|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
OP
|
$2,375.75
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,138.18 |
| Rate for Payer: Aetna Commercial |
$2,019.39
|
| Rate for Payer: Aetna Commercial |
$3,029.09
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,316.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$586.79
|
| Rate for Payer: BCBS Trust/PPO |
$586.79
|
| Rate for Payer: BCN Commercial |
$586.79
|
| Rate for Payer: BCN Commercial |
$586.79
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cofinity Advantage |
$2,494.54
|
| Rate for Payer: Cofinity Advantage |
$1,663.03
|
| Rate for Payer: Cofinity Commercial |
$3,064.72
|
| Rate for Payer: Cofinity Commercial |
$2,043.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,138.18
|
| Rate for Payer: Healthscope Commercial |
$3,207.27
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,019.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,029.09
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,672.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.81
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$3,029.09
|
| Rate for Payer: PHP Commercial |
$2,019.39
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,245.09
|
| Rate for Payer: Priority Health SBD |
$1,496.72
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,544.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,316.36
|
| Rate for Payer: UHC Core |
$1,856.65
|
| Rate for Payer: UHC Core |
$1,237.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,400.51
|
| Rate for Payer: UHC Exchange |
$933.67
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM NO JOINT W CON
|
Facility
|
IP
|
$2,375.75
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
61000018
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,496.72 |
| Max. Negotiated Rate |
$2,138.18 |
| Rate for Payer: Aetna Commercial |
$2,019.39
|
| Rate for Payer: Aetna Commercial |
$3,029.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,316.36
|
| Rate for Payer: Cash Price |
$1,900.60
|
| Rate for Payer: Cash Price |
$2,850.90
|
| Rate for Payer: Cofinity Advantage |
$1,663.03
|
| Rate for Payer: Cofinity Advantage |
$2,494.54
|
| Rate for Payer: Cofinity Commercial |
$2,043.14
|
| Rate for Payer: Cofinity Commercial |
$3,064.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,850.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.60
|
| Rate for Payer: Healthscope Commercial |
$3,207.27
|
| Rate for Payer: Healthscope Commercial |
$2,138.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,019.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,029.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,672.72
|
| Rate for Payer: PHP Commercial |
$2,019.39
|
| Rate for Payer: PHP Commercial |
$3,029.09
|
| Rate for Payer: Priority Health SBD |
$1,496.72
|
| Rate for Payer: Priority Health SBD |
$2,245.09
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
OP
|
$2,035.12
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Commercial |
$2,594.79
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$548.94
|
| Rate for Payer: BCBS Trust/PPO |
$548.94
|
| Rate for Payer: BCN Commercial |
$548.94
|
| Rate for Payer: BCN Commercial |
$548.94
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cofinity Advantage |
$2,136.88
|
| Rate for Payer: Cofinity Advantage |
$1,424.58
|
| Rate for Payer: Cofinity Commercial |
$2,625.31
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Healthscope Commercial |
$2,747.42
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$2,594.79
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$1,923.19
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,984.25
|
| Rate for Payer: UHC Core |
$1,590.45
|
| Rate for Payer: UHC Core |
$1,060.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$1,199.71
|
| Rate for Payer: UHC Exchange |
$799.80
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC MR UPPER EXTREM NO JOINT WO CON
|
Facility
|
IP
|
$2,035.12
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
61000016
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,282.13 |
| Max. Negotiated Rate |
$1,831.61 |
| Rate for Payer: Aetna Commercial |
$1,729.85
|
| Rate for Payer: Aetna Commercial |
$2,594.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.25
|
| Rate for Payer: Cash Price |
$1,628.10
|
| Rate for Payer: Cash Price |
$2,442.15
|
| Rate for Payer: Cofinity Advantage |
$1,424.58
|
| Rate for Payer: Cofinity Advantage |
$2,136.88
|
| Rate for Payer: Cofinity Commercial |
$1,750.20
|
| Rate for Payer: Cofinity Commercial |
$2,625.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,442.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,628.10
|
| Rate for Payer: Healthscope Commercial |
$2,747.42
|
| Rate for Payer: Healthscope Commercial |
$1,831.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,729.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,289.52
|
| Rate for Payer: PHP Commercial |
$1,729.85
|
| Rate for Payer: PHP Commercial |
$2,594.79
|
| Rate for Payer: Priority Health SBD |
$1,282.13
|
| Rate for Payer: Priority Health SBD |
$1,923.19
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
OP
|
$2,336.68
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$181.81 |
| Max. Negotiated Rate |
$2,103.01 |
| Rate for Payer: Aetna Commercial |
$1,986.18
|
| Rate for Payer: Aetna Commercial |
$2,979.28
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna Medicare |
$361.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,278.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$434.52
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS Complete |
$190.91
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS MAPPO |
$347.62
|
| Rate for Payer: BCBS Trust/PPO |
$710.20
|
