|
HC MOG FACS, S
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$446.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.25
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$451.50
|
| Rate for Payer: Cofinity Commercial |
$367.50
|
| Rate for Payer: Healthscope Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: PHP Commercial |
$446.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: Priority Health SBD |
$330.75
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$466.91 |
| Max. Negotiated Rate |
$667.02 |
| Rate for Payer: Aetna Commercial |
$629.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.73
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$518.79
|
| Rate for Payer: Cofinity Commercial |
$637.37
|
| Rate for Payer: Healthscope Commercial |
$667.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: PHP Commercial |
$629.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: Priority Health SBD |
$466.91
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.03 |
| Max. Negotiated Rate |
$667.02 |
| Rate for Payer: Aetna Commercial |
$629.96
|
| Rate for Payer: Aetna Medicare |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.74
|
| Rate for Payer: BCBS Complete |
$79.84
|
| Rate for Payer: BCBS MAPPO |
$138.99
|
| Rate for Payer: BCBS Trust/PPO |
$422.58
|
| Rate for Payer: BCN Medicare Advantage |
$138.99
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$518.79
|
| Rate for Payer: Cofinity Commercial |
$637.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.99
|
| Rate for Payer: Healthscope Commercial |
$667.02
|
| Rate for Payer: Mclaren Medicaid |
$76.03
|
| Rate for Payer: Mclaren Medicare |
$138.99
|
| Rate for Payer: Meridian Medicaid |
$79.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: PACE Medicare |
$132.04
|
| Rate for Payer: PACE SWMI |
$138.99
|
| Rate for Payer: PHP Commercial |
$629.96
|
| Rate for Payer: PHP Medicare Advantage |
$138.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$138.99
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Priority Health SBD |
$466.91
|
| Rate for Payer: Railroad Medicare Medicare |
$138.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.99
|
| Rate for Payer: UHC Medicare Advantage |
$143.16
|
| Rate for Payer: VA VA |
$138.99
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.08
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$168.09
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health SBD |
$151.28
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$122.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.98
|
| Rate for Payer: BCBS Complete |
$67.54
|
| Rate for Payer: BCBS MAPPO |
$117.58
|
| Rate for Payer: BCBS Trust/PPO |
$70.61
|
| Rate for Payer: BCN Medicare Advantage |
$117.58
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$168.09
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Mclaren Medicaid |
$64.32
|
| Rate for Payer: Mclaren Medicare |
$117.58
|
| Rate for Payer: Meridian Medicaid |
$67.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PACE Medicare |
$111.70
|
| Rate for Payer: PACE SWMI |
$117.58
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: PHP Medicare Advantage |
$117.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health Medicare |
$117.58
|
| Rate for Payer: Priority Health SBD |
$151.28
|
| Rate for Payer: Railroad Medicare Medicare |
$117.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.58
|
| Rate for Payer: UHC Exchange |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$121.11
|
| Rate for Payer: VA VA |
$117.58
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| 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 MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.83
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$2.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.22
|
| Rate for Payer: UHC Core |
$8.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.05
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health SBD |
$73.71
|
| Rate for Payer: UHC Core |
$41.98
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.05
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Cofinity Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health SBD |
$73.71
|
|
|
HC MOUSE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
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 MOUSE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200048
|
|
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 |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| 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 MPCDS CELL SORTING BM
|
Facility
|
OP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$906.83 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna Medicare |
$332.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$399.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$399.80
|
| Rate for Payer: BCBS Complete |
$183.72
|
| Rate for Payer: BCBS MAPPO |
$319.84
|
| Rate for Payer: BCBS Trust/PPO |
$91.84
|
| Rate for Payer: BCN Medicare Advantage |
$319.84
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.84
