|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$405.96
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$365.36 |
| Rate for Payer: Aetna Commercial |
$345.07
|
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna Medicare |
$125.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.91
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS MAPPO |
$120.73
|
| Rate for Payer: BCBS Trust/PPO |
$87.85
|
| Rate for Payer: BCBS Trust/PPO |
$87.85
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.73
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$284.17
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.73
|
| Rate for Payer: Healthscope Commercial |
$365.36
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicaid |
$66.04
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Mclaren Medicare |
$120.73
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE Medicare |
$114.69
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PACE SWMI |
$120.73
|
| Rate for Payer: PHP Commercial |
$345.07
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: PHP Medicare Advantage |
$120.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health Medicare |
$120.73
|
| Rate for Payer: Priority Health SBD |
$213.57
|
| Rate for Payer: Priority Health SBD |
$255.75
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: Railroad Medicare Medicare |
$120.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.73
|
| Rate for Payer: UHC Exchange |
$38.64
|
| Rate for Payer: UHC Exchange |
$38.64
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: UHC Medicare Advantage |
$124.35
|
| Rate for Payer: VA VA |
$120.73
|
| Rate for Payer: VA VA |
$120.73
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$541.17 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$601.30
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health SBD |
$433.11
|
| Rate for Payer: Priority Health SBD |
$541.17
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Cofinity Commercial |
$481.24
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Cofinity Commercial |
$601.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health SBD |
$541.17
|
| Rate for Payer: Priority Health SBD |
$433.11
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: VA VA |
$239.13
|
| Rate for Payer: VA VA |
$239.13
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$289.29
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health SBD |
$260.36
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$120.45 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna Medicare |
$248.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.91
|
| Rate for Payer: BCBS Complete |
$137.36
|
| Rate for Payer: BCBS MAPPO |
$239.13
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: BCN Medicare Advantage |
$239.13
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Cofinity Commercial |
$289.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.13
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Mclaren Medicaid |
$130.80
|
| Rate for Payer: Mclaren Medicare |
$239.13
|
| Rate for Payer: Meridian Medicaid |
$137.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$251.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PACE Medicare |
$227.17
|
| Rate for Payer: PACE SWMI |
$239.13
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: PHP Medicare Advantage |
$239.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health Medicare |
$239.13
|
| Rate for Payer: Priority Health SBD |
$260.36
|
| Rate for Payer: Railroad Medicare Medicare |
$239.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.13
|
| Rate for Payer: UHC Medicare Advantage |
$246.30
|
| Rate for Payer: VA VA |
$239.13
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$541.17 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.36
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$601.30
|
| Rate for Payer: Cofinity Commercial |
$158.70
|
| Rate for Payer: Cofinity Commercial |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Healthscope Commercial |
$204.04
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: PHP Commercial |
$192.70
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health SBD |
$541.17
|
| Rate for Payer: Priority Health SBD |
$142.83
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: Aetna Medicare |
$110.97
|
| Rate for Payer: Aetna Medicare |
$110.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$133.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$133.38
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: BCBS Complete |
$61.29
|
| Rate for Payer: BCBS MAPPO |
$106.70
|
| Rate for Payer: BCBS MAPPO |
$106.70
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: BCN Medicare Advantage |
$106.70
|
| Rate for Payer: BCN Medicare Advantage |
$106.70
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cofinity Commercial |
$601.30
|
| Rate for Payer: Cofinity Commercial |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Cofinity Commercial |
$158.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.70
|
| Rate for Payer: Healthscope Commercial |
$204.04
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Mclaren Medicare |
$106.70
|
| Rate for Payer: Mclaren Medicare |
$106.70
|
| Rate for Payer: Meridian Medicaid |
$61.29
|
| Rate for Payer: Meridian Medicaid |
$61.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: PACE Medicare |
$101.36
|
| Rate for Payer: PACE Medicare |
$101.36
|
| Rate for Payer: PACE SWMI |
$106.70
|
| Rate for Payer: PACE SWMI |
$106.70
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: PHP Commercial |
$192.70
|
| Rate for Payer: PHP Medicare Advantage |
$106.70
|
| Rate for Payer: PHP Medicare Advantage |
$106.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$366.98
|
| Rate for Payer: Priority Health Medicare |
$106.70
|
| Rate for Payer: Priority Health Medicare |
$106.70
|
| Rate for Payer: Priority Health Narrow Network |
$293.58
|
| Rate for Payer: Priority Health Narrow Network |
$293.58
|
| Rate for Payer: Priority Health SBD |
$541.17
|
| Rate for Payer: Priority Health SBD |
$142.83
|
| Rate for Payer: Railroad Medicare Medicare |
$106.70
|
| Rate for Payer: Railroad Medicare Medicare |
$106.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.70
|
| Rate for Payer: UHC Medicare Advantage |
$109.90
|
| Rate for Payer: UHC Medicare Advantage |
$109.90
|
| Rate for Payer: VA VA |
$106.70
|