| Rate for Payer: BCBS Trust/PPO |
$710.20
|
| Rate for Payer: BCN Commercial |
$710.20
|
| Rate for Payer: BCN Commercial |
$710.20
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: BCN Medicare Advantage |
$347.62
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cofinity Advantage |
$2,453.52
|
| Rate for Payer: Cofinity Advantage |
$1,635.68
|
| Rate for Payer: Cofinity Commercial |
$3,014.33
|
| Rate for Payer: Cofinity Commercial |
$2,009.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.62
|
| Rate for Payer: Healthscope Commercial |
$2,103.01
|
| Rate for Payer: Healthscope Commercial |
$3,154.53
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicaid |
$181.81
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Mclaren Medicare |
$347.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: Meridian Medicaid |
$365.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$399.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$382.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Nomi Health Commercial |
$1,042.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE Medicare |
$330.24
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PACE SWMI |
$347.62
|
| Rate for Payer: PHP Commercial |
$2,979.28
|
| Rate for Payer: PHP Commercial |
$1,986.18
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: PHP Medicare Advantage |
$347.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.16
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health Medicare |
$347.62
|
| Rate for Payer: Priority Health SBD |
$2,208.17
|
| Rate for Payer: Priority Health SBD |
$1,472.11
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Priority Health Tiered Network |
$899.33
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: Railroad Medicare Medicare |
$347.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,518.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,278.27
|
| Rate for Payer: UHC Core |
$1,826.12
|
| Rate for Payer: UHC Core |
$1,217.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$347.62
|
| Rate for Payer: UHC Exchange |
$1,377.48
|
| Rate for Payer: UHC Exchange |
$918.32
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHC Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: UHCCP Medicaid |
$181.81
|
| Rate for Payer: VA VA |
$347.62
|
| Rate for Payer: VA VA |
$347.62
|
|
|
HC MR UPPER EXTREM NO JOINT WO W CON
|
Facility
|
IP
|
$2,336.68
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
61000020
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,472.11 |
| Max. Negotiated Rate |
$2,103.01 |
| Rate for Payer: Aetna Commercial |
$1,986.18
|
| Rate for Payer: Aetna Commercial |
$2,979.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,278.27
|
| Rate for Payer: Cash Price |
$1,869.34
|
| Rate for Payer: Cash Price |
$2,804.02
|
| Rate for Payer: Cofinity Advantage |
$1,635.68
|
| Rate for Payer: Cofinity Advantage |
$2,453.52
|
| Rate for Payer: Cofinity Commercial |
$2,009.54
|
| Rate for Payer: Cofinity Commercial |
$3,014.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,804.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,869.34
|
| Rate for Payer: Healthscope Commercial |
$3,154.53
|
| Rate for Payer: Healthscope Commercial |
$2,103.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,986.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,979.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,752.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,628.77
|
| Rate for Payer: PHP Commercial |
$1,986.18
|
| Rate for Payer: PHP Commercial |
$2,979.28
|
| Rate for Payer: Priority Health SBD |
$1,472.11
|
| Rate for Payer: Priority Health SBD |
$2,208.17
|
|
|
HC MSMART BM CMPT1
|
Facility
|
IP
|
$293.76
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$185.07 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Advantage |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$252.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PHP Commercial |
$249.70
|
| Rate for Payer: Priority Health SBD |
$185.07
|
|
|
HC MSMART BM CMPT1
|
Facility
|
OP
|
$293.76
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100045
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.70
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$210.67
|
| Rate for Payer: BCN Commercial |
$210.67
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cash Price |
$235.01
|
| Rate for Payer: Cofinity Advantage |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$252.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.70
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.32
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$249.70
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health SBD |
$185.07
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$80.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.15
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC MSMART BM CMPT2
|
Facility
|
IP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$184.45 |
| Rate for Payer: Aetna Commercial |
$174.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.21
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cofinity Advantage |
$143.46
|
| Rate for Payer: Cofinity Commercial |
$176.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.95
|
| Rate for Payer: Healthscope Commercial |
$184.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.71
|
| Rate for Payer: PHP Commercial |
$174.20
|
| Rate for Payer: Priority Health SBD |
$129.11
|
|
|
HC MSMART BM CMPT2
|
Facility
|
OP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100046
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$129.11 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$174.20
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.88
|
| Rate for Payer: BCN Commercial |
