|
HC RUBEOLA VIRUS IGG
|
Facility
|
OP
|
$86.10
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.10
|
| Rate for Payer: BCBS Complete |
$7.40
|
| Rate for Payer: BCBS MAPPO |
$12.88
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Mclaren Medicaid |
$7.05
|
| Rate for Payer: Mclaren Medicare |
$12.88
|
| Rate for Payer: Meridian Medicaid |
$7.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PACE Medicare |
$12.24
|
| Rate for Payer: PACE SWMI |
$12.88
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health SBD |
$54.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.46
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.88
|
| Rate for Payer: UHC Exchange |
$12.88
|
| Rate for Payer: UHC Medicare Advantage |
$13.27
|
| Rate for Payer: VA VA |
$12.88
|
|
|
HC RUBEOLA VIRUS IGG
|
Facility
|
IP
|
$86.10
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
30200318
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.24 |
| Max. Negotiated Rate |
$77.49 |
| Rate for Payer: Aetna Commercial |
$73.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.96
|
| Rate for Payer: Cash Price |
$68.88
|
| Rate for Payer: Cofinity Commercial |
$60.27
|
| Rate for Payer: Cofinity Commercial |
$74.05
|
| Rate for Payer: Healthscope Commercial |
$77.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.18
|
| Rate for Payer: PHP Commercial |
$73.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.27
|
| Rate for Payer: Priority Health SBD |
$54.24
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
IP
|
$60.40
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.05 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health SBD |
$38.05
|
|
|
HC RUSSELL VIPER VENOM TIME DILUTED
|
Facility
|
OP
|
$60.40
|
|
|
Service Code
|
CPT 85613
|
| Hospital Charge Code |
30500059
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$54.36 |
| Rate for Payer: Aetna Commercial |
$51.34
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.98
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.51
|
| Rate for Payer: BCN Medicare Advantage |
$9.58
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cash Price |
$48.32
|
| Rate for Payer: Cofinity Commercial |
$51.94
|
| Rate for Payer: Cofinity Commercial |
$42.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$54.36
|
| Rate for Payer: Mclaren Medicaid |
$5.24
|
| Rate for Payer: Mclaren Medicare |
$9.58
|
| Rate for Payer: Meridian Medicaid |
$5.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.34
|
| Rate for Payer: PACE Medicare |
$9.10
|
| Rate for Payer: PACE SWMI |
$9.58
|
| Rate for Payer: PHP Commercial |
$51.34
|
| Rate for Payer: PHP Medicare Advantage |
$9.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.28
|
| Rate for Payer: Priority Health Medicare |
$9.58
|
| Rate for Payer: Priority Health SBD |
$38.05
|
| Rate for Payer: Railroad Medicare Medicare |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.50
|
| Rate for Payer: UHC Core |
$16.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.58
|
| Rate for Payer: UHC Exchange |
$9.58
|
| Rate for Payer: UHC Medicare Advantage |
$9.87
|
| Rate for Payer: VA VA |
$9.58
|
|
|
HC RUSSIAN THISTLE IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 RUSSIAN THISTLE IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200100
|
|
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 SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
OP
|
$1,326.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,127.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.90
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.36
|
| Rate for Payer: Cofinity Commercial |
$928.20
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.10
|
| Rate for Payer: PHP Commercial |
$1,127.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health SBD |
$835.38
|
|
|
HC SACRAL NERVE STIM, TEST LEAD, EACH
|
Facility
|
IP
|
$1,326.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27200315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.38 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Commercial |
$1,127.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.90
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.36
|
| Rate for Payer: Cofinity Commercial |
$928.20
|
| Rate for Payer: Healthscope Commercial |
$1,193.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,127.10
|
| Rate for Payer: PHP Commercial |
$1,127.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health SBD |
$835.38
|
|
|
HC SALICYLATE LVL.
