|
HC INCISION OF URETHRA
|
Facility
|
IP
|
$2,797.64
|
|
|
Service Code
|
CPT 53020
|
| Hospital Charge Code |
76100296
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,762.51 |
| Max. Negotiated Rate |
$2,517.88 |
| Rate for Payer: Aetna Commercial |
$2,377.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,818.47
|
| Rate for Payer: Cash Price |
$2,238.11
|
| Rate for Payer: Cofinity Commercial |
$1,958.35
|
| Rate for Payer: Cofinity Commercial |
$2,405.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,958.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,238.11
|
| Rate for Payer: Healthscope Commercial |
$2,517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,377.99
|
| Rate for Payer: PHP Commercial |
$2,377.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,818.47
|
| Rate for Payer: Priority Health SBD |
$1,762.51
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
IP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$734.76 |
| Max. Negotiated Rate |
$1,049.66 |
| Rate for Payer: Aetna Commercial |
$991.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.09
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$1,003.01
|
| Rate for Payer: Cofinity Commercial |
$816.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Healthscope Commercial |
$1,049.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: PHP Commercial |
$991.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: Priority Health SBD |
$734.76
|
|
|
HC INDIRECT CALORIMETRY
|
Facility
|
OP
|
$1,166.29
|
|
|
Service Code
|
CPT 94690
|
| Hospital Charge Code |
46000008
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$1,049.66 |
| Rate for Payer: Aetna Commercial |
$991.35
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cash Price |
$933.03
|
| Rate for Payer: Cofinity Commercial |
$816.40
|
| Rate for Payer: Cofinity Commercial |
$1,003.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$816.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$933.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$1,049.66
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$991.35
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$991.35
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.09
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$734.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$863.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$863.05
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
IP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$524.95 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health SBD |
$367.47
|
|
|
HC INDIUM 111 DTPA PER MCI
|
Facility
|
OP
|
$583.28
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
34300015
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$367.47 |
| Max. Negotiated Rate |
$2,013.47 |
| Rate for Payer: Aetna Commercial |
$495.79
|
| Rate for Payer: Aetna Medicare |
$743.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.11
|
| Rate for Payer: BCBS Complete |
$402.57
|
| Rate for Payer: BCBS MAPPO |
$715.29
|
| Rate for Payer: BCN Medicare Advantage |
$715.29
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cash Price |
$466.62
|
| Rate for Payer: Cofinity Commercial |
$501.62
|
| Rate for Payer: Cofinity Commercial |
$408.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$408.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.29
|
| Rate for Payer: Healthscope Commercial |
$524.95
|
| Rate for Payer: Mclaren Medicaid |
$383.40
|
| Rate for Payer: Mclaren Medicare |
$715.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$751.05
|
| Rate for Payer: Meridian Medicaid |
$402.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.79
|
| Rate for Payer: PACE Medicare |
$679.53
|
| Rate for Payer: PACE SWMI |
$715.29
|
| Rate for Payer: PHP Commercial |
$495.79
|
| Rate for Payer: PHP Medicare Advantage |
$715.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.13
|
| Rate for Payer: Priority Health Medicare |
$715.29
|
| Rate for Payer: Priority Health SBD |
$367.47
|
| Rate for Payer: Railroad Medicare Medicare |
$715.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,013.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.29
|
| Rate for Payer: UHC Medicare Advantage |
$715.29
|
| Rate for Payer: UHCCP Medicaid |
$402.71
|
| Rate for Payer: VA VA |
$715.29
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
OP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$414.14 |
| Max. Negotiated Rate |
$2,395.03 |
| Rate for Payer: Aetna Commercial |
$2,261.97
|
| Rate for Payer: Aetna Medicare |
$803.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,729.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$965.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$965.80
|
| Rate for Payer: BCBS Complete |
$434.84
|
| Rate for Payer: BCBS MAPPO |
$772.64
|
| Rate for Payer: BCN Medicare Advantage |
$772.64
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$2,288.58
|
| Rate for Payer: Cofinity Commercial |
$1,862.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,862.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.64
|
| Rate for Payer: Healthscope Commercial |
$2,395.03
|
| Rate for Payer: Mclaren Medicaid |
$414.14
|
| Rate for Payer: Mclaren Medicare |
$772.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.27
|
| Rate for Payer: Meridian Medicaid |
$434.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$888.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: PACE Medicare |
$734.01
|
| Rate for Payer: PACE SWMI |
$772.64
|
| Rate for Payer: PHP Commercial |
$2,261.97
|
| Rate for Payer: PHP Medicare Advantage |
$772.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: Priority Health Medicare |
$772.64
|
| Rate for Payer: Priority Health SBD |
$1,676.52
|
| Rate for Payer: Railroad Medicare Medicare |
$772.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,174.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.64
|
| Rate for Payer: UHC Medicare Advantage |
$772.64
|
| Rate for Payer: UHCCP Medicaid |
$435.00
|
| Rate for Payer: VA VA |
$772.64
|
|
|
HC INDIUM 111 PER 0.5 MCI
|
Facility
|
IP
|
$2,661.14
|
|
|
Service Code
|
HCPCS A9547
|
| Hospital Charge Code |
63600040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,676.52 |
| Max. Negotiated Rate |
$2,395.03 |
| Rate for Payer: Aetna Commercial |
$2,261.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,729.74
|
| Rate for Payer: Cash Price |
$2,128.91
|
| Rate for Payer: Cofinity Commercial |
$1,862.80
|
| Rate for Payer: Cofinity Commercial |
