|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| 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 |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.22
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: Priority Health SBD |
$7.00
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.22
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: Priority Health SBD |
$7.00
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$241.72 |
| Rate for Payer: Aetna Commercial |
$180.94
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.34
|
| Rate for Payer: BCBS Complete |
$48.33
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Cofinity Commercial |
$149.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$191.58
|
| Rate for Payer: Mclaren Medicaid |
$46.03
|
| Rate for Payer: Mclaren Medicare |
$85.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Meridian Medicaid |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: PACE Medicare |
$81.58
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Commercial |
$180.94
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: Priority Health SBD |
$134.11
|
| Rate for Payer: Railroad Medicare Medicare |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.72
|
| Rate for Payer: UHC Core |
$157.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Exchange |
$157.52
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
| Rate for Payer: UHCCP Medicaid |
$48.34
|
| Rate for Payer: VA VA |
$85.87
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$191.58 |
| Rate for Payer: Aetna Commercial |
$180.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.37
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$149.01
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$191.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: PHP Commercial |
$180.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health SBD |
$134.11
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.77 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health SBD |
$48.77
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$54.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$48.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$4.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.65
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS MAPPO |
$4.52
|
| Rate for Payer: BCN Medicare Advantage |
$4.52
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Mclaren Medicaid |
$2.42
|
| Rate for Payer: Mclaren Medicare |
$4.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.75
|
| Rate for Payer: Meridian Medicaid |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: PACE Medicare |
$4.29
|
| Rate for Payer: PACE SWMI |
$4.52
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health Medicare |
$4.52
|
| Rate for Payer: Priority Health SBD |
$23.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.52
|
| Rate for Payer: UHC Medicare Advantage |
$4.52
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$4.52
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.93
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$25.77
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health SBD |
$23.20
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,760.99 |
| Max. Negotiated Rate |
$5,372.84 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,880.38
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$4,178.87
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,178.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health SBD |
$3,760.99
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,880.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Cofinity Commercial |
$4,178.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,178.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Priority Health SBD |
$3,760.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,791.33
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$124.59 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.98
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Cofinity Commercial |
$96.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health SBD |
$87.21
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$124.59 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.98
|
| Rate for Payer: BCBS Complete |
$55.37
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Cofinity Commercial |
$96.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health SBD |
$87.21
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC KIT ATS
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.45
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$107.10
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health SBD |
$96.39
|
|
|
HC KIT DILATOR VASC
|
Facility
|
IP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$337.37 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.07
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health SBD |
$337.37
|
|
|
HC KIT DILATOR VASC
|
Facility
|
OP
|
$535.50
|
|
| Hospital Charge Code |
27000101
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.07
|
| Rate for Payer: BCBS Complete |
$214.20
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.07
|
| Rate for Payer: Priority Health SBD |
$337.37
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
IP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.63 |
| Max. Negotiated Rate |
$110.90 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.09
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Healthscope Commercial |
$110.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: PHP Commercial |
$104.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: Priority Health SBD |
$77.63
|
|
|
HC KLEIHAUER-BETKE STAIN
|
Facility
|
OP
|
$123.22
|
|
|
Service Code
|
CPT 85460
|
| Hospital Charge Code |
30500046
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$110.90 |
| Rate for Payer: Aetna Commercial |
$104.74
|
| Rate for Payer: Aetna Medicare |
$8.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.66
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$7.73
|
| Rate for Payer: BCN Medicare Advantage |
$7.73
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cash Price |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Cofinity Commercial |
$105.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.73
|
| Rate for Payer: Healthscope Commercial |
$110.90
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicare |
$7.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.12
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.74
|
| Rate for Payer: PACE Medicare |
$7.34
|
| Rate for Payer: PACE SWMI |
$7.73
|
| Rate for Payer: PHP Commercial |
$104.74
|
| Rate for Payer: PHP Medicare Advantage |
$7.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.09
|
| Rate for Payer: Priority Health Medicare |
$7.73
|
| Rate for Payer: Priority Health SBD |
$77.63
|
| Rate for Payer: Railroad Medicare Medicare |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.73
|
| Rate for Payer: UHC Medicare Advantage |
$7.73
|
| Rate for Payer: UHCCP Medicaid |
$4.35
|
| Rate for Payer: VA VA |
$7.73
|
|
|
HC KOH PREPARATION
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| 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 |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$2.29
|
| Rate for Payer: Mclaren Medicare |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP Medicaid |
$2.40
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC KOH PREPARATION
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
30600111
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.55
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$16.75
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health SBD |
$15.08
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
OP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,174.57 |
| Max. Negotiated Rate |
$2,642.79 |
| Rate for Payer: Aetna Commercial |
$2,495.97
|
| Rate for Payer: Aetna Medicare |
$1,468.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,908.68
|
| Rate for Payer: BCBS Complete |
$1,174.57
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,055.50
|
| Rate for Payer: Cofinity Commercial |
$2,525.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,055.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: PHP Commercial |
$2,495.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: Priority Health SBD |
$1,849.95
|
|
|
HC KYLEENA 19.5MG
|
Facility
|
IP
|
$2,936.43
|
|
|
Service Code
|
CPT J7296
|
| Hospital Charge Code |
63600165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,849.95 |
| Max. Negotiated Rate |
$2,642.79 |
| Rate for Payer: Aetna Commercial |
$2,495.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,908.68
|
| Rate for Payer: Cash Price |
$2,349.14
|
| Rate for Payer: Cofinity Commercial |
$2,055.50
|
| Rate for Payer: Cofinity Commercial |
$2,525.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,055.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,349.14
|
| Rate for Payer: Healthscope Commercial |
$2,642.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,495.97
|
| Rate for Payer: PHP Commercial |
$2,495.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,908.68
|
| Rate for Payer: Priority Health SBD |
$1,849.95
|
|