|
Facility
|
OP
|
$100.43
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.99 |
| Max. Negotiated Rate |
$95.77 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.68
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$48.67
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Mclaren Medicaid |
$33.99
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Medicaid |
$35.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$63.27
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Core |
$95.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC SALICYLATE LVL.
|
Facility
|
IP
|
$100.43
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100649
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$90.39 |
| Rate for Payer: Aetna Commercial |
$85.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.28
|
| Rate for Payer: Cash Price |
$80.34
|
| Rate for Payer: Cofinity Commercial |
$70.30
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Healthscope Commercial |
$90.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.37
|
| Rate for Payer: PHP Commercial |
$85.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.30
|
| Rate for Payer: Priority Health SBD |
$63.27
|
|
|
HC SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| 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 SALICYLATE THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80179
|
| Hospital Charge Code |
30100730
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| 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 |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC SALMON IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
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 SALMON IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200059
|
|
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 |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| 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 SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
IP
|
$12,425.25
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$7,827.91 |
| Max. Negotiated Rate |
$11,182.72 |
| Rate for Payer: Aetna Commercial |
$10,561.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,076.41
|
| Rate for Payer: Cash Price |
$9,940.20
|
| Rate for Payer: Cofinity Commercial |
$10,685.72
|
| Rate for Payer: Cofinity Commercial |
$8,697.68
|
| Rate for Payer: Healthscope Commercial |
$11,182.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,561.46
|
| Rate for Payer: PHP Commercial |
$10,561.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,697.68
|
| Rate for Payer: Priority Health SBD |
$7,827.91
|
|
|
HC SAMARIUM 153 THERAPEUTIC PER TREATMENT DOSE
|
Facility
|
OP
|
$12,425.25
|
|
|
Service Code
|
HCPCS A9604
|
| Hospital Charge Code |
34400005
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$7,827.91 |
| Max. Negotiated Rate |
$21,574.82 |
| Rate for Payer: Aetna Commercial |
$10,561.46
|
| Rate for Payer: Aetna Medicare |
$17,950.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,076.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,574.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,574.82
|
| Rate for Payer: BCBS Complete |
$9,914.06
|
| Rate for Payer: BCBS MAPPO |
$17,259.85
|
| Rate for Payer: BCBS Trust/PPO |
$17,000.96
|
| Rate for Payer: BCN Medicare Advantage |
$17,259.85
|
| Rate for Payer: Cash Price |
$9,940.20
|
| Rate for Payer: Cash Price |
$9,940.20
|
| Rate for Payer: Cofinity Commercial |
$8,697.68
|
| Rate for Payer: Cofinity Commercial |
$10,685.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,259.85
|
| Rate for Payer: Healthscope Commercial |
$11,182.72
|
| Rate for Payer: Mclaren Medicaid |
$9,441.14
|
| Rate for Payer: Mclaren Medicare |
$17,259.85
|
| Rate for Payer: Meridian Medicaid |
$9,914.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,122.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,848.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,561.46
|
| Rate for Payer: PACE Medicare |
$16,396.86
|
| Rate for Payer: PACE SWMI |
$17,259.85
|
| Rate for Payer: PHP Commercial |
$10,561.46
|
| Rate for Payer: PHP Medicare Advantage |
$17,259.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,441.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,697.68
|
| Rate for Payer: Priority Health Medicare |
$17,259.85
|
| Rate for Payer: Priority Health SBD |
$7,827.91
|
| Rate for Payer: Railroad Medicare Medicare |
$17,259.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,259.85
|
| Rate for Payer: UHC Medicare Advantage |
$17,777.65
|
| Rate for Payer: VA VA |
$17,259.85
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health SBD |
$43.70
|
|
|
HC SARS CORONAVIRUS 2 IGG AB,S
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
30200479
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$43.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.66
|
| Rate for Payer: BCBS Complete |
$24.20
|
| Rate for Payer: BCBS MAPPO |
$42.13
|
| Rate for Payer: BCN Medicare Advantage |
$42.13
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$48.55
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.13
