|
HC RFABLATION NRV INNERVATING SI JT W IMAG
|
Facility
|
OP
|
$2,630.61
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
36100594
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$5,467.25 |
| Rate for Payer: Aetna Commercial |
$2,236.02
|
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cash Price |
$2,104.49
|
| Rate for Payer: Cofinity Commercial |
$1,841.43
|
| Rate for Payer: Cofinity Commercial |
$2,262.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Healthscope Commercial |
$2,367.55
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,236.02
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Commercial |
$2,236.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,841.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,467.25
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,373.80
|
| Rate for Payer: Priority Health SBD |
$1,657.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.35
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$191.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
IP
|
$1,753.45
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,104.67 |
| Max. Negotiated Rate |
$1,578.10 |
| Rate for Payer: Aetna Commercial |
$1,490.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,139.74
|
| Rate for Payer: Cash Price |
$1,402.76
|
| Rate for Payer: Cofinity Commercial |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,507.97
|
| Rate for Payer: Healthscope Commercial |
$1,578.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,490.43
|
| Rate for Payer: PHP Commercial |
$1,490.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.42
|
| Rate for Payer: Priority Health SBD |
$1,104.67
|
|
|
HC RF TRANSSEPTAL NEEDLE
|
Facility
|
OP
|
$1,753.45
|
|
| Hospital Charge Code |
27200285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$701.38 |
| Max. Negotiated Rate |
$1,578.10 |
| Rate for Payer: Aetna Commercial |
$1,490.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,139.74
|
| Rate for Payer: BCBS Complete |
$701.38
|
| Rate for Payer: Cash Price |
$1,402.76
|
| Rate for Payer: Cofinity Commercial |
$1,227.42
|
| Rate for Payer: Cofinity Commercial |
$1,507.97
|
| Rate for Payer: Healthscope Commercial |
$1,578.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,490.43
|
| Rate for Payer: PHP Commercial |
$1,490.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.42
|
| Rate for Payer: Priority Health SBD |
$1,104.67
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC RHEUMATOID FACTOR
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
30200211
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$5.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.09
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS MAPPO |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: BCN Medicare Advantage |
$5.67
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.67
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$3.10
|
| Rate for Payer: Mclaren Medicare |
$5.67
|
| Rate for Payer: Meridian Medicaid |
$3.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$5.39
|
| Rate for Payer: PACE SWMI |
$5.67
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.80
|
| Rate for Payer: UHC Core |
$9.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.67
|
| Rate for Payer: UHC Exchange |
$5.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.84
|
| Rate for Payer: VA VA |
$5.67
|
|
|
HC RHOGAM
|
Facility
|
OP
|
$278.41
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$266.98 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: BCBS Complete |
$111.36
|
| Rate for Payer: BCBS Trust/PPO |
$266.98
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.89
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC RHOGAM
|
Facility
|
IP
|
$278.41
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
63600006
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.40 |
| Max. Negotiated Rate |
$250.57 |
| Rate for Payer: Aetna Commercial |
$236.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.97
|
| Rate for Payer: Cash Price |
$222.73
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$239.43
|
| Rate for Payer: Healthscope Commercial |
$250.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$236.65
|
| Rate for Payer: PHP Commercial |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.89
|
| Rate for Payer: Priority Health SBD |
$175.40
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| 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 |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC RIBOSOME P AB, IGG
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200433
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
IP
|
$3,693.37
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,326.82 |
| Max. Negotiated Rate |
$3,324.03 |
| Rate for Payer: Aetna Commercial |
$3,139.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.69
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$2,585.36
|
| Rate for Payer: Cofinity Commercial |
$3,176.30
|
| Rate for Payer: Healthscope Commercial |
$3,324.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PHP Commercial |
$3,139.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health SBD |
$2,326.82
|
|
|
HC RIGHT VENTRICULAR RECORDING
|
Facility
|
OP
|
$3,693.37
|
|
|
Service Code
|
CPT 93603
|
| Hospital Charge Code |
48100031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$579.26 |
| Max. Negotiated Rate |
$3,324.03 |
| Rate for Payer: Aetna Commercial |
$3,139.36
|
| Rate for Payer: Aetna Medicare |
$1,101.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,323.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,323.71
|
| Rate for Payer: BCBS Complete |
$608.27
|
| Rate for Payer: BCBS MAPPO |
$1,058.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,245.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,058.97
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cash Price |
$2,954.70
|
| Rate for Payer: Cofinity Commercial |
$3,176.30
|
| Rate for Payer: Cofinity Commercial |
$2,585.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,058.97
|
| Rate for Payer: Healthscope Commercial |
$3,324.03
|
| Rate for Payer: Mclaren Medicaid |
$579.26
|
| Rate for Payer: Mclaren Medicare |
$1,058.97
|
| Rate for Payer: Meridian Medicaid |
$608.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,111.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,217.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,139.36
|
| Rate for Payer: PACE Medicare |
$1,006.02
|
| Rate for Payer: PACE SWMI |
$1,058.97
|
| Rate for Payer: PHP Commercial |
$3,139.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,058.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,585.36
|
| Rate for Payer: Priority Health Medicare |
$1,058.97
|
| Rate for Payer: Priority Health SBD |
$2,326.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,058.97
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,058.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.74
|
| Rate for Payer: VA VA |
$1,058.97
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health SBD |
$69.93
|
|
|
HC RISPERIDONE AND METABOLIT
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
30100691
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Aetna Commercial |
$94.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.15
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$95.46
|
| Rate for Payer: Cofinity Commercial |
$77.70
|
| Rate for Payer: Healthscope Commercial |
$99.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.35
|
