|
HC T4 TOTAL
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
30100435
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.76 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$39.10
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS MAPPO |
$6.87
|
| Rate for Payer: BCBS Trust/PPO |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.87
|
| Rate for Payer: Healthscope Commercial |
$41.40
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Mclaren Medicare |
$6.87
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.10
|
| Rate for Payer: PACE Medicare |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.87
|
| Rate for Payer: PHP Commercial |
$39.10
|
| Rate for Payer: PHP Medicare Advantage |
$6.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: Priority Health SBD |
$28.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.24
|
| Rate for Payer: UHC Core |
$11.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.87
|
| Rate for Payer: UHC Exchange |
$6.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.08
|
| Rate for Payer: VA VA |
$6.87
|
|
|
HC TACROLIMUS LEVEL
|
Facility
|
IP
|
$64.26
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
30100047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health SBD |
$40.48
|
|
|
HC TACROLIMUS LEVEL
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
30100047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$57.83 |
| Rate for Payer: Aetna Commercial |
$54.62
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.89
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$10.75
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cash Price |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$44.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$57.83
|
| Rate for Payer: Mclaren Medicaid |
$7.51
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Medicaid |
$7.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.62
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$54.62
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.98
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$40.48
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.48
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.73
|
| Rate for Payer: UHC Exchange |
$13.73
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC T AND B CELL QUANTITATION
|
Facility
|
OP
|
$57.97
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200204
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Mclaren Medicaid |
$20.64
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Medicaid |
$21.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$36.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.28
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$38.86
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC T AND B CELL QUANTITATION
|
Facility
|
IP
|
$57.97
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200204
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health SBD |
$36.52
|
|
|
HC T AND B CELL QUANTITATION CMPT1
|
Facility
|
OP
|
$72.20
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200206
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$79.86 |
| Rate for Payer: Aetna Commercial |
$61.37
|
| Rate for Payer: Aetna Medicare |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.72
|
| Rate for Payer: BCBS Complete |
$26.99
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$36.79
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$57.76
|
| Rate for Payer: Cash Price |
$57.76
|
| Rate for Payer: Cofinity Commercial |
$62.09
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$64.98
|
| Rate for Payer: Mclaren Medicaid |
$25.70
|
| Rate for Payer: Mclaren Medicare |
$46.98
|
| Rate for Payer: Meridian Medicaid |
$26.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.37
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$61.37
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.54
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health SBD |
$45.49
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.38
|
| Rate for Payer: UHC Core |
$79.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.98
|
| Rate for Payer: UHC Exchange |
$46.98
|
| Rate for Payer: UHC Medicare Advantage |
$48.39
|
| Rate for Payer: VA VA |
$46.98
|
|
|
HC T AND B CELL QUANTITATION CMPT1
|
Facility
|
IP
|
$72.20
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200206
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$64.98 |
| Rate for Payer: Aetna Commercial |
$61.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.93
|
| Rate for Payer: Cash Price |
$57.76
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Cofinity Commercial |
$62.09
|
| Rate for Payer: Healthscope Commercial |
$64.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.37
|
| Rate for Payer: PHP Commercial |
$61.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.54
|
| Rate for Payer: Priority Health SBD |
$45.49
|
|
|
HC T AND B CELL QUANTITATION CMPT2
|
Facility
|
IP
|
$57.97
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
30200202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health SBD |
$36.52
|
|
|
HC T AND B CELL QUANTITATION CMPT2
|
Facility
|
OP
|
$57.97
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
30200202
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Mclaren Medicaid |
$20.64
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Medicaid |
$21.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$36.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.28
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$38.86
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC T AND B CELL QUANTITATION CMPT3
|
Facility
|
OP
|
$57.97
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
30200203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Mclaren Medicaid |
$20.64
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Medicaid |
$21.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$36.52
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.28
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$38.86
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC T AND B CELL QUANTITATION CMPT3
|
Facility
|
IP
|
$57.97
|
|
|
Service Code
|
CPT 86357
|
| Hospital Charge Code |
30200203
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$52.17 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.68
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cofinity Commercial |
$40.58
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$52.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.58
|
| Rate for Payer: Priority Health SBD |
$36.52
|
|
|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$81.91
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$149.25 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS Trust/PPO |
$149.25
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.41
|
| Rate for Payer: UHC Exchange |
$21.28
|
|
|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$81.91
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.24
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$57.34
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health SBD |
$51.60
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.67 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$78.81
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$189.21
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$170.29
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$36.67
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.29 |
| Max. Negotiated Rate |
$243.27 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.70
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$189.21
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health SBD |
$170.29
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,000.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,625.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24,375.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$26,250.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: Priority Health SBD |
$23,625.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,593.75 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,250.00 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,406.25
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$28,437.50
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: Priority Health SBD |
$25,593.75
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$251.86 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$84.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.08
|
| Rate for Payer: BCBS Complete |
$46.45
|
| Rate for Payer: BCBS MAPPO |
$80.86
|
| Rate for Payer: BCN Medicare Advantage |
$80.86
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.86
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Mclaren Medicaid |
$44.23
|
| Rate for Payer: Mclaren Medicare |
$80.86
|
| Rate for Payer: Meridian Medicaid |
$46.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Medicare |
$76.82
|
| Rate for Payer: PACE SWMI |
$80.86
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: PHP Medicare Advantage |
$80.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.86
|
| Rate for Payer: Priority Health Medicare |
$80.86
|
| Rate for Payer: Priority Health Narrow Network |
$201.49
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: Railroad Medicare Medicare |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.86
|
| Rate for Payer: UHC Exchange |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$83.29
|
| Rate for Payer: VA VA |
$80.86
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health SBD |
$15.12
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$74.83 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Mclaren Medicaid |
$14.49
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.83
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health Narrow Network |
$59.86
|
| Rate for Payer: Priority Health SBD |
$15.12
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.16
|
| Rate for Payer: UHC Core |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Exchange |
$10.15
|
| Rate for Payer: UHC Medicare Advantage |
$27.28
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.38
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS Trust/PPO |
$133.75
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health SBD |
$97.29
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$97.29 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.38
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$108.10
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health SBD |
$97.29
|
|