$2,288.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,862.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,128.91
|
| Rate for Payer: Healthscope Commercial |
$2,395.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,261.97
|
| Rate for Payer: PHP Commercial |
$2,261.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.74
|
| Rate for Payer: Priority Health SBD |
$1,676.52
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
IP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$103.79 |
| Max. Negotiated Rate |
$148.28 |
| Rate for Payer: Aetna Commercial |
$140.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.09
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$115.33
|
| Rate for Payer: Cofinity Commercial |
$141.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: PHP Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: Priority Health SBD |
$103.79
|
|
|
HC INDIVIDUAL SESSION 30 MIN RD G0108
|
Facility
|
OP
|
$164.75
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
94200029
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$65.90 |
| Max. Negotiated Rate |
$148.28 |
| Rate for Payer: Aetna Commercial |
$140.04
|
| Rate for Payer: Aetna Medicare |
$82.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.09
|
| Rate for Payer: BCBS Complete |
$65.90
|
| Rate for Payer: Cash Price |
$131.80
|
| Rate for Payer: Cofinity Commercial |
$115.33
|
| Rate for Payer: Cofinity Commercial |
$141.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.80
|
| Rate for Payer: Healthscope Commercial |
$148.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.04
|
| Rate for Payer: PHP Commercial |
$140.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.09
|
| Rate for Payer: Priority Health SBD |
$103.79
|
| Rate for Payer: UHC Core |
$121.92
|
| Rate for Payer: UHC Exchange |
$121.92
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
OP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$634.61 |
| Max. Negotiated Rate |
$3,377.92 |
| Rate for Payer: Aetna Commercial |
$3,190.25
|
| Rate for Payer: Aetna Medicare |
$1,231.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,479.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,479.97
|
| Rate for Payer: BCBS Complete |
$666.34
|
| Rate for Payer: BCBS MAPPO |
$1,183.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,183.98
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$2,627.27
|
| Rate for Payer: Cofinity Commercial |
$3,227.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,183.98
|
| Rate for Payer: Healthscope Commercial |
$3,377.92
|
| Rate for Payer: Mclaren Medicaid |
$634.61
|
| Rate for Payer: Mclaren Medicare |
$1,183.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,243.18
|
| Rate for Payer: Meridian Medicaid |
$666.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,361.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: PACE Medicare |
$1,124.78
|
| Rate for Payer: PACE SWMI |
$1,183.98
|
| Rate for Payer: PHP Commercial |
$3,190.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,183.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: Priority Health Medicare |
$1,183.98
|
| Rate for Payer: Priority Health SBD |
$2,364.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,183.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,332.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,183.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,183.98
|
| Rate for Payer: UHCCP Medicaid |
$666.58
|
| Rate for Payer: VA VA |
$1,183.98
|
|
|
HC INDUCTION OF ARRHYTHMIA
|
Facility
|
IP
|
$3,753.24
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
48100036
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,364.54 |
| Max. Negotiated Rate |
$3,377.92 |
| Rate for Payer: Aetna Commercial |
$3,190.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,439.61
|
| Rate for Payer: Cash Price |
$3,002.59
|
| Rate for Payer: Cofinity Commercial |
$2,627.27
|
| Rate for Payer: Cofinity Commercial |
$3,227.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,627.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.59
|
| Rate for Payer: Healthscope Commercial |
$3,377.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.25
|
| Rate for Payer: PHP Commercial |
$3,190.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.61
|
| Rate for Payer: Priority Health SBD |
$2,364.54
|
|
|
HC INDWELLING PORT
|
Facility
|
IP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$857.75 |
| Max. Negotiated Rate |
$1,225.35 |
| Rate for Payer: Aetna Commercial |
$1,157.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.98
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,170.89
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: PHP Commercial |
$1,157.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health SBD |
$857.75
|
|
|
HC INDWELLING PORT
|
Facility
|
OP
|
$1,361.50
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$1,225.35 |
| Rate for Payer: Aetna Commercial |
$1,157.28
|
| Rate for Payer: Aetna Medicare |
$680.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.98
|
| Rate for Payer: BCBS Complete |
$544.60
|
| Rate for Payer: Cash Price |
$1,089.20
|
| Rate for Payer: Cofinity Commercial |
$1,170.89
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$953.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,089.20
|
| Rate for Payer: Healthscope Commercial |
$1,225.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.28
|
| Rate for Payer: PHP Commercial |
$1,157.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.98
|
| Rate for Payer: Priority Health SBD |
$857.75
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
IP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$422.67 |
| Max. Negotiated Rate |
$603.82 |
| Rate for Payer: Aetna Commercial |
$570.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.09
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Cofinity Commercial |
$576.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: PHP Commercial |
$570.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health SBD |
$422.67
|
|
|
HC INFANT COOLING SYSTEM
|
Facility
|
OP
|
$670.91
|
|
| Hospital Charge Code |
27000644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$268.36 |
| Max. Negotiated Rate |
$603.82 |
| Rate for Payer: Aetna Commercial |
$570.27
|
| Rate for Payer: Aetna Medicare |
$335.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.09
|
| Rate for Payer: BCBS Complete |
$268.36
|
| Rate for Payer: Cash Price |
$536.73
|
| Rate for Payer: Cofinity Commercial |
