|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
OP
|
$24.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.51
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
IP
|
$24.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$21.72 |
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.68
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$20.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.51
|
| Rate for Payer: PHP Commercial |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health SBD |
$15.20
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$31.83 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.99
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Commercial |
$30.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health SBD |
$22.28
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.08 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$345.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.90
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$483.43
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$483.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health SBD |
$435.08
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,916.14 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.97
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,129.05
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,129.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.97
|
| Rate for Payer: Priority Health SBD |
$1,916.14
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,216.60 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: Aetna Medicare |
$1,520.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.97
|
| Rate for Payer: BCBS Complete |
$1,216.60
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,129.05
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,129.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.97
|
| Rate for Payer: Priority Health SBD |
$1,916.14
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$276.32 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.09
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health SBD |
$276.32
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: BCBS Complete |
$32.10
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCN Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.04
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Mclaren Medicaid |
$30.57
|
| Rate for Payer: Mclaren Medicare |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.89
|
| Rate for Payer: Meridian Medicaid |
$32.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: PACE Medicare |
$54.19
|
| Rate for Payer: PACE SWMI |
$57.04
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: PHP Medicare Advantage |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health SBD |
$276.32
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.04
|
| Rate for Payer: UHC Medicare Advantage |
$57.04
|
| Rate for Payer: UHCCP Medicaid |
$32.11
|
| Rate for Payer: VA VA |
$57.04
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$46.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: BCBS Complete |
$25.26
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Mclaren Medicaid |
$24.06
|
| Rate for Payer: Mclaren Medicare |
$44.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$25.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PACE Medicare |
$42.65
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health SBD |
$161.94
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.89
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UHCCP Medicaid |
$25.27
|
| Rate for Payer: VA VA |
$44.89
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Medicare Advantage |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$10.57
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,254.81 |
| Max. Negotiated Rate |
$1,792.58 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.64
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,394.23
|
| Rate for Payer: Cofinity Commercial |
$1,712.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,394.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health SBD |
$1,254.81
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,066.57 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: Aetna Medicare |
$1,502.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,394.23
|
| Rate for Payer: Cofinity Commercial |
$1,712.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,394.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Priority Health SBD |
$1,254.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,066.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$813.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,591.00 |
| Max. Negotiated Rate |
$5,130.00 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,705.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,990.00
|
| Rate for Payer: Cofinity Commercial |
$4,902.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,990.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health SBD |
$3,591.00
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,623.80 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: Aetna Medicare |
$2,077.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,705.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$4,902.00
|
| Rate for Payer: Cofinity Commercial |
$3,990.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,990.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health SBD |
$3,591.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,623.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,124.80
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$229.98 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health SBD |
$229.98
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$328.55 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$328.55
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health SBD |
$229.98
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.41
|
| Rate for Payer: UHC Core |
$270.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$270.14
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$46.28
|
| Rate for Payer: VA VA |
$82.21
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health SBD |
$168.91
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.41
|
| Rate for Payer: UHC Core |
$198.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$198.40
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$46.28
|
| Rate for Payer: VA VA |
$82.21
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health SBD |
$168.91
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health SBD |
$168.91
|
|
