|
HC JADA SYSTEM
|
Facility
|
IP
|
$3,697.50
|
|
| Hospital Charge Code |
27200395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,329.43 |
| Max. Negotiated Rate |
$3,327.75 |
| Rate for Payer: Aetna Commercial |
$3,142.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,403.38
|
| Rate for Payer: Cash Price |
$2,958.00
|
| Rate for Payer: Cofinity Advantage |
$2,588.25
|
| Rate for Payer: Cofinity Commercial |
$3,179.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,958.00
|
| Rate for Payer: Healthscope Commercial |
$3,327.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,142.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,773.12
|
| Rate for Payer: PHP Commercial |
$3,142.88
|
| Rate for Payer: Priority Health SBD |
$2,329.43
|
|
|
HC JADA SYSTEM
|
Facility
|
OP
|
$3,697.50
|
|
| Hospital Charge Code |
27200395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,453.12 |
| Max. Negotiated Rate |
$3,327.75 |
| Rate for Payer: Aetna Commercial |
$3,142.88
|
| Rate for Payer: Aetna Medicare |
$1,848.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,403.38
|
| Rate for Payer: BCBS Complete |
$1,479.00
|
| Rate for Payer: Cash Price |
$2,958.00
|
| Rate for Payer: Cofinity Advantage |
$2,588.25
|
| Rate for Payer: Cofinity Commercial |
$3,179.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,958.00
|
| Rate for Payer: Healthscope Commercial |
$3,327.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,958.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,142.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,773.12
|
| Rate for Payer: PHP Commercial |
$3,142.88
|
| Rate for Payer: Priority Health SBD |
$2,329.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,403.38
|
| Rate for Payer: UHC Core |
$1,926.40
|
| Rate for Payer: UHC Exchange |
$1,453.12
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
IP
|
$380.79
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$239.90 |
| Max. Negotiated Rate |
$342.71 |
| Rate for Payer: Aetna Commercial |
$323.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.51
|
| Rate for Payer: Cash Price |
$304.63
|
| Rate for Payer: Cofinity Advantage |
$266.55
|
| Rate for Payer: Cofinity Commercial |
$327.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.63
|
| Rate for Payer: Healthscope Commercial |
$342.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.59
|
| Rate for Payer: PHP Commercial |
$323.67
|
| Rate for Payer: Priority Health SBD |
$239.90
|
|
|
HC JAK2 EXON 12 MUTATION DETECTION
|
Facility
|
OP
|
$380.79
|
|
|
Service Code
|
CPT 0027U
|
| Hospital Charge Code |
31000148
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$365.73 |
| Rate for Payer: Aetna Commercial |
$323.67
|
| Rate for Payer: Aetna Medicare |
$126.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.39
|
| Rate for Payer: BCBS Complete |
$66.95
|
| Rate for Payer: BCBS MAPPO |
$121.91
|
| Rate for Payer: BCBS Trust/PPO |
$129.98
|
| Rate for Payer: BCN Commercial |
$129.98
|
| Rate for Payer: BCN Medicare Advantage |
$121.91
|
| Rate for Payer: Cash Price |
$304.63
|
| Rate for Payer: Cash Price |
$304.63
|
| Rate for Payer: Cofinity Advantage |
$266.55
|
| Rate for Payer: Cofinity Commercial |
$327.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.91
|
| Rate for Payer: Healthscope Commercial |
$342.71
|
| Rate for Payer: Mclaren Medicaid |
$63.76
|
| Rate for Payer: Mclaren Medicare |
$121.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.01
|
| Rate for Payer: Meridian Medicaid |
$128.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.67
|
| Rate for Payer: Nomi Health Commercial |
$365.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.59
|
| Rate for Payer: PACE Medicare |
$115.81
|
| Rate for Payer: PACE SWMI |
$121.91
|
| Rate for Payer: PHP Commercial |
$323.67
|
| Rate for Payer: PHP Medicare Advantage |
$121.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$121.91
|
| Rate for Payer: Priority Health Medicare |
$121.91
|
| Rate for Payer: Priority Health SBD |
$239.90
|
| Rate for Payer: Priority Health Tiered Network |
$97.53
|
| Rate for Payer: Railroad Medicare Medicare |
$121.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.87
|
| Rate for Payer: UHC Core |
$182.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$121.91
|
| Rate for Payer: UHC Exchange |
$182.87
|
| Rate for Payer: UHC Medicaid |
$63.76
|
| Rate for Payer: UHCCP Medicaid |
$63.76
|
| Rate for Payer: VA VA |
$121.91
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$395.83
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$336.46
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: BCBS Complete |
$50.34
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCN Commercial |
$97.73
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$316.66
|
| Rate for Payer: Cash Price |
