|
HC LYMPHOMA IMMUNOPHENO 2
|
Facility
|
OP
|
$15.30
|
|
|
Service Code
|
CPT 85060
|
| Hospital Charge Code |
30500014
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: BCBS Complete |
$6.12
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.21
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Exchange |
$22.92
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$148.19 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS Trust/PPO |
$148.19
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health SBD |
$415.80
|
|
|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna Commercial |
$561.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$462.00
|
| Rate for Payer: Cofinity Commercial |
$567.60
|
| Rate for Payer: Healthscope Commercial |
$594.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$561.00
|
| Rate for Payer: PHP Commercial |
$561.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.00
|
| Rate for Payer: Priority Health SBD |
$415.80
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$3,657.70
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,304.35 |
| Max. Negotiated Rate |
$3,291.93 |
| Rate for Payer: Aetna Commercial |
$3,109.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,377.50
|
| Rate for Payer: Cash Price |
$2,926.16
|
| Rate for Payer: Cofinity Commercial |
$2,560.39
|
| Rate for Payer: Cofinity Commercial |
$3,145.62
|
| Rate for Payer: Healthscope Commercial |
$3,291.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,109.04
|
| Rate for Payer: PHP Commercial |
$3,109.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,560.39
|
| Rate for Payer: Priority Health SBD |
$2,304.35
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$3,657.70
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$5,561.92 |
| Rate for Payer: Aetna Commercial |
$3,109.04
|
| Rate for Payer: Aetna Medicare |
$1,884.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,377.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,265.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,265.42
|
| Rate for Payer: BCBS Complete |
$1,041.01
|
| Rate for Payer: BCBS MAPPO |
$1,812.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,812.34
|
| Rate for Payer: Cash Price |
$2,926.16
|
| Rate for Payer: Cash Price |
$2,926.16
|
| Rate for Payer: Cofinity Commercial |
$3,145.62
|
| Rate for Payer: Cofinity Commercial |
$2,560.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,812.34
|
| Rate for Payer: Healthscope Commercial |
$3,291.93
|
| Rate for Payer: Mclaren Medicaid |
$991.35
|
| Rate for Payer: Mclaren Medicare |
$1,812.34
|
| Rate for Payer: Meridian Medicaid |
$1,041.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,902.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,084.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,109.04
|
| Rate for Payer: PACE Medicare |
$1,721.72
|
| Rate for Payer: PACE SWMI |
$1,812.34
|
| Rate for Payer: PHP Commercial |
$3,109.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,812.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,560.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,561.92
|
| Rate for Payer: Priority Health Medicare |
$1,812.34
|
| Rate for Payer: Priority Health Narrow Network |
$4,449.54
|
| Rate for Payer: Priority Health SBD |
$2,304.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,812.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.83
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,812.34
|
| Rate for Payer: UHC Exchange |
$197.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,866.71
|
| Rate for Payer: VA VA |
$1,812.34
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$1,408.21 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna Medicare |
$509.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$611.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$611.96
|
| Rate for Payer: BCBS Complete |
$281.21
|
| Rate for Payer: BCBS MAPPO |
$489.57
|
| Rate for Payer: BCBS Trust/PPO |
$207.62
|
| Rate for Payer: BCN Medicare Advantage |
$489.57
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$945.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.57
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Mclaren Medicaid |
$267.79
|
| Rate for Payer: Mclaren Medicare |
$489.57
|
| Rate for Payer: Meridian Medicaid |
$281.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$514.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PACE Medicare |
$465.09
|
| Rate for Payer: PACE SWMI |
$489.57
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: PHP Medicare Advantage |
$489.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.21
|
| Rate for Payer: Priority Health Medicare |
$489.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,126.56
|
| Rate for Payer: Priority Health SBD |
$850.50
|
| Rate for Payer: Railroad Medicare Medicare |
$489.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.57
|
| Rate for Payer: UHC Exchange |
$149.97
|
| Rate for Payer: UHC Medicare Advantage |
$504.26
|
| Rate for Payer: VA VA |
$489.57
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$1,215.00 |
| Rate for Payer: Aetna Commercial |
$1,147.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$877.50
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$1,161.00
|
| Rate for Payer: Cofinity Commercial |
$945.00
|
| Rate for Payer: Healthscope Commercial |
$1,215.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,147.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health SBD |
$850.50
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,808.16 |
| Max. Negotiated Rate |
$6,868.80 |
| Rate for Payer: Aetna Commercial |
$6,487.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,960.80
|
| Rate for Payer: Cash Price |
$6,105.60
|
| Rate for Payer: Cofinity Commercial |
$6,563.52
|
| Rate for Payer: Cofinity Commercial |
$5,342.40
|
| Rate for Payer: Healthscope Commercial |
$6,868.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,487.20
|
| Rate for Payer: PHP Commercial |
$6,487.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,342.40
|
| Rate for Payer: Priority Health SBD |
$4,808.16
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$6,868.80 |
| Rate for Payer: Aetna Commercial |
$6,487.20
|
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,960.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Cash Price |
$6,105.60
|
| Rate for Payer: Cash Price |
$6,105.60
|
| Rate for Payer: Cofinity Commercial |
$6,563.52
|
| Rate for Payer: Cofinity Commercial |
$5,342.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Healthscope Commercial |
$6,868.80
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,487.20
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Commercial |
$6,487.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,342.40
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Priority Health SBD |
