|
HC IR Z ABSCESS PERIANAL
|
Facility
|
IP
|
$1,232.52
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$776.49 |
| Max. Negotiated Rate |
$1,109.27 |
| Rate for Payer: Aetna Commercial |
$1,047.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.14
|
| Rate for Payer: Cash Price |
$986.02
|
| Rate for Payer: Cofinity Advantage |
$862.76
|
| Rate for Payer: Cofinity Commercial |
$1,059.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.02
|
| Rate for Payer: Healthscope Commercial |
$1,109.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,047.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$924.39
|
| Rate for Payer: PHP Commercial |
$1,047.64
|
| Rate for Payer: Priority Health SBD |
$776.49
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
OP
|
$164.59
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna Medicare |
$35.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.42
|
| Rate for Payer: BCBS Complete |
$18.64
|
| Rate for Payer: BCBS MAPPO |
$33.94
|
| Rate for Payer: BCN Medicare Advantage |
$33.94
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Advantage |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.94
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Mclaren Medicaid |
$17.75
|
| Rate for Payer: Mclaren Medicare |
$33.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.64
|
| Rate for Payer: Meridian Medicaid |
$35.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: Nomi Health Commercial |
$50.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.44
|
| Rate for Payer: PACE Medicare |
$32.24
|
| Rate for Payer: PACE SWMI |
$33.94
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: PHP Medicare Advantage |
$33.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.94
|
| Rate for Payer: Priority Health Medicare |
$33.94
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: Priority Health Tiered Network |
$27.15
|
| Rate for Payer: Railroad Medicare Medicare |
$33.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.91
|
| Rate for Payer: UHC Core |
$50.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.94
|
| Rate for Payer: UHC Exchange |
$50.91
|
| Rate for Payer: UHC Medicaid |
$17.75
|
| Rate for Payer: UHCCP Medicaid |
$17.75
|
| Rate for Payer: VA VA |
$33.94
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
IP
|
$164.59
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$148.13 |
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cofinity Advantage |
$115.21
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.44
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: Priority Health SBD |
$103.69
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
OP
|
$56.24
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$12.94
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$25.13
|
| Rate for Payer: BCN Commercial |
$25.13
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$35.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.57
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$35.43
|
| Rate for Payer: Priority Health Tiered Network |
$18.86
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.36
|
| Rate for Payer: UHC Core |
$35.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.57
|
| Rate for Payer: UHC Exchange |
$35.36
|
| Rate for Payer: UHC Medicaid |
$12.33
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
IP
|
$56.24
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: Priority Health SBD |
$35.43
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$15.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$70.19
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: Priority Health SBD |
$70.19
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.19 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: Priority Health SBD |
$70.19
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$15.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$70.19
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$162.30
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: BCBS Complete |
$64.92
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Advantage |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health SBD |
$102.25
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$162.30
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.25 |
| Max. Negotiated Rate |
$146.07 |
| Rate for Payer: Aetna Commercial |
$137.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.50
|
| Rate for Payer: Cash Price |
$129.84
|
| Rate for Payer: Cofinity Advantage |
$113.61
|
| Rate for Payer: Cofinity Commercial |
$139.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.84
|
| Rate for Payer: Healthscope Commercial |
$146.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.72
|
| Rate for Payer: PHP Commercial |
$137.96
|
| Rate for Payer: Priority Health SBD |
$102.25
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.59
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Advantage |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health SBD |
$1.54
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.59
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cofinity Advantage |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.96
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.08
|
| Rate for Payer: Priority Health SBD |
$1.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.66
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.55
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.98
|
| Rate for Payer: BCN Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: Priority Health SBD |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.66
|
| Rate for Payer: UHC Core |
$0.66
|
| Rate for Payer: UHC Exchange |
$0.66
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.55
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Cash Price |
$3.64
|
| Rate for Payer: Cofinity Advantage |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.41
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: Priority Health SBD |
$2.87
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health SBD |
$1.25
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.10
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Advantage |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.53 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.10
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Advantage |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.07
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.26
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Advantage |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PHP Commercial |
$1.65
|
| Rate for Payer: Priority Health SBD |
$1.22
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.26
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$0.37
|
| Rate for Payer: BCN Commercial |
$0.37
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Advantage |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.46
|
| Rate for Payer: PHP Commercial |
$1.65
|
| Rate for Payer: Priority Health SBD |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Core |
$0.25
|
| Rate for Payer: UHC Exchange |
$0.25
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$328.12
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.72 |
| Max. Negotiated Rate |
$295.31 |
| Rate for Payer: Aetna Commercial |
$278.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.28
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cofinity Advantage |
$229.68
|
| Rate for Payer: Cofinity Commercial |
$282.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.50
|
| Rate for Payer: Healthscope Commercial |
$295.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.09
|
| Rate for Payer: PHP Commercial |
$278.90
|
| Rate for Payer: Priority Health SBD |
$206.72
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$328.12
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.35 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Commercial |
$278.90
|
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$128.35
|
| Rate for Payer: BCN Commercial |
$128.35
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cofinity Advantage |
$229.68
|
| Rate for Payer: Cofinity Commercial |
$282.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Healthscope Commercial |
$295.31
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.90
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$246.09
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Commercial |
$278.90
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health SBD |
$206.72
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.28
|
| Rate for Payer: UHC Core |
$170.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Exchange |
$128.95
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$122.11
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: Aetna Commercial |
$103.79
|
| Rate for Payer: Aetna Medicare |
$61.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.37
|
| Rate for Payer: BCBS Complete |
$48.84
|
| Rate for Payer: Cash Price |
$97.69
|
| Rate for Payer: Cofinity Advantage |
$85.48
|
| Rate for Payer: Cofinity Commercial |
$105.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.69
|
| Rate for Payer: Healthscope Commercial |
$109.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.58
|
| Rate for Payer: PHP Commercial |
$103.79
|
| Rate for Payer: Priority Health SBD |
$76.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.37
|
| Rate for Payer: UHC Core |
$63.62
|
| Rate for Payer: UHC Exchange |
$47.99
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$122.11
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: Aetna Commercial |
$103.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.37
|
| Rate for Payer: Cash Price |
$97.69
|
| Rate for Payer: Cofinity Advantage |
$85.48
|
| Rate for Payer: Cofinity Commercial |
$105.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.69
|
| Rate for Payer: Healthscope Commercial |
$109.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.58
|
| Rate for Payer: PHP Commercial |
$103.79
|
| Rate for Payer: Priority Health SBD |
$76.93
|
|