$316.66
|
| Rate for Payer: Cofinity Advantage |
$277.08
|
| Rate for Payer: Cofinity Commercial |
$340.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$356.25
|
| Rate for Payer: Mclaren Medicaid |
$47.94
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$96.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.46
|
| Rate for Payer: Nomi Health Commercial |
$274.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.87
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$336.46
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91.66
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health SBD |
$249.37
|
| Rate for Payer: Priority Health Tiered Network |
$73.33
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.49
|
| Rate for Payer: UHC Core |
$137.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.66
|
| Rate for Payer: UHC Exchange |
$137.49
|
| Rate for Payer: UHC Medicaid |
$47.94
|
| Rate for Payer: UHCCP Medicaid |
$47.94
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
IP
|
$395.83
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$249.37 |
| Max. Negotiated Rate |
$356.25 |
| Rate for Payer: Aetna Commercial |
$336.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.29
|
| Rate for Payer: Cash Price |
$316.66
|
| Rate for Payer: Cofinity Advantage |
$277.08
|
| Rate for Payer: Cofinity Commercial |
$340.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.66
|
| Rate for Payer: Healthscope Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.87
|
| Rate for Payer: PHP Commercial |
$336.46
|
| Rate for Payer: Priority Health SBD |
$249.37
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
OP
|
$110.28
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Aetna Commercial |
$93.74
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cofinity Advantage |
$77.20
|
| Rate for Payer: Cofinity Commercial |
$94.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$99.25
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.74
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.71
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$93.74
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$69.48
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
IP
|
$110.28
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$99.25 |
| Rate for Payer: Aetna Commercial |
$93.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.68
|
| Rate for Payer: Cash Price |
$88.22
|
| Rate for Payer: Cofinity Advantage |
$77.20
|
| Rate for Payer: Cofinity Commercial |
$94.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.22
|
| Rate for Payer: Healthscope Commercial |
$99.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.71
|
| Rate for Payer: PHP Commercial |
$93.74
|
| Rate for Payer: Priority Health SBD |
$69.48
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
IP
|
$2,627.73
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,655.47 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
OP
|
$2,627.73
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$84.39 |
| Max. Negotiated Rate |
$2,364.96 |
| Rate for Payer: Aetna Commercial |
$2,233.57
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Commercial |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cash Price |
$2,102.18
|
| Rate for Payer: Cofinity Advantage |
$1,839.41
|
| Rate for Payer: Cofinity Commercial |
$2,259.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,102.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$2,364.96
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,233.57
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,970.80
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$2,233.57
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$1,655.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,708.02
|
| Rate for Payer: UHC Core |
$1,369.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$1,032.70
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC JET VENT SUB DAY
|
Facility
|
OP
|
$1,935.76
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$1,990.71 |
| Rate for Payer: Aetna Commercial |
$1,645.40
|
| Rate for Payer: Aetna Medicare |
$640.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.46
|
| Rate for Payer: BCBS Complete |
$338.07
|
| Rate for Payer: BCBS MAPPO |
$615.57
|
| Rate for Payer: BCBS Trust/PPO |
$62.18
|
| Rate for Payer: BCN Commercial |
$62.18
|
| Rate for Payer: BCN Medicare Advantage |
$615.57
|
| Rate for Payer: Cash Price |
$1,548.61
|
| Rate for Payer: Cash Price |
$1,548.61
|
| Rate for Payer: Cofinity Advantage |
$1,355.03
|
| Rate for Payer: Cofinity Commercial |
$1,664.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,548.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.57
|
| Rate for Payer: Healthscope Commercial |
$1,742.18
|
| Rate for Payer: Mclaren Medicaid |
