|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
OP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.37 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: Aetna Medicare |
$247.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.35
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$347.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health SBD |
$312.43
|
|
|
HC EPIFIX 2X3 PER SQ CM
|
Facility
|
IP
|
$495.92
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$312.43 |
| Max. Negotiated Rate |
$446.33 |
| Rate for Payer: Aetna Commercial |
$421.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.35
|
| Rate for Payer: Cash Price |
$396.74
|
| Rate for Payer: Cofinity Commercial |
$347.14
|
| Rate for Payer: Cofinity Commercial |
$426.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$347.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.74
|
| Rate for Payer: Healthscope Commercial |
$446.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.53
|
| Rate for Payer: PHP Commercial |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.35
|
| Rate for Payer: Priority Health SBD |
$312.43
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
IP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$276.53 |
| Max. Negotiated Rate |
$395.04 |
| Rate for Payer: Aetna Commercial |
$373.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.30
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$307.25
|
| Rate for Payer: Cofinity Commercial |
$377.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Healthscope Commercial |
$395.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: PHP Commercial |
$373.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: Priority Health SBD |
$276.53
|
|
|
HC EPIFIX 2X4 PER SQ CM
|
Facility
|
OP
|
$438.93
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.57 |
| Max. Negotiated Rate |
$395.04 |
| Rate for Payer: Aetna Commercial |
$373.09
|
| Rate for Payer: Aetna Medicare |
$219.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.30
|
| Rate for Payer: BCBS Complete |
$175.57
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cash Price |
$351.14
|
| Rate for Payer: Cofinity Commercial |
$307.25
|
| Rate for Payer: Cofinity Commercial |
$377.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.14
|
| Rate for Payer: Healthscope Commercial |
$395.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.09
|
| Rate for Payer: PHP Commercial |
$373.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.30
|
| Rate for Payer: Priority Health SBD |
$276.53
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
OP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$371.27 |
| Rate for Payer: Aetna Commercial |
$350.64
|
| Rate for Payer: Aetna Medicare |
$206.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.14
|
| Rate for Payer: BCBS Complete |
$165.01
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$288.76
|
| Rate for Payer: Cofinity Commercial |
$354.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Healthscope Commercial |
$371.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: PHP Commercial |
$350.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health SBD |
$259.89
|
|
|
HC EPIFIX 3X4 PER SQ CM
|
Facility
|
IP
|
$412.52
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.89 |
| Max. Negotiated Rate |
$371.27 |
| Rate for Payer: Aetna Commercial |
$350.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.14
|
| Rate for Payer: Cash Price |
$330.02
|
| Rate for Payer: Cofinity Commercial |
$288.76
|
| Rate for Payer: Cofinity Commercial |
$354.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$288.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.02
|
| Rate for Payer: Healthscope Commercial |
$371.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.64
|
| Rate for Payer: PHP Commercial |
$350.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.14
|
| Rate for Payer: Priority Health SBD |
$259.89
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
IP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$190.61 |
| Rate for Payer: Aetna Commercial |
$180.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.66
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$148.25
|
| Rate for Payer: Cofinity Commercial |
$182.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Healthscope Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: PHP Commercial |
$180.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health SBD |
$133.43
|
|
|
HC EPIFIX 4 X 4.5 PER SQ CM
|
Facility
|
OP
|
$211.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.72 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$180.02
|
| Rate for Payer: Aetna Medicare |
$105.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.66
|
| Rate for Payer: BCBS Complete |
$84.72
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cash Price |
$169.43
|
| Rate for Payer: Cofinity Commercial |
$148.25
|
| Rate for Payer: Cofinity Commercial |
$182.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.43
|
| Rate for Payer: Healthscope Commercial |
$190.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.02
|
| Rate for Payer: PHP Commercial |
$180.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health SBD |
$133.43
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
OP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.72 |
| Max. Negotiated Rate |
$357.11 |
| Rate for Payer: Aetna Commercial |
$337.27
|
| Rate for Payer: Aetna Medicare |
$198.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.91
|
| Rate for Payer: BCBS Complete |
$158.72
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$277.75
|
| Rate for Payer: Cofinity Commercial |
$341.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Healthscope Commercial |
$357.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: PHP Commercial |
$337.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: Priority Health SBD |
$249.98
|
|
|
HC EPIFIX 4X4 PER SQ CM
|
Facility
|
IP
|
$396.79
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600134
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.98 |
| Max. Negotiated Rate |
$357.11 |
| Rate for Payer: Aetna Commercial |
$337.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.91
|
| Rate for Payer: Cash Price |
$317.43
|
| Rate for Payer: Cofinity Commercial |
$277.75
|
| Rate for Payer: Cofinity Commercial |
$341.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$277.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.43
|
| Rate for Payer: Healthscope Commercial |
$357.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.27
|
| Rate for Payer: PHP Commercial |
$337.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.91
|
| Rate for Payer: Priority Health SBD |
$249.98
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.49 |
| Max. Negotiated Rate |
$267.85 |
| Rate for Payer: Aetna Commercial |
$252.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.45