$132.88
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cash Price |
$163.95
|
| Rate for Payer: Cofinity Advantage |
$143.46
|
| Rate for Payer: Cofinity Commercial |
$176.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$184.45
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.20
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.71
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$174.20
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$129.11
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC MSMART BM CMPT3
|
Facility
|
OP
|
$179.99
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Aetna Commercial |
$152.99
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.99
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cofinity Advantage |
$125.99
|
| Rate for Payer: Cofinity Commercial |
$154.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$161.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.99
|
| Rate for Payer: PHP Commercial |
$152.99
|
| Rate for Payer: Priority Health SBD |
$113.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC MSMART BM CMPT3
|
Facility
|
IP
|
$179.99
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100047
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$113.39 |
| Max. Negotiated Rate |
$161.99 |
| Rate for Payer: Aetna Commercial |
$152.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.99
|
| Rate for Payer: Cash Price |
$143.99
|
| Rate for Payer: Cofinity Advantage |
$125.99
|
| Rate for Payer: Cofinity Commercial |
$154.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.99
|
| Rate for Payer: Healthscope Commercial |
$161.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.99
|
| Rate for Payer: PHP Commercial |
$152.99
|
| Rate for Payer: Priority Health SBD |
$113.39
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
OP
|
$74.61
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Aetna Commercial |
$63.42
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cofinity Advantage |
$52.23
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$67.15
|
| Rate for Payer: Mclaren Medicaid |
$21.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: Meridian Medicaid |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.42
|
| Rate for Payer: Nomi Health Commercial |
$62.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.96
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$63.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.68
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health SBD |
$47.00
|
| Rate for Payer: Priority Health Tiered Network |
$33.34
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.52
|
| Rate for Payer: UHC Core |
$62.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.68
|
| Rate for Payer: UHC Exchange |
$62.52
|
| Rate for Payer: UHC Medicaid |
$21.80
|
| Rate for Payer: UHCCP Medicaid |
$21.80
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR
|
Facility
|
IP
|
$74.61
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600293
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Aetna Commercial |
$63.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.50
|
| Rate for Payer: Cash Price |
$59.69
|
| Rate for Payer: Cofinity Advantage |
$52.23
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.69
|
| Rate for Payer: Healthscope Commercial |
$67.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.96
|
| Rate for Payer: PHP Commercial |
$63.42
|
| Rate for Payer: Priority Health SBD |
$47.00
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
OP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$56.54 |
| Rate for Payer: Aetna Commercial |
$53.40
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Advantage |
$43.97
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$56.54
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$53.40
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$39.58
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MTB RIFAMPIN RESISTANCE GENE PCR CMPT
|
Facility
|
IP
|
$62.82
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600294
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$56.54 |
| Rate for Payer: Aetna Commercial |
$53.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.83
|
| Rate for Payer: Cash Price |
$50.26
|
| Rate for Payer: Cofinity Advantage |
$43.97
|
| Rate for Payer: Cofinity Commercial |
$54.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.26
|
| Rate for Payer: Healthscope Commercial |
$56.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.12
|
| Rate for Payer: PHP Commercial |
$53.40
|
| Rate for Payer: Priority Health SBD |
$39.58
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
OP
|
$517.08
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$465.37 |
| Rate for Payer: Aetna Commercial |
$439.52
|
| Rate for Payer: Aetna Medicare |
$67.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.67
|
| Rate for Payer: BCBS Complete |
$35.88
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$413.66
|
| Rate for Payer: Cash Price |
$413.66
|
| Rate for Payer: Cofinity Advantage |
$361.96
|
| Rate for Payer: Cofinity Commercial |
$444.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$465.37
|
| Rate for Payer: Mclaren Medicaid |
$34.17
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: Meridian Medicaid |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.52
|
| Rate for Payer: Nomi Health Commercial |
$196.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.81
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$439.52
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.34
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health SBD |
$325.76
|
| Rate for Payer: Priority Health Tiered Network |
$52.27
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.01