$321.94
|
| Rate for Payer: Mclaren Medicare |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.35
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,645.40
|
| Rate for Payer: Nomi Health Commercial |
$1,846.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,451.82
|
| Rate for Payer: PACE Medicare |
$584.79
|
| Rate for Payer: PACE SWMI |
$615.57
|
| Rate for Payer: PHP Commercial |
$1,645.40
|
| Rate for Payer: PHP Medicare Advantage |
$615.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,990.71
|
| Rate for Payer: Priority Health Medicare |
$615.57
|
| Rate for Payer: Priority Health SBD |
$1,219.53
|
| Rate for Payer: Priority Health Tiered Network |
$1,592.57
|
| Rate for Payer: Railroad Medicare Medicare |
$615.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.24
|
| Rate for Payer: UHC Core |
$1,008.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.57
|
| Rate for Payer: UHC Exchange |
$760.75
|
| Rate for Payer: UHC Medicaid |
$321.94
|
| Rate for Payer: UHCCP Medicaid |
$321.94
|
| Rate for Payer: VA VA |
$615.57
|
|
|
HC JET VENT SUB DAY
|
Facility
|
IP
|
$1,935.76
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,219.53 |
| Max. Negotiated Rate |
$1,742.18 |
| Rate for Payer: Aetna Commercial |
$1,645.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.24
|
| Rate for Payer: Cash Price |
$1,548.61
|
| Rate for Payer: Cofinity Advantage |
$1,355.03
|
| Rate for Payer: Cofinity Commercial |
$1,664.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,548.61
|
| Rate for Payer: Healthscope Commercial |
$1,742.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,645.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,451.82
|
| Rate for Payer: PHP Commercial |
$1,645.40
|
| Rate for Payer: Priority Health SBD |
$1,219.53
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$9.85
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.12
|
| Rate for Payer: BCN Commercial |
$19.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Mclaren Medicaid |
$9.38
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.60
|
| Rate for Payer: Priority Health Tiered Network |
$14.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Core |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.93
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$9.38
|
| Rate for Payer: UHCCP Medicaid |
$9.38
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
IP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.32
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Advantage |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: Priority Health SBD |
$22.60
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$11.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.50
|
| Rate for Payer: PHP Commercial |
$9.63
|
| Rate for Payer: Priority Health SBD |
$7.14
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$11.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.63
|
| Rate for Payer: Aetna Medicare |
$5.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.36
|
| Rate for Payer: BCBS Complete |
$4.53
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cofinity Advantage |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.06
|
| Rate for Payer: Healthscope Commercial |
$10.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.50
|
| Rate for Payer: PHP Commercial |
$9.63
|
| Rate for Payer: Priority Health SBD |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.36
|
| Rate for Payer: UHC Core |
$5.90
|
| Rate for Payer: UHC Exchange |
$4.45
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$217.13
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$280.42 |
| Rate for Payer: Aetna Commercial |
$184.56
|
| Rate for Payer: Aetna Medicare |
$90.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.39
|
| Rate for Payer: BCBS Complete |
$47.62
|
| Rate for Payer: BCBS MAPPO |
$86.71
|
| Rate for Payer: BCBS Trust/PPO |
$123.41
|
| Rate for Payer: BCN Commercial |
$123.41
|
| Rate for Payer: BCN Medicare Advantage |
$86.71
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Advantage |
$151.99
|
| Rate for Payer: Cofinity Commercial |
$186.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.71
|
| Rate for Payer: Healthscope Commercial |
$195.42
|
| Rate for Payer: Mclaren Medicaid |
$45.35
|
| Rate for Payer: Mclaren Medicare |
$86.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.05
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Nomi Health Commercial |
$260.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: PACE Medicare |
$82.37
|
| Rate for Payer: PACE SWMI |
$86.71
|
| Rate for Payer: PHP Commercial |
$184.56
|
| Rate for Payer: PHP Medicare Advantage |
$86.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.42
|
| Rate for Payer: Priority Health Medicare |
$86.71
|