$469.64
|
| Rate for Payer: Cofinity Commercial |
$576.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$469.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$536.73
|
| Rate for Payer: Healthscope Commercial |
$603.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.27
|
| Rate for Payer: PHP Commercial |
$570.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.09
|
| Rate for Payer: Priority Health SBD |
$422.67
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$269.67 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health SBD |
$98.32
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$53.94
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFECT AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30000171
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC INFLIXIMAB AB
|
Facility
|
OP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$14.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.65
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS MAPPO |
$14.12
|
| Rate for Payer: BCN Medicare Advantage |
$14.12
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Cofinity Commercial |
$132.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.12
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Mclaren Medicaid |
$7.57
|
| Rate for Payer: Mclaren Medicare |
$14.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.83
|
| Rate for Payer: Meridian Medicaid |
$7.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: PACE Medicare |
$13.41
|
| Rate for Payer: PACE SWMI |
$14.12
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: PHP Medicare Advantage |
$14.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health Medicare |
$14.12
|
| Rate for Payer: Priority Health SBD |
$118.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.12
|
| Rate for Payer: UHC Medicare Advantage |
$14.12
|
| Rate for Payer: UHCCP Medicaid |
$7.95
|
| Rate for Payer: VA VA |
$14.12
|
|
|
HC INFLIXIMAB AB
|
Facility
|
IP
|
$188.70
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100662
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.88 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.66
|
| Rate for Payer: Cash Price |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$132.09
|
| Rate for Payer: Cofinity Commercial |
$162.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$169.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.40
|
| Rate for Payer: PHP Commercial |
$160.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.66
|
| Rate for Payer: Priority Health SBD |
$118.88
|
|
|
HC INFLIXIMAB, S
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$21.71
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$20.67
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$21.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.57
|
| Rate for Payer: UHC Medicare Advantage |
$38.57
|
| Rate for Payer: UHCCP Medicaid |
$21.71
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC INFLIXIMAB, S
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 80230
|
| Hospital Charge Code |
30100705
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
OP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.45 |
| Max. Negotiated Rate |
$401.49 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$80.27
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$151.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$195.25
|
| Rate for Payer: Mclaren Medicaid |
$76.45
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: Meridian Medicaid |
$80.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$136.68
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$142.63
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC INFLUENZA A AND B PCR
|
Facility
|
IP
|
$216.95
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
30600207
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$136.68 |
| Max. Negotiated Rate |
$195.25 |
| Rate for Payer: Aetna Commercial |
$184.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.02
|
| Rate for Payer: Cash Price |
$173.56
|
| Rate for Payer: Cofinity Commercial |
$151.87
|
| Rate for Payer: Cofinity Commercial |
$186.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.56
|
| Rate for Payer: Healthscope Commercial |
$195.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.41
|
| Rate for Payer: PHP Commercial |
$184.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.02
|
| Rate for Payer: Priority Health SBD |
$136.68
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
OP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$269.67 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna Medicare |
$99.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.75
|
| Rate for Payer: BCBS Complete |
$53.92
|
| Rate for Payer: BCBS MAPPO |
$95.80
|
| Rate for Payer: BCN Medicare Advantage |
$95.80
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$102.01
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.80
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Mclaren Medicaid |
$51.35
|
| Rate for Payer: Mclaren Medicare |
$95.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.59
|
| Rate for Payer: Meridian Medicaid |
$53.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: PACE Medicare |
$91.01
|
| Rate for Payer: PACE SWMI |
$95.80
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: PHP Medicare Advantage |
$95.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health Medicare |
$95.80
|
| Rate for Payer: Priority Health SBD |
$91.81
|
| Rate for Payer: Railroad Medicare Medicare |
$95.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.80
|
| Rate for Payer: UHC Medicare Advantage |
$95.80
|
| Rate for Payer: UHCCP Medicaid |
$53.94
|
| Rate for Payer: VA VA |
$95.80
|
|
|
HC INFLUENZA A/B DNA AMP PROBE
|
Facility
|
IP
|
$145.73
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
30600314
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$91.81 |
| Max. Negotiated Rate |
$131.16 |
| Rate for Payer: Aetna Commercial |
$123.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.72
|
| Rate for Payer: Cash Price |
$116.58
|
| Rate for Payer: Cofinity Commercial |
$102.01
|
| Rate for Payer: Cofinity Commercial |
$125.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.58
|
| Rate for Payer: Healthscope Commercial |
$131.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.87
|
| Rate for Payer: PHP Commercial |
$123.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.72
|
| Rate for Payer: Priority Health SBD |
$91.81
|
|
