|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$7.39
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Cofinity Commercial |
$65.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Mclaren Medicaid |
$5.16
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Medicaid |
$5.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health SBD |
$58.59
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC Core |
$16.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.10
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCBS Trust/PPO |
$11.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$7.92
|
| Rate for Payer: Mclaren Medicare |
$14.48
|
| Rate for Payer: Meridian Medicaid |
$8.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Medicare |
$13.76
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.38
|
| Rate for Payer: UHC Core |
$18.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.48
|
| Rate for Payer: UHC Exchange |
$14.48
|
| Rate for Payer: UHC Medicare Advantage |
$14.91
|
| Rate for Payer: VA VA |
$14.48
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.77 |
| Max. Negotiated Rate |
$300.98 |
| Rate for Payer: Aetna Commercial |
$284.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.37
|
| Rate for Payer: BCBS Complete |
$133.77
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$234.09
|
| Rate for Payer: Cofinity Commercial |
$287.60
|
| Rate for Payer: Healthscope Commercial |
$300.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: PHP Commercial |
$284.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: Priority Health SBD |
$210.68
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.68 |
| Max. Negotiated Rate |
$300.98 |
| Rate for Payer: Aetna Commercial |
$284.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.37
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$234.09
|
| Rate for Payer: Cofinity Commercial |
$287.60
|
| Rate for Payer: Healthscope Commercial |
$300.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: PHP Commercial |
$284.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: Priority Health SBD |
$210.68
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: Aetna Commercial |
$289.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.33
|
| Rate for Payer: BCBS Complete |
$136.20
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$238.36
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Healthscope Commercial |
$306.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: PHP Commercial |
$289.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health SBD |
$214.52
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.52 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: Aetna Commercial |
$289.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.33
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$238.36
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Healthscope Commercial |
$306.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: PHP Commercial |
$289.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health SBD |
$214.52
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$83.96 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$88.17
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Mclaren Medicaid |
$83.96
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Medicaid |
$88.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$149.69
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.20
|
| Rate for Payer: UHC Core |
$184.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Exchange |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$158.10
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.44
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$166.32
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health SBD |
$149.69
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: BCBS Complete |
$57.44
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.31
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$112.58
|
| Rate for Payer: Cofinity Commercial |
$138.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$144.75
|
| Rate for Payer: Mclaren Medicaid |
$54.70
|
| Rate for Payer: Mclaren Medicare |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$57.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$136.71
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health SBD |
$101.32
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.00
|
| Rate for Payer: UHC Core |
$127.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.00
|
| Rate for Payer: UHC Exchange |
$100.00
|
| Rate for Payer: UHC Medicare Advantage |
$103.00
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.32 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.54
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$112.58
|
| Rate for Payer: Cofinity Commercial |
$138.31
|
| Rate for Payer: Healthscope Commercial |
$144.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: PHP Commercial |
$136.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: Priority Health SBD |
$101.32
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.90 |
| Max. Negotiated Rate |
$105.35 |
| Rate for Payer: Aetna Commercial |
$97.80
|
| Rate for Payer: Aetna Medicare |
$64.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.48
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$48.54
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$103.55
|
| Rate for Payer: Mclaren Medicaid |
$33.90
|
| Rate for Payer: Mclaren Medicare |
$61.98
|
| Rate for Payer: Meridian Medicaid |
$35.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$97.80
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health SBD |
$72.49
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.38
|
| Rate for Payer: UHC Core |
$105.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.98
|
| Rate for Payer: UHC Exchange |
$61.98
|
| Rate for Payer: UHC Medicare Advantage |
$63.84
|
| Rate for Payer: VA VA |
$61.98
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$115.06
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.49 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$97.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.79
|
| Rate for Payer: Cash Price |
$92.05
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Healthscope Commercial |
$103.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.80
|
| Rate for Payer: PHP Commercial |
$97.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.54
|
| Rate for Payer: Priority Health SBD |
$72.49
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health SBD |
$35.28
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.99 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Cofinity Commercial |
$39.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Mclaren Medicaid |
$7.99
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Medicaid |
$8.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health SBD |
$35.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.60
|
| Rate for Payer: UHC Exchange |
$14.60
|
| Rate for Payer: UHC Medicare Advantage |
$15.04
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$1,004.62 |
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: Aetna Medicare |
$337.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.93
|
| Rate for Payer: BCBS Complete |
$186.53
|
| Rate for Payer: BCBS MAPPO |
$324.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.62
|
| Rate for Payer: BCN Medicare Advantage |
$324.74
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.74
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Mclaren Medicaid |
$177.63
|
| Rate for Payer: Mclaren Medicare |
$324.74
|
| Rate for Payer: Meridian Medicaid |
$186.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$340.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$373.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PACE Medicare |
$308.51
|
| Rate for Payer: PACE SWMI |
$324.74
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: PHP Medicare Advantage |
$324.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health Medicare |
$324.74
