946.36
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC IVUS OR OCT EACH ADDL VESSEL
|
Facility
|
IP
|
$1,502.16
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
48100107
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$946.36 |
| Max. Negotiated Rate |
$1,351.94 |
| Rate for Payer: Aetna Commercial |
$1,276.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.40
|
| Rate for Payer: Cash Price |
$1,201.73
|
| Rate for Payer: Cofinity Commercial |
$1,051.51
|
| Rate for Payer: Cofinity Commercial |
$1,291.86
|
| Rate for Payer: Healthscope Commercial |
$1,351.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,276.84
|
| Rate for Payer: PHP Commercial |
$1,276.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.51
|
| Rate for Payer: Priority Health SBD |
$946.36
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
IP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,281.51 |
| Max. Negotiated Rate |
$3,259.30 |
| Rate for Payer: Aetna Commercial |
$3,078.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,353.94
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$2,535.02
|
| Rate for Payer: Cofinity Commercial |
$3,114.45
|
| Rate for Payer: Healthscope Commercial |
$3,259.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: PHP Commercial |
$3,078.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: Priority Health SBD |
$2,281.51
|
|
|
HC IVUS OR OCT INITIAL VESSEL
|
Facility
|
OP
|
$3,621.45
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
48100106
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$843.46 |
| Max. Negotiated Rate |
$3,259.30 |
| Rate for Payer: Aetna Commercial |
$3,078.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,353.94
|
| Rate for Payer: BCBS Complete |
$1,448.58
|
| Rate for Payer: BCBS Trust/PPO |
$843.46
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cash Price |
$2,897.16
|
| Rate for Payer: Cofinity Commercial |
$3,114.45
|
| Rate for Payer: Cofinity Commercial |
$2,535.02
|
| Rate for Payer: Healthscope Commercial |
$3,259.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,078.23
|
| Rate for Payer: PHP Commercial |
$3,078.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,535.02
|
| Rate for Payer: Priority Health SBD |
$2,281.51
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna Medicare |
$126.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.39
|
| Rate for Payer: BCBS Complete |
$70.03
|
| Rate for Payer: BCBS MAPPO |
$121.91
|
| Rate for Payer: BCBS Trust/PPO |
$95.46
|
| Rate for Payer: BCN Medicare Advantage |
$121.91
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.91
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Mclaren Medicaid |
$66.68
|
| Rate for Payer: Mclaren Medicare |
$121.91
|
| Rate for Payer: Meridian Medicaid |
$70.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PACE Medicare |
$115.81
|
| Rate for Payer: PACE SWMI |
$121.91
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: PHP Medicare Advantage |
$121.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health Medicare |
$121.91
|
| Rate for Payer: Priority Health SBD |
$230.58
|
| Rate for Payer: Railroad Medicare Medicare |
$121.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.29
|
| Rate for Payer: UHC Core |
$180.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.91
|
| Rate for Payer: UHC Exchange |
$121.91
|
| Rate for Payer: UHC Medicare Advantage |
$125.57
|
| Rate for Payer: VA VA |
$121.91
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$230.58 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Aetna Commercial |
$311.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.90
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$256.20
|
| Rate for Payer: Cofinity Commercial |
$314.76
|
| Rate for Payer: Healthscope Commercial |
$329.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.10
|
| Rate for Payer: PHP Commercial |
$311.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.20
|
| Rate for Payer: Priority Health SBD |
$230.58
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
IP
|
$380.46
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$239.69 |
| Max. Negotiated Rate |
$342.41 |
| Rate for Payer: Aetna Commercial |
$323.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.30
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cofinity Commercial |
$327.20
|
| Rate for Payer: Cofinity Commercial |
$266.32
|
| Rate for Payer: Healthscope Commercial |
$342.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.39
|
| Rate for Payer: PHP Commercial |
$323.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.32
|
| Rate for Payer: Priority Health SBD |
$239.69
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$380.46
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$342.41 |
| Rate for Payer: Aetna Commercial |
$323.39
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: BCBS Complete |
$52.65
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$71.78
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cash Price |
$304.37
|
| Rate for Payer: Cofinity Commercial |
$266.32
|
| Rate for Payer: Cofinity Commercial |
$327.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$342.41
|
| Rate for Payer: Mclaren Medicaid |
$50.14
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Medicaid |
$52.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.39
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$323.39
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.32
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health SBD |
$239.69
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.99
|
| Rate for Payer: UHC Core |
$150.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Exchange |
$91.66
|
| Rate for Payer: UHC Medicare Advantage |
$94.41
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$90.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.90
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Cofinity Commercial |
$91.16
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: PHP Commercial |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health SBD |
$66.78
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Aetna Commercial |
$90.10
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Cofinity Commercial |
$91.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$95.40
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.10
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$90.10
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$66.78
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$10.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Healthscope Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.26
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.62
|
| Rate for Payer: Priority Health SBD |
$6.86
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$10.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.08
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Healthscope Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.26
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.62
|
| Rate for Payer: Priority Health SBD |
$6.86
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$208.70
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$187.83 |
| Rate for Payer: Aetna Commercial |
$177.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.66
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$146.09
|
| Rate for Payer: Cofinity Commercial |
$179.48
|
| Rate for Payer: Healthscope Commercial |
$187.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: PHP Commercial |
$177.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: Priority Health SBD |
$131.48
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$208.70
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.23 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$177.40
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCBS Trust/PPO |
$90.46
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cash Price |
$166.96
|
| Rate for Payer: Cofinity Commercial |
$179.48
|
| Rate for Payer: Cofinity Commercial |
$146.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$187.83
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.40
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$177.40
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$131.48
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$54.03
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health SBD |
$47.82
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$75.90
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$68.31 |
| Rate for Payer: Aetna Commercial |
$64.52
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cash Price |
$60.72
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Cofinity Commercial |
$53.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$68.31
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.52
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$64.52
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.13
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$47.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$20.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.10
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$32.49 |
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Medicaid |
$2.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.68
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$30.68
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.27
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health SBD |
$22.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.42
|
| Rate for Payer: UHC Core |
$7.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Exchange |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: VA VA |
$4.52
|
|