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Mclaren Medicaid |
$174.95
|
| Rate for Payer: Mclaren Medicare |
$319.84
|
| Rate for Payer: Meridian Medicaid |
$183.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PACE Medicare |
$303.85
|
| Rate for Payer: PACE SWMI |
$319.84
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: PHP Medicare Advantage |
$319.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$906.83
|
| Rate for Payer: Priority Health Medicare |
$319.84
|
| Rate for Payer: Priority Health Narrow Network |
$725.46
|
| Rate for Payer: Priority Health SBD |
$105.48
|
| Rate for Payer: Railroad Medicare Medicare |
$319.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.28
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.84
|
| Rate for Payer: UHC Exchange |
$76.62
|
| Rate for Payer: UHC Medicare Advantage |
$329.44
|
| Rate for Payer: VA VA |
$319.84
|
|
|
HC MPCDS CELL SORTING BM
|
Facility
|
IP
|
$167.43
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100048
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$105.48 |
| Max. Negotiated Rate |
$150.69 |
| Rate for Payer: Aetna Commercial |
$142.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.83
|
| Rate for Payer: Cash Price |
$133.94
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Healthscope Commercial |
$150.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.32
|
| Rate for Payer: PHP Commercial |
$142.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.20
|
| Rate for Payer: Priority Health SBD |
$105.48
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.27
|
| Rate for Payer: BCBS Complete |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Cofinity Commercial |
$36.91
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health SBD |
$33.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.58
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Exchange |
$23.25
|
|
|
HC MPCDS CELL SORTING BM CMPT
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100049
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.27
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$36.91
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health SBD |
$33.22
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
OP
|
$372.30
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$335.07 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: BCBS Complete |
$106.38
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$145.03
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cofinity Commercial |
$260.61
|
| Rate for Payer: Cofinity Commercial |
$320.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$335.07
|
| Rate for Payer: Mclaren Medicaid |
$101.30
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Medicaid |
$106.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.46
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$316.46
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.61
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health SBD |
$234.55
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.24
|
| Rate for Payer: UHC Core |
$222.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Exchange |
$185.20
|
| Rate for Payer: UHC Medicare Advantage |
$190.76
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC MPL EXON 10 MUTATION DETECTION
|
Facility
|
IP
|
$372.30
|
|
|
Service Code
|
CPT 81339
|
| Hospital Charge Code |
31000149
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$234.55 |
| Max. Negotiated Rate |
$335.07 |
| Rate for Payer: Aetna Commercial |
$316.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.00
|
| Rate for Payer: Cash Price |
$297.84
|
| Rate for Payer: Cofinity Commercial |
$260.61
|
| Rate for Payer: Cofinity Commercial |
$320.18
|
| Rate for Payer: Healthscope Commercial |
$335.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.46
|
| Rate for Payer: PHP Commercial |
$316.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.61
|
| Rate for Payer: Priority Health SBD |
$234.55
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
IP
|
$588.54
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$370.78 |
| Max. Negotiated Rate |
$529.69 |
| Rate for Payer: Aetna Commercial |
$500.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.55
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cofinity Commercial |
$411.98
|
| Rate for Payer: Cofinity Commercial |
$506.14
|
| Rate for Payer: Healthscope Commercial |
$529.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$500.26
|
| Rate for Payer: PHP Commercial |
$500.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.98
|
| Rate for Payer: Priority Health SBD |
$370.78
|
|
|
HC MPL EXON10 MUTATION DETECTION
|
Facility
|
OP
|
$588.54
|
|
|
Service Code
|
CPT 81170
|
| Hospital Charge Code |
30000109
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.10 |
| Max. Negotiated Rate |
$529.69 |
| Rate for Payer: Aetna Commercial |
$500.26
|
| Rate for Payer: Aetna Medicare |
$312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$375.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$375.00
|
