|
HC GI PATHOGEN PANEL, PCR, F
|
Facility
|
OP
|
$718.71
|
|
|
Service Code
|
HCPCS 87507
|
| Hospital Charge Code |
30600322
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$223.39 |
| Max. Negotiated Rate |
$1,173.19 |
| Rate for Payer: Aetna Commercial |
$610.90
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$234.56
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cash Price |
$574.97
|
| Rate for Payer: Cofinity Commercial |
$618.09
|
| Rate for Payer: Cofinity Commercial |
$503.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$646.84
|
| Rate for Payer: Mclaren Medicaid |
$223.39
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$234.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$610.90
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$610.90
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.16
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$452.79
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.78
|
| Rate for Payer: UHC Medicare Advantage |
$416.78
|
| Rate for Payer: UHCCP Medicaid |
$234.65
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Cofinity Commercial |
$621.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$559.04
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI REPLAC D OR J TUBE W F
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
36100230
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.04 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.78
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$621.15
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health SBD |
$559.04
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
OP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Cofinity Commercial |
$621.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$559.04
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI REPLAC GJ TUBE W FLUOR
|
Facility
|
IP
|
$887.36
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
36100231
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$559.04 |
| Max. Negotiated Rate |
$798.62 |
| Rate for Payer: Aetna Commercial |
$754.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$576.78
|
| Rate for Payer: Cash Price |
$709.89
|
| Rate for Payer: Cofinity Commercial |
$621.15
|
| Rate for Payer: Cofinity Commercial |
$763.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.89
|
| Rate for Payer: Healthscope Commercial |
$798.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.26
|
| Rate for Payer: PHP Commercial |
$754.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.78
|
| Rate for Payer: Priority Health SBD |
$559.04
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
IP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$575.48 |
| Max. Negotiated Rate |
$822.11 |
| Rate for Payer: Aetna Commercial |
$776.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.75
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$639.42
|
| Rate for Payer: Cofinity Commercial |
$785.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Healthscope Commercial |
$822.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: PHP Commercial |
$776.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: Priority Health SBD |
$575.48
|
|
|
HC GI REPLAC G OR EC TUBE W
|
Facility
|
OP
|
$913.46
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
36100229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$776.44
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cash Price |
$730.77
|
| Rate for Payer: Cofinity Commercial |
$785.58
|
| Rate for Payer: Cofinity Commercial |
$639.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$822.11
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.44
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$776.44
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.75
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$575.48
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
IP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$772.70 |
| Max. Negotiated Rate |
$1,103.86 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.23
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Cofinity Commercial |
$858.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health SBD |
$772.70
|
|
|
HC GI TRANSIT WIRELESS CAPSULE STOMACH TO COLON
|
Facility
|
OP
|
$1,226.51
|
|
|
Service Code
|
CPT 91112
|
| Hospital Charge Code |
75000010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Commercial |
$1,042.53
|
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cash Price |
$981.21
|
| Rate for Payer: Cofinity Commercial |
$858.56
|
| Rate for Payer: Cofinity Commercial |
$1,054.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$858.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$981.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Healthscope Commercial |
$1,103.86
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,042.53
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Commercial |
$1,042.53
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.23
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Priority Health SBD |
$772.70
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$514.80
|
| Rate for Payer: VA VA |
$914.38
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
OP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC GLIADIN AB DEAMINATED IGA
|
Facility
|
IP
|
$36.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200007
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$30.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Cash Price |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.13
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.95
|
| Rate for Payer: PHP Commercial |
$30.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.67
|
| Rate for Payer: Priority Health SBD |
$22.94
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$32.46 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC GLIADIN AB DEAMINATED IGG
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200009
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health SBD |
$31.49
|
|
|
HC GLIADIN (DEAMIDATED) AB, IGA OR IGG, S
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 86258
|
| Hospital Charge Code |