| Rate for Payer: VA VA |
$106.70
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
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 RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.34
|
| Rate for Payer: BCBS Complete |
$2.45
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| 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 |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Medicaid |
$2.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$7.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC RPR TITER
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
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 RPR TITER
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
30200425
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$4.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.50
|
| Rate for Payer: BCBS Complete |
$2.53
|
| Rate for Payer: BCBS MAPPO |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Medicare Advantage |
$4.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$2.41
|
| Rate for Payer: Mclaren Medicare |
$4.40
|
| Rate for Payer: Meridian Medicaid |
$2.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Medicare |
$4.18
|
| Rate for Payer: PACE SWMI |
$4.40
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$4.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health Medicare |
$4.40
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: Railroad Medicare Medicare |
$4.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC Core |
$7.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.40
|
| Rate for Payer: UHC Exchange |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$4.53
|
| Rate for Payer: VA VA |
$4.40
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health SBD |
$48.20
|
|
|
HC RSV DNA/RNA AMP PROBE
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 87634
|
| Hospital Charge Code |
30600315
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$103.99 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.75
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$70.20
|
| Rate for Payer: BCBS Trust/PPO |
$54.97
|
| Rate for Payer: BCN Medicare Advantage |
$70.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$38.40
|
| Rate for Payer: Mclaren Medicare |
$70.20
|
| Rate for Payer: Meridian Medicaid |
$40.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$66.69
|
| Rate for Payer: PACE SWMI |
$70.20
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$70.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$70.20
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$70.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.24
|
| Rate for Payer: UHC Core |
$103.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.20
|
| Rate for Payer: UHC Exchange |
$70.20
|
| Rate for Payer: UHC Medicare Advantage |
$72.31
|
| Rate for Payer: VA VA |
$70.20
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$1,467.09 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.09
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Cofinity Commercial |
$893.90
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health SBD |
$804.51
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 0.5ML IM
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
63600232
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$804.51 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$893.90
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health SBD |
$804.51
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
OP
|
$1,277.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$510.80 |
| Max. Negotiated Rate |
$1,467.09 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.09
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$893.90
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health SBD |
$804.51
|
|
|
HC RSV MONOCLONAL ANTB SEASONAL 1 ML IM
|
Facility
|
IP
|
$1,277.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
63600233
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$804.51 |
| Max. Negotiated Rate |
$1,149.30 |
| Rate for Payer: Aetna Commercial |
$1,085.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.05
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.22
|
| Rate for Payer: Cofinity Commercial |
$893.90
|
| Rate for Payer: Healthscope Commercial |
$1,149.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,085.45
|
| Rate for Payer: PHP Commercial |
$1,085.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
| Rate for Payer: Priority Health SBD |
$804.51
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
OP
|
$69.30
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: BCBS Complete |
$27.72
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$48.51
|
| Rate for Payer: Cofinity Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$62.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
| Rate for Payer: Priority Health SBD |
$43.66
|
|
|
HC RT ANGLE BALL COR CANN
|
Facility
|
IP
|
$69.30
|
|
| Hospital Charge Code |
27000268
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.66 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.04
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Cofinity Commercial |
$48.51
|
| Rate for Payer: Cofinity Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$62.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.90
|
| Rate for Payer: PHP Commercial |
$58.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.51
|
| Rate for Payer: Priority Health SBD |
$43.66
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC RUBELLA ANTIBODY IGC
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200315
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC RUBELLA ANTIBODY IGM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
30200423
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.99
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.27
|
| Rate for Payer: BCN Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$14.39
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$13.67
|
| Rate for Payer: PACE SWMI |
$14.39
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$14.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$14.39
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.27
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.39
|
| Rate for Payer: UHC Exchange |
$14.39
|
| Rate for Payer: UHC Medicare Advantage |
$14.82
|
| Rate for Payer: VA VA |
$14.39
|
|