| Rate for Payer: BCBS Complete |
$172.32
|
| Rate for Payer: BCBS MAPPO |
$300.00
|
| Rate for Payer: BCBS Trust/PPO |
$234.92
|
| Rate for Payer: BCN Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cash Price |
$470.83
|
| Rate for Payer: Cofinity Commercial |
$411.98
|
| Rate for Payer: Cofinity Commercial |
$506.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$529.69
|
| Rate for Payer: Mclaren Medicaid |
$164.10
|
| Rate for Payer: Mclaren Medicare |
$300.00
|
| Rate for Payer: Meridian Medicaid |
$172.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$315.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$500.26
|
| Rate for Payer: PACE Medicare |
$285.00
|
| Rate for Payer: PACE SWMI |
$300.00
|
| Rate for Payer: PHP Commercial |
$500.26
|
| Rate for Payer: PHP Medicare Advantage |
$300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.98
|
| Rate for Payer: Priority Health Medicare |
$300.00
|
| Rate for Payer: Priority Health SBD |
$370.78
|
| Rate for Payer: Railroad Medicare Medicare |
$300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.00
|
| Rate for Payer: UHC Core |
$395.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.00
|
| Rate for Payer: UHC Exchange |
$300.00
|
| Rate for Payer: UHC Medicare Advantage |
$309.00
|
| Rate for Payer: VA VA |
$300.00
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
OP
|
$635.46
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$571.91 |
| Rate for Payer: Aetna Commercial |
$540.14
|
| Rate for Payer: Aetna Medicare |
$126.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.04
|
| Rate for Payer: BCBS Complete |
$69.86
|
| Rate for Payer: BCBS MAPPO |
$121.63
|
| Rate for Payer: BCBS Trust/PPO |
$95.24
|
| Rate for Payer: BCN Medicare Advantage |
$121.63
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cofinity Commercial |
$444.82
|
| Rate for Payer: Cofinity Commercial |
$546.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.63
|
| Rate for Payer: Healthscope Commercial |
$571.91
|
| Rate for Payer: Mclaren Medicaid |
$66.53
|
| Rate for Payer: Mclaren Medicare |
$121.63
|
| Rate for Payer: Meridian Medicaid |
$69.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.14
|
| Rate for Payer: PACE Medicare |
$115.55
|
| Rate for Payer: PACE SWMI |
$121.63
|
| Rate for Payer: PHP Commercial |
$540.14
|
| Rate for Payer: PHP Medicare Advantage |
$121.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.82
|
| Rate for Payer: Priority Health Medicare |
$121.63
|
| Rate for Payer: Priority Health SBD |
$400.34
|
| Rate for Payer: Railroad Medicare Medicare |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.96
|
| Rate for Payer: UHC Core |
$198.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.63
|
| Rate for Payer: UHC Exchange |
$121.63
|
| Rate for Payer: UHC Medicare Advantage |
$125.28
|
| Rate for Payer: VA VA |
$121.63
|
|
|
HC MPN, CALR GENE MUTATION, EXON 9
|
Facility
|
IP
|
$635.46
|
|
|
Service Code
|
CPT 81219
|
| Hospital Charge Code |
30000110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$400.34 |
| Max. Negotiated Rate |
$571.91 |
| Rate for Payer: Aetna Commercial |
$540.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.05
|
| Rate for Payer: Cash Price |
$508.37
|
| Rate for Payer: Cofinity Commercial |
$444.82
|
| Rate for Payer: Cofinity Commercial |
$546.50
|
| Rate for Payer: Healthscope Commercial |
$571.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$540.14
|
| Rate for Payer: PHP Commercial |
$540.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.82
|
| Rate for Payer: Priority Health SBD |
$400.34
|
|
|
HC MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
OP
|
$403.92
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$363.53 |
| Rate for Payer: Aetna Commercial |
$343.33
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.55
|
| 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 |
$323.14
|
| Rate for Payer: Cash Price |
$323.14
|
| Rate for Payer: Cofinity Commercial |
$347.37
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$363.53
|
| 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 |
$343.33
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$343.33
|
| 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 |
$282.74
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health SBD |
$254.47
|
| 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 MPN (JAK2, V617F, CALR, MPL) REFLEX
|
Facility
|
IP
|
$403.92
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
30000107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$254.47 |
| Max. Negotiated Rate |
$363.53 |
| Rate for Payer: Aetna Commercial |
$343.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.55
|
| Rate for Payer: Cash Price |
$323.14
|
| Rate for Payer: Cofinity Commercial |
$282.74
|
| Rate for Payer: Cofinity Commercial |
$347.37
|
| Rate for Payer: Healthscope Commercial |
$363.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.33
|
| Rate for Payer: PHP Commercial |
$343.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.74
|
| Rate for Payer: Priority Health SBD |
$254.47
|
|