30200509
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| 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 |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$31.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
IP
|
$309.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.82 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health SBD |
$194.82
|
|
|
HC GLIDEWIRE EXCHANGE
|
Facility
|
OP
|
$309.24
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.70 |
| Max. Negotiated Rate |
$278.32 |
| Rate for Payer: Aetna Commercial |
$262.85
|
| Rate for Payer: Aetna Medicare |
$154.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.01
|
| Rate for Payer: BCBS Complete |
$123.70
|
| Rate for Payer: Cash Price |
$247.39
|
| Rate for Payer: Cofinity Commercial |
$216.47
|
| Rate for Payer: Cofinity Commercial |
$265.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.39
|
| Rate for Payer: Healthscope Commercial |
$278.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.85
|
| Rate for Payer: PHP Commercial |
$262.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.01
|
| Rate for Payer: Priority Health SBD |
$194.82
|
|
|
HC GLUC 6 PHOS DEHYDROGENASE
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
30100228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.14
|
| Rate for Payer: Priority Health SBD |
$34.06
|
|
|
HC GLUC 6 PHOS DEHYDROGENASE
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
30100228
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$10.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.12
|
| Rate for Payer: BCBS Complete |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$9.70
|
| Rate for Payer: BCN Medicare Advantage |
$9.70
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.70
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$5.20
|
| Rate for Payer: Mclaren Medicare |
$9.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.19
|
| Rate for Payer: Meridian Medicaid |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: PACE Medicare |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.70
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.14
|
| Rate for Payer: Priority Health Medicare |
$9.70
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.70
|
| Rate for Payer: UHC Medicare Advantage |
$9.70
|
| Rate for Payer: UHCCP Medicaid |
$5.46
|
| Rate for Payer: VA VA |
$9.70
|
|
|
HC GLUCAGON LEVEL
|
Facility
|
IP
|
$82.62
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
30100221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.05 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health SBD |
$52.05
|
|
|
HC GLUCAGON LEVEL
|
Facility
|
OP
|
$82.62
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
30100221
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$74.36 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$14.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.86
|
| Rate for Payer: BCBS Complete |
$8.04
|
| Rate for Payer: BCBS MAPPO |
$14.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.29
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cash Price |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$74.36
|
| Rate for Payer: Mclaren Medicaid |
$7.66
|
| Rate for Payer: Mclaren Medicare |
$14.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.00
|
| Rate for Payer: Meridian Medicaid |
$8.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.23
|
| Rate for Payer: PACE Medicare |
$13.58
|
| Rate for Payer: PACE SWMI |
$14.29
|
| Rate for Payer: PHP Commercial |
$70.23
|
| Rate for Payer: PHP Medicare Advantage |
$14.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health SBD |
$52.05
|
| Rate for Payer: Railroad Medicare Medicare |
$14.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.29
|
| Rate for Payer: UHC Medicare Advantage |
$14.29
|
| Rate for Payer: UHCCP Medicaid |
$8.05
|
| Rate for Payer: VA VA |
$14.29
|
|
|
HC GLUCEPTATE PER STUDY
|
Facility
|
OP
|
$135.98
|
|
|
Service Code
|
HCPCS A9550
|
| Hospital Charge Code |
34300008
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$122.38 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: Aetna Medicare |
$67.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.39
|
| Rate for Payer: BCBS Complete |
$54.39
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$95.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Healthscope Commercial |
$122.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.58
|
| Rate for Payer: PHP Commercial |
$115.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.39
|
| Rate for Payer: Priority Health SBD |
$85.67
|
|
|
HC GLUCEPTATE PER STUDY
|
Facility
|
IP
|
$135.98
|
|
|
Service Code
|
HCPCS A9550
|
| Hospital Charge Code |
34300008
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$122.38 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.39
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$95.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Healthscope Commercial |
$122.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.58
|
| Rate for Payer: PHP Commercial |
$115.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.39
|
| Rate for Payer: Priority Health SBD |
$85.67
|
|
|
HC GLUCOSE (ADDITIONAL).
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
30100227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.90
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS MAPPO |
$3.92
|
| Rate for Payer: BCN Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicare |
$3.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.12
|
| Rate for Payer: Meridian Medicaid |
$2.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PACE Medicare |
$3.72
|
| Rate for Payer: PACE SWMI |
$3.92
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health SBD |
$24.36
|
| Rate for Payer: Railroad Medicare Medicare |
$3.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$3.92
|
| Rate for Payer: UHCCP Medicaid |
$2.21
|
| Rate for Payer: VA VA |
$3.92
|
|
|
HC GLUCOSE (ADDITIONAL).
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
30100227
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.13
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health SBD |
$24.36
|
|