|
| Rate for Payer: Priority Health SBD |
$640.65
|
| Rate for Payer: Railroad Medicare Medicare |
$324.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.74
|
| Rate for Payer: UHC Medicare Advantage |
$334.49
|
| Rate for Payer: VA VA |
$324.74
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,016.90
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$640.65 |
| Max. Negotiated Rate |
$915.21 |
| Rate for Payer: Aetna Commercial |
$864.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.98
|
| Rate for Payer: Cash Price |
$813.52
|
| Rate for Payer: Cofinity Commercial |
$711.83
|
| Rate for Payer: Cofinity Commercial |
$874.53
|
| Rate for Payer: Healthscope Commercial |
$915.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$864.36
|
| Rate for Payer: PHP Commercial |
$864.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$711.83
|
| Rate for Payer: Priority Health SBD |
$640.65
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Aetna Commercial |
$157.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.20
|
| Rate for Payer: BCBS Complete |
$73.97
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$159.03
|
| Rate for Payer: Cofinity Commercial |
$129.44
|
| Rate for Payer: Healthscope Commercial |
$166.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: PHP Commercial |
$157.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: Priority Health SBD |
$116.50
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$184.92
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.50 |
| Max. Negotiated Rate |
$166.43 |
| Rate for Payer: Aetna Commercial |
$157.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.20
|
| Rate for Payer: Cash Price |
$147.94
|
| Rate for Payer: Cofinity Commercial |
$129.44
|
| Rate for Payer: Cofinity Commercial |
$159.03
|
| Rate for Payer: Healthscope Commercial |
$166.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.18
|
| Rate for Payer: PHP Commercial |
$157.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.44
|
| Rate for Payer: Priority Health SBD |
$116.50
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$421.26
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$265.39 |
| Max. Negotiated Rate |
$379.13 |
| Rate for Payer: Aetna Commercial |
$358.07
|
| Rate for Payer: Aetna Commercial |
$376.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.82
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$310.10
|
| Rate for Payer: Cofinity Commercial |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Cofinity Commercial |
$380.98
|
| Rate for Payer: Healthscope Commercial |
$379.13
|
| Rate for Payer: Healthscope Commercial |
$398.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: PHP Commercial |
$358.07
|
| Rate for Payer: PHP Commercial |
$376.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health SBD |
$265.39
|
| Rate for Payer: Priority Health SBD |
$279.09
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$66.04 |
| Max. Negotiated Rate |
$398.70 |
| Rate for Payer: Aetna Commercial |
$376.55
|
| Rate for Payer: Aetna Commercial |
$358.07
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cash Price |
$337.01
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Cofinity Commercial |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$310.10
|
| Rate for Payer: Cofinity Commercial |
$380.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Healthscope Commercial |
$398.70
|
| Rate for Payer: Healthscope Commercial |
$379.13
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$358.07
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PHP Commercial |
$358.07
|
| Rate for Payer: PHP Commercial |
$376.55
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.88
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health SBD |
$279.09
|
| Rate for Payer: Priority Health SBD |
$265.39
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: VA VA |
$120.73
|
| Rate for Payer: VA VA |
$120.73
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$252.52 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Aetna Medicare |
$167.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.45
|
| Rate for Payer: BCBS Complete |
$92.57
|
| Rate for Payer: BCBS MAPPO |
$161.16
|
| Rate for Payer: BCBS Trust/PPO |
$153.69
|
| Rate for Payer: BCN Medicare Advantage |
$161.16
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$241.30
|
| Rate for Payer: Cofinity Commercial |
$196.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.16
|
| Rate for Payer: Healthscope Commercial |
$252.52
|
| Rate for Payer: Mclaren Medicaid |
$88.16
|
| Rate for Payer: Mclaren Medicare |
$161.16
|
| Rate for Payer: Meridian Medicaid |
$92.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$169.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: PACE Medicare |
$153.10
|
| Rate for Payer: PACE SWMI |
$161.16
|
| Rate for Payer: PHP Commercial |
$238.49
|
| Rate for Payer: PHP Medicare Advantage |
$161.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: Priority Health Medicare |
$161.16
|
| Rate for Payer: Priority Health SBD |
$176.77
|
| Rate for Payer: Railroad Medicare Medicare |
$161.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.16
|
| Rate for Payer: UHC Medicare Advantage |
$166.00
|
| Rate for Payer: VA VA |
$161.16
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$280.58
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$176.77 |
| Max. Negotiated Rate |
$252.52 |
| Rate for Payer: Aetna Commercial |
$238.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.38
|
| Rate for Payer: Cash Price |
$224.46
|
| Rate for Payer: Cofinity Commercial |
$196.41
|
| Rate for Payer: Cofinity Commercial |
$241.30
|
| Rate for Payer: Healthscope Commercial |
$252.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.49
|
| Rate for Payer: PHP Commercial |
$238.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.41
|
| Rate for Payer: Priority Health SBD |
$176.77
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
IP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,422.10 |
| Max. Negotiated Rate |
$3,460.15 |
| Rate for Payer: Aetna Commercial |
$3,267.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,499.00
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$2,691.23
|
| Rate for Payer: Cofinity Commercial |
$3,306.36
|
| Rate for Payer: Healthscope Commercial |
$3,460.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: PHP Commercial |
$3,267.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: Priority Health SBD |
$2,422.10
|
|
|
HC RADXF UNL ABD PERITONEUM OMENT
|
Facility
|
OP
|
$3,844.61
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
36100481
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$364.26 |
| Max. Negotiated Rate |
$3,460.15 |
| Rate for Payer: Aetna Commercial |
$3,267.92
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,499.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,008.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,008.22
|
| Rate for Payer: BCBS Complete |
$463.30
|
| Rate for Payer: BCBS MAPPO |
$806.58
|
| Rate for Payer: BCBS Trust/PPO |
$364.26
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cash Price |
$3,075.69
|
| Rate for Payer: Cofinity Commercial |
$3,306.36
|
| Rate for Payer: Cofinity Commercial |
$2,691.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$3,460.15
|
| Rate for Payer: Mclaren Medicaid |
$441.20
|
| Rate for Payer: Mclaren Medicare |
$806.58
|
| Rate for Payer: Meridian Medicaid |
$463.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$927.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,267.92
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$3,267.92
|
| Rate for Payer: PHP Medicare Advantage |
$806.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$441.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,691.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,519.41
|
| Rate for Payer: Priority Health Medicare |
$806.58
|
| Rate for Payer: Priority Health Narrow Network |
$2,015.53
|
| Rate for Payer: Priority Health SBD |
$2,422.10
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