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$23.05
|
| Rate for Payer: Mclaren Medicare |
$42.13
|
| Rate for Payer: Meridian Medicaid |
$24.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Medicare |
$40.02
|
| Rate for Payer: PACE SWMI |
$42.13
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$42.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health Medicare |
$42.13
|
| Rate for Payer: Priority Health SBD |
$43.70
|
| Rate for Payer: Railroad Medicare Medicare |
$42.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.56
|
| Rate for Payer: UHC Core |
$50.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.13
|
| Rate for Payer: UHC Exchange |
$42.13
|
| Rate for Payer: UHC Medicare Advantage |
$43.39
|
| Rate for Payer: VA VA |
$42.13
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna Commercial |
$128.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.15
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$105.70
|
| Rate for Payer: Cofinity Commercial |
$129.86
|
| Rate for Payer: Healthscope Commercial |
$135.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.35
|
| Rate for Payer: PHP Commercial |
$128.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
| Rate for Payer: Priority Health SBD |
$95.13
|
|
|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600339
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna Commercial |
$128.35
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.09
|
| Rate for Payer: BCCCP Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$105.70
|
| Rate for Payer: Cofinity Commercial |
$129.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$135.90
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.35
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$128.35
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.70
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$95.13
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$61.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
OP
|
$214.20
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$111.69
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Cofinity Commercial |
$149.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.07
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.94
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$134.95
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Core |
$171.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARS-COV2/FLU A&B
|
Facility
|
IP
|
$214.20
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
30600318
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$149.94
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.07
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.94
|
| Rate for Payer: Priority Health SBD |
$134.95
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.42
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.93
|
| Rate for Payer: Priority Health SBD |
$157.44
|
|
|
HC SARS-COV2/FLU A&B/RSV
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 87637
|
| Hospital Charge Code |
30600319
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Medicare |
$148.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$178.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$178.29
|
| Rate for Payer: BCBS Complete |
$81.93
|
| Rate for Payer: BCBS MAPPO |
$142.63
|
| Rate for Payer: BCBS Trust/PPO |
$111.69
|
| Rate for Payer: BCN Medicare Advantage |
$142.63
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Cofinity Commercial |
$174.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Mclaren Medicaid |
$78.02
|
| Rate for Payer: Mclaren Medicare |
$142.63
|
| Rate for Payer: Meridian Medicaid |
$81.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.42
|
| Rate for Payer: PACE Medicare |
$135.50
|
| Rate for Payer: PACE SWMI |
$142.63
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: PHP Medicare Advantage |
$142.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.93
|
| Rate for Payer: Priority Health Medicare |
$142.63
|
| Rate for Payer: Priority Health SBD |
$157.44
|
| Rate for Payer: Railroad Medicare Medicare |
$142.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.16
|
| Rate for Payer: UHC Core |
$171.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.63
|
| Rate for Payer: UHC Exchange |
$142.63
|
| Rate for Payer: UHC Medicare Advantage |
$146.91
|
| Rate for Payer: VA VA |
$142.63
|
|
|
HC SARSCOV2 VAC 10MCG/0.3ML TRS-SUC IM
|
Facility
|
IP
|
$214.83
|
|
|
Service Code
|
CPT 91319
|
| Hospital Charge Code |
63600230
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.34 |
| Max. Negotiated Rate |
$193.35 |
| Rate for Payer: Aetna Commercial |
$182.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.64
|
| Rate for Payer: Cash Price |
$171.86
|
| Rate for Payer: Cofinity Commercial |
$150.38
|
| Rate for Payer: Cofinity Commercial |
$184.75
|
| Rate for Payer: Healthscope Commercial |
$193.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$182.61
|
| Rate for Payer: PHP Commercial |
$182.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.38
|
| Rate for Payer: Priority Health SBD |
$135.34
|
|