|
| Rate for Payer: UHC Core |
$98.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.34
|
| Rate for Payer: UHC Exchange |
$98.01
|
| Rate for Payer: UHC Medicaid |
$34.17
|
| Rate for Payer: UHCCP Medicaid |
$34.17
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC MTHFR 2 MUTATIONS
|
Facility
|
IP
|
$517.08
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000126
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$325.76 |
| Max. Negotiated Rate |
$465.37 |
| Rate for Payer: Aetna Commercial |
$439.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.10
|
| Rate for Payer: Cash Price |
$413.66
|
| Rate for Payer: Cofinity Advantage |
$361.96
|
| Rate for Payer: Cofinity Commercial |
$444.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.66
|
| Rate for Payer: Healthscope Commercial |
$465.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.81
|
| Rate for Payer: PHP Commercial |
$439.52
|
| Rate for Payer: Priority Health SBD |
$325.76
|
|
|
HC MTHFR MUTATION
|
Facility
|
IP
|
$390.15
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$245.79 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: Priority Health SBD |
$245.79
|
|
|
HC MTHFR MUTATION
|
Facility
|
OP
|
$390.15
|
|
|
Service Code
|
CPT 81291
|
| Hospital Charge Code |
31000102
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.17 |
| Max. Negotiated Rate |
$351.13 |
| Rate for Payer: Aetna Commercial |
$331.63
|
| Rate for Payer: Aetna Medicare |
$67.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.67
|
| Rate for Payer: BCBS Complete |
$35.88
|
| Rate for Payer: BCBS MAPPO |
$65.34
|
| Rate for Payer: BCN Medicare Advantage |
$65.34
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cash Price |
$312.12
|
| Rate for Payer: Cofinity Advantage |
$273.11
|
| Rate for Payer: Cofinity Commercial |
$335.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Mclaren Medicaid |
$34.17
|
| Rate for Payer: Mclaren Medicare |
$65.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.61
|
| Rate for Payer: Meridian Medicaid |
$68.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.63
|
| Rate for Payer: Nomi Health Commercial |
$196.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.61
|
| Rate for Payer: PACE Medicare |
$62.07
|
| Rate for Payer: PACE SWMI |
$65.34
|
| Rate for Payer: PHP Commercial |
$331.63
|
| Rate for Payer: PHP Medicare Advantage |
$65.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.34
|
| Rate for Payer: Priority Health Medicare |
$65.34
|
| Rate for Payer: Priority Health SBD |
$245.79
|
| Rate for Payer: Priority Health Tiered Network |
$52.27
|
| Rate for Payer: Railroad Medicare Medicare |
$65.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.01
|
| Rate for Payer: UHC Core |
$98.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.34
|
| Rate for Payer: UHC Exchange |
$98.01
|
| Rate for Payer: UHC Medicaid |
$34.17
|
| Rate for Payer: UHCCP Medicaid |
$34.17
|
| Rate for Payer: VA VA |
$65.34
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
IP
|
$201.84
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$181.66 |
| Rate for Payer: Aetna Commercial |
$171.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.20
|
| Rate for Payer: Cash Price |
$161.47
|
| Rate for Payer: Cofinity Advantage |
$141.29
|
| Rate for Payer: Cofinity Commercial |
$173.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.47
|
| Rate for Payer: Healthscope Commercial |
$181.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.38
|
| Rate for Payer: PHP Commercial |
$171.56
|
| Rate for Payer: Priority Health SBD |
$127.16
|
|
|
HC M TUBERCULOSIS COMPLEX, PCR
|
Facility
|
OP
|
$201.84
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
30600291
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$181.66 |
| Rate for Payer: Aetna Commercial |
$171.56
|
| Rate for Payer: Aetna Medicare |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.10
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: BCBS MAPPO |
$41.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.44
|
| Rate for Payer: BCN Commercial |
$44.44
|
| Rate for Payer: BCN Medicare Advantage |
$41.68
|
| Rate for Payer: Cash Price |
$161.47
|
| Rate for Payer: Cash Price |
$161.47
|
| Rate for Payer: Cofinity Advantage |
$141.29
|
| Rate for Payer: Cofinity Commercial |
$173.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.68
|
| Rate for Payer: Healthscope Commercial |
$181.66
|
| Rate for Payer: Mclaren Medicaid |
$21.80
|
| Rate for Payer: Mclaren Medicare |
$41.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.76
|
| Rate for Payer: Meridian Medicaid |
$43.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.56
|
| Rate for Payer: Nomi Health Commercial |
$62.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.38
|
| Rate for Payer: PACE Medicare |
$39.60
|
| Rate for Payer: PACE SWMI |
$41.68
|
| Rate for Payer: PHP Commercial |
$171.56
|
| Rate for Payer: PHP Medicare Advantage |
$41.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.68
|
| Rate for Payer: Priority Health Medicare |
$41.68
|
| Rate for Payer: Priority Health SBD |
$127.16
|
| Rate for Payer: Priority Health Tiered Network |
$33.34
|
| Rate for Payer: Railroad Medicare Medicare |
$41.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.52
|
| Rate for Payer: UHC Core |
$62.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.68
|
| Rate for Payer: UHC Exchange |
$62.52
|
| Rate for Payer: UHC Medicaid |
$21.80
|
| Rate for Payer: UHCCP Medicaid |
$21.80
|
| Rate for Payer: VA VA |
$41.68
|
|
|
HC MUCORE RACEMOSUS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC MUCORE RACEMOSUS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC MUGWORT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