$4,808.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
HC MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
IP
|
$44.06
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
30600092
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$37.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.64
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$37.89
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.45
|
| Rate for Payer: PHP Commercial |
$37.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.84
|
| Rate for Payer: Priority Health SBD |
$27.76
|
|
|
HC MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
OP
|
$44.06
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
30600092
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$37.45
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$37.89
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.45
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$37.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.84
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$27.76
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$43.20
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
30600093
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.39
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$4.31
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$37.15
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$38.88
|
| Rate for Payer: Mclaren Medicaid |
$2.36
|
| Rate for Payer: Mclaren Medicare |
$4.31
|
| Rate for Payer: Meridian Medicaid |
$2.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: PACE Medicare |
$4.09
|
| Rate for Payer: PACE SWMI |
$4.31
|
| Rate for Payer: PHP Commercial |
$36.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health SBD |
$27.22
|
| Rate for Payer: Railroad Medicare Medicare |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.31
|
| Rate for Payer: UHC Exchange |
$4.31
|
| Rate for Payer: UHC Medicare Advantage |
$4.44
|
| Rate for Payer: VA VA |
$4.31
|
|
|
HC MACROSCOPIC EXAM PARASITE
|
Facility
|
IP
|
$43.20
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
30600093
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$38.88 |
| Rate for Payer: Aetna Commercial |
$36.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.08
|
| Rate for Payer: Cash Price |
$34.56
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Cofinity Commercial |
$37.15
|
| Rate for Payer: Healthscope Commercial |
$38.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.72
|
| Rate for Payer: PHP Commercial |
$36.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.24
|
| Rate for Payer: Priority Health SBD |
$27.22
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
OP
|
$942.69
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$377.08 |
| Max. Negotiated Rate |
$848.42 |
| Rate for Payer: Aetna Commercial |
$801.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.75
|
| Rate for Payer: BCBS Complete |
$377.08
|
| Rate for Payer: BCBS Trust/PPO |
$466.92
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cofinity Commercial |
$659.88
|
| Rate for Payer: Cofinity Commercial |
$810.71
|
| Rate for Payer: Healthscope Commercial |
$848.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$801.29
|
| Rate for Payer: PHP Commercial |
$801.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.88
|
| Rate for Payer: Priority Health SBD |
$593.89
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
IP
|
$942.69
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$593.89 |
| Max. Negotiated Rate |
$848.42 |
| Rate for Payer: Aetna Commercial |
$801.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.75
|
| Rate for Payer: Cash Price |
$754.15
|
| Rate for Payer: Cofinity Commercial |
$659.88
|
| Rate for Payer: Cofinity Commercial |
$810.71
|
| Rate for Payer: Healthscope Commercial |
$848.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$801.29
|
| Rate for Payer: PHP Commercial |
$801.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$659.88
|
| Rate for Payer: Priority Health SBD |
$593.89
|
|
|
HC MAGGOT THERAPY
|
Facility
|
IP
|
$1,071.00
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$674.73 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
HC MAGGOT THERAPY
|
Facility
|
OP
|
$1,071.00
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: BCBS Complete |
$428.40
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$910.35
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.70
|
| Rate for Payer: Priority Health SBD |
$674.73
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.38
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$6.70
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.70
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.70
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.66
|
| Rate for Payer: Mclaren Medicare |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$6.36
|
| Rate for Payer: PACE SWMI |
$6.70
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$6.70
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.04
|
| Rate for Payer: UHC Core |
$11.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.70
|
| Rate for Payer: UHC Exchange |
$6.70
|
| Rate for Payer: UHC Medicare Advantage |
$6.90
|
| Rate for Payer: VA VA |
$6.70
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.10
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Medicare Advantage |
$12.08
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.08
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Mclaren Medicare |
$12.08
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PACE Medicare |
$11.48
|
| Rate for Payer: PACE SWMI |
$12.08
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: Railroad Medicare Medicare |
$12.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.08
|
| Rate for Payer: UHC Medicare Advantage |
$12.45
|
| Rate for Payer: VA VA |
$12.08
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$3.28
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Medicaid |
$3.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.19
|
| Rate for Payer: UHC Core |
$10.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Exchange |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
IP
|
$1,304.30
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$821.71 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.80
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Cofinity Commercial |
$913.01
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health SBD |
$821.71
|
|
|
HC MALONEY/BOUGIE DILATATION
|
Facility
|
OP
|
$1,304.30
|
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.72 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.80
|
| Rate for Payer: BCBS Complete |
$521.72
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Cofinity Commercial |
$913.01
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health SBD |
$821.71
|
|