| Rate for Payer: PHP Commercial |
$94.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health SBD |
$69.93
|
| Rate for Payer: UHC Core |
$25.43
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
OP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Cofinity Commercial |
$47.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Mclaren Medicaid |
$12.55
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Medicaid |
$13.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$42.67
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.53
|
| Rate for Payer: UHC Core |
$39.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC RISTOCETIN COFACTOR
|
Facility
|
IP
|
$67.73
|
|
|
Service Code
|
CPT 85245
|
| Hospital Charge Code |
30500023
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$60.96 |
| Rate for Payer: Aetna Commercial |
$57.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.02
|
| Rate for Payer: Cash Price |
$54.18
|
| Rate for Payer: Cofinity Commercial |
$58.25
|
| Rate for Payer: Cofinity Commercial |
$47.41
|
| Rate for Payer: Healthscope Commercial |
$60.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.57
|
| Rate for Payer: PHP Commercial |
$57.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.41
|
| Rate for Payer: Priority Health SBD |
$42.67
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
IP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.78 |
| Max. Negotiated Rate |
$83.97 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$65.31
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Healthscope Commercial |
$83.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: Priority Health SBD |
$58.78
|
|
|
HC RIV 4 VACC RECOMBINANT DNA PRSRV ABX FREE
|
Facility
|
OP
|
$93.30
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
63600171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.32 |
| Max. Negotiated Rate |
$213.92 |
| Rate for Payer: Aetna Commercial |
$79.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.64
|
| Rate for Payer: BCBS Complete |
$37.32
|
| Rate for Payer: BCBS Trust/PPO |
$213.92
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cash Price |
$74.64
|
| Rate for Payer: Cofinity Commercial |
$65.31
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Healthscope Commercial |
$83.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.30
|
| Rate for Payer: PHP Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.31
|
| Rate for Payer: Priority Health SBD |
$58.78
|
|
|
HC RLC W INTERVENTION
|
Facility
|
OP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,202.04 |
| Max. Negotiated Rate |
$9,881.90 |
| Rate for Payer: Aetna Commercial |
$9,332.91
|
| Rate for Payer: Aetna Medicare |
$3,015.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,136.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,624.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,624.31
|
| Rate for Payer: BCBS Complete |
$1,665.44
|
| Rate for Payer: BCBS MAPPO |
$2,899.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,046.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,899.45
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$7,685.92
|
| Rate for Payer: Cofinity Commercial |
$9,442.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,899.45
|
| Rate for Payer: Healthscope Commercial |
$9,881.90
|
| Rate for Payer: Mclaren Medicaid |
$1,586.00
|
| Rate for Payer: Mclaren Medicare |
$2,899.45
|
| Rate for Payer: Meridian Medicaid |
$1,665.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,044.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,334.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: PACE Medicare |
$2,754.48
|
| Rate for Payer: PACE SWMI |
$2,899.45
|
| Rate for Payer: PHP Commercial |
$9,332.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,899.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,586.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: Priority Health Medicare |
$2,899.45
|
| Rate for Payer: Priority Health SBD |
$6,917.33
|
| Rate for Payer: Railroad Medicare Medicare |
$2,899.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.24
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,899.45
|
| Rate for Payer: UHC Exchange |
$1,202.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,986.43
|
| Rate for Payer: VA VA |
$2,899.45
|
|
|
HC RLC W INTERVENTION
|
Facility
|
IP
|
$10,979.89
|
|
|
Service Code
|
CPT 93460
|
| Hospital Charge Code |
48100020
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,917.33 |
| Max. Negotiated Rate |
$9,881.90 |
| Rate for Payer: Aetna Commercial |
$9,332.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,136.93
|
| Rate for Payer: Cash Price |
$8,783.91
|
| Rate for Payer: Cofinity Commercial |
$7,685.92
|
| Rate for Payer: Cofinity Commercial |
$9,442.71
|
| Rate for Payer: Healthscope Commercial |
$9,881.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,332.91
|
| Rate for Payer: PHP Commercial |
$9,332.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,685.92
|
| Rate for Payer: Priority Health SBD |
$6,917.33
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,480.50 |
| Max. Negotiated Rate |
$2,115.00 |
| Rate for Payer: Aetna Commercial |
$1,997.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.50
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$1,645.00
|
| Rate for Payer: Cofinity Commercial |
$2,021.00
|
| Rate for Payer: Healthscope Commercial |
$2,115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,997.50
|
| Rate for Payer: PHP Commercial |
$1,997.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: Priority Health SBD |
$1,480.50
|
|
|
HC RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
76100458
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.64 |
| Max. Negotiated Rate |
$2,519.41 |
| Rate for Payer: Aetna Commercial |
$1,997.50
|
| Rate for Payer: Aetna Medicare |
$838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,527.50
|
| 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 |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$806.58
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cofinity Commercial |
$1,645.00
|
| Rate for Payer: Cofinity Commercial |
$2,021.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$806.58
|
| Rate for Payer: Healthscope Commercial |
$2,115.00
|
| 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 |
$1,997.50
|
| Rate for Payer: PACE Medicare |
$766.25
|
| Rate for Payer: PACE SWMI |
$806.58
|
| Rate for Payer: PHP Commercial |
$1,997.50
|
| 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 |
$1,645.00
|
| 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 |
$1,480.50
|
| Rate for Payer: Railroad Medicare Medicare |
$806.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$806.58
|
| Rate for Payer: UHC Exchange |
$112.64
|
| Rate for Payer: UHC Medicare Advantage |
$830.78
|
| Rate for Payer: VA VA |
$806.58
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Mclaren Medicaid |
$6.31
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Medicaid |
$6.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Exchange |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.88
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC RNA POLYMERASE III AB IGG
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200413
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC RNP 70 ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200164
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| 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 |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