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$208.33
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Healthscope Commercial |
$267.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: PHP Commercial |
$252.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: Priority Health SBD |
$187.49
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$297.61
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.04 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$252.97
|
| Rate for Payer: Aetna Medicare |
$148.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.45
|
| Rate for Payer: BCBS Complete |
$119.04
|
| Rate for Payer: BCBS Trust/PPO |
$289.76
|
| Rate for Payer: BCN Commercial |
$289.76
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cash Price |
$238.09
|
| Rate for Payer: Cofinity Commercial |
$208.33
|
| Rate for Payer: Cofinity Commercial |
$255.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.09
|
| Rate for Payer: Healthscope Commercial |
$267.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.97
|
| Rate for Payer: PHP Commercial |
$252.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.45
|
| Rate for Payer: Priority Health SBD |
$187.49
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.18 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: Priority Health SBD |
$262.18
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$416.16
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.46 |
| Max. Negotiated Rate |
$374.54 |
| Rate for Payer: Aetna Commercial |
$353.74
|
| Rate for Payer: Aetna Medicare |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.50
|
| Rate for Payer: BCBS Complete |
$166.46
|
| Rate for Payer: Cash Price |
$332.93
|
| Rate for Payer: Cofinity Commercial |
$291.31
|
| Rate for Payer: Cofinity Commercial |
$357.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.93
|
| Rate for Payer: Healthscope Commercial |
$374.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.74
|
| Rate for Payer: PHP Commercial |
$353.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.50
|
| Rate for Payer: Priority Health SBD |
$262.18
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$958.92 |
| Rate for Payer: Aetna Commercial |
$794.84
|
| Rate for Payer: Aetna Medicare |
$317.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$381.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$381.38
|
| Rate for Payer: BCBS Complete |
$171.71
|
| Rate for Payer: BCBS MAPPO |
$305.10
|
| Rate for Payer: BCBS Trust/PPO |
$580.31
|
| Rate for Payer: BCN Commercial |
$580.31
|
| Rate for Payer: BCN Medicare Advantage |
$305.10
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$804.19
|
| Rate for Payer: Cofinity Commercial |
$654.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$654.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$841.59
|
| Rate for Payer: Mclaren Medicaid |
$163.53
|
| Rate for Payer: Mclaren Medicare |
$305.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.36
|
| Rate for Payer: Meridian Medicaid |
$171.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: Nomi Health Commercial |
$915.30
|
| Rate for Payer: PACE Medicare |
$289.84
|
| Rate for Payer: PACE SWMI |
$305.10
|
| Rate for Payer: PHP Commercial |
$794.84
|
| Rate for Payer: PHP Medicare Advantage |
$305.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.92
|
| Rate for Payer: Priority Health Medicare |
$305.10
|
| Rate for Payer: Priority Health Narrow Network |
$767.14
|
| Rate for Payer: Priority Health SBD |
$589.11
|
| Rate for Payer: Railroad Medicare Medicare |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.10
|
| Rate for Payer: UHC Exchange |
$691.97
|
| Rate for Payer: UHC Medicare Advantage |
$305.10
|
| Rate for Payer: UHCCP Medicaid |
$171.77
|
| Rate for Payer: VA VA |
$305.10
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$935.10
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$589.11 |
| Max. Negotiated Rate |
$841.59 |
| Rate for Payer: Aetna Commercial |
$794.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.82
|
| Rate for Payer: Cash Price |
$748.08
|
| Rate for Payer: Cofinity Commercial |
$654.57
|
| Rate for Payer: Cofinity Commercial |
$804.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$654.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$748.08
|
| Rate for Payer: Healthscope Commercial |
$841.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$794.84
|
| Rate for Payer: PHP Commercial |
$794.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.82
|
| Rate for Payer: Priority Health SBD |
$589.11
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$999.60 |
| Max. Negotiated Rate |
$75,545.59 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$24,997.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,045.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,045.32
|
| Rate for Payer: BCBS Complete |
$13,527.61
|
| Rate for Payer: BCBS MAPPO |
$24,036.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.06
|
| Rate for Payer: BCN Commercial |
$1,007.06
|
| Rate for Payer: BCN Medicare Advantage |
$24,036.26
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,036.26
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Mclaren Medicaid |
$12,883.44
|
| Rate for Payer: Mclaren Medicare |
$24,036.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,238.07
|
| Rate for Payer: Meridian Medicaid |
$13,527.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,641.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$50,476.15
|
| Rate for Payer: PACE Medicare |
$22,834.45
|
| Rate for Payer: PACE SWMI |
$24,036.26
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$24,036.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,883.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,545.59
|
| Rate for Payer: Priority Health Medicare |
$24,036.26
|
| Rate for Payer: Priority Health Narrow Network |
$60,436.47
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
| Rate for Payer: Railroad Medicare Medicare |
$24,036.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$999.60
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,036.26
|
| Rate for Payer: UHC Exchange |
$11,353.00
|
| Rate for Payer: UHC Medicare Advantage |
$24,036.26
|
| Rate for Payer: UHCCP Medicaid |
$13,532.41
|
| Rate for Payer: VA VA |
$24,036.26
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,608.26 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.54
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.23
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.40
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$11.61
|
| Rate for Payer: BCN Commercial |
$11.61
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.50
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health Narrow Network |
$10.80
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.12
|
| Rate for Payer: UHC Medicare Advantage |
$13.12
|
| Rate for Payer: UHCCP Medicaid |
$7.39
|
| Rate for Payer: VA VA |
$13.12
|
|