| Rate for Payer: Priority Health SBD |
$136.79
|
| Rate for Payer: Priority Health Tiered Network |
$224.34
|
| Rate for Payer: Railroad Medicare Medicare |
$86.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.13
|
| Rate for Payer: UHC Core |
$113.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.71
|
| Rate for Payer: UHC Exchange |
$85.33
|
| Rate for Payer: UHC Medicaid |
$45.35
|
| Rate for Payer: UHCCP Medicaid |
$45.35
|
| Rate for Payer: VA VA |
$86.71
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$217.13
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.79 |
| Max. Negotiated Rate |
$195.42 |
| Rate for Payer: Aetna Commercial |
$184.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.13
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cofinity Advantage |
$151.99
|
| Rate for Payer: Cofinity Commercial |
$186.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.70
|
| Rate for Payer: Healthscope Commercial |
$195.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: PHP Commercial |
$184.56
|
| Rate for Payer: Priority Health SBD |
$136.79
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.75
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$49.75
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KARIUS SPECTRUM, PLASMA
|
Facility
|
OP
|
$2,225.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,112.00 |
| Max. Negotiated Rate |
$3,189.30 |
| Rate for Payer: Aetna Commercial |
$1,891.25
|
| Rate for Payer: Aetna Medicare |
$2,211.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,657.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,657.75
|
| Rate for Payer: BCBS Complete |
$1,167.71
|
| Rate for Payer: BCBS MAPPO |
$2,126.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,126.20
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Advantage |
$1,557.50
|
| Rate for Payer: Cofinity Commercial |
$1,913.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,126.20
|
| Rate for Payer: Healthscope Commercial |
$2,002.50
|
| Rate for Payer: Mclaren Medicaid |
$1,112.00
|
| Rate for Payer: Mclaren Medicare |
$2,126.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,232.51
|
| Rate for Payer: Meridian Medicaid |
$2,232.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,445.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,338.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.25
|
| Rate for Payer: Nomi Health Commercial |
$3,189.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.75
|
| Rate for Payer: PACE Medicare |
$2,019.89
|
| Rate for Payer: PACE SWMI |
$2,126.20
|
| Rate for Payer: PHP Commercial |
$1,891.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,126.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,126.20
|
| Rate for Payer: Priority Health Medicare |
$2,126.20
|
| Rate for Payer: Priority Health SBD |
$1,401.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,700.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2,126.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,189.30
|
| Rate for Payer: UHC Core |
$3,189.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,126.20
|
| Rate for Payer: UHC Exchange |
$3,189.30
|
| Rate for Payer: UHC Medicaid |
$1,112.00
|
| Rate for Payer: UHCCP Medicaid |
$1,112.00
|
| Rate for Payer: VA VA |
$2,126.20
|
|
|
HC KARIUS SPECTRUM, PLASMA
|
Facility
|
IP
|
$2,225.00
|
|
|
Service Code
|
CPT 0152U
|
| Hospital Charge Code |
30000177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,401.75 |
| Max. Negotiated Rate |
$2,002.50 |
| Rate for Payer: Aetna Commercial |
$1,891.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.25
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Advantage |
$1,557.50
|
| Rate for Payer: Cofinity Commercial |
$1,913.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.00
|
| Rate for Payer: Healthscope Commercial |
$2,002.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.75
|
| Rate for Payer: PHP Commercial |
$1,891.25
|
| Rate for Payer: Priority Health SBD |
$1,401.75
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC KERECIS OMEGA3 MARIGEN 3X3.5, PER SQ CM
|
Facility
|
OP
|
$182.07
|
|
|
Service Code
|
HCPCS Q4158
|
| Hospital Charge Code |
63600272
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$154.76
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$88.86
|
| Rate for Payer: BCN Commercial |
$265.37
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cash Price |
$145.66
|
| Rate for Payer: Cofinity Advantage |
$127.45
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$163.86
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.76
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.55
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$154.76
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$114.70
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
