|
HC PHOSPHO-TAU 217,P
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 84393
|
| Hospital Charge Code |
30000176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$134.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$161.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$161.15
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$128.92
|
| Rate for Payer: BCN Medicare Advantage |
$128.92
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Advantage |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.92
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$67.43
|
| Rate for Payer: Mclaren Medicare |
$128.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.37
|
| Rate for Payer: Meridian Medicaid |
$135.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Nomi Health Commercial |
$193.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: PACE Medicare |
$122.47
|
| Rate for Payer: PACE SWMI |
$128.92
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Medicare Advantage |
$128.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$128.92
|
| Rate for Payer: Priority Health SBD |
$236.25
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$128.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.38
|
| Rate for Payer: UHC Core |
$193.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.92
|
| Rate for Payer: UHC Exchange |
$193.38
|
| Rate for Payer: UHC Medicaid |
$67.43
|
| Rate for Payer: UHCCP Medicaid |
$67.43
|
| Rate for Payer: VA VA |
$128.92
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$47.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: BCBS Complete |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.37
|
| Rate for Payer: BCN Commercial |
$31.37
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.00
|
| Rate for Payer: Priority Health SBD |
$60.17
|
| Rate for Payer: Priority Health Tiered Network |
$23.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$49.76
|
| Rate for Payer: UHC Exchange |
$37.54
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.17 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health SBD |
$60.17
|
|
|
HC PICC INTRODUCER
|
Facility
|
OP
|
$100.29
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$90.26 |
| Rate for Payer: Aetna Commercial |
$85.25
|
| Rate for Payer: Aetna Medicare |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.19
|
| Rate for Payer: BCBS Complete |
$40.12
|
| Rate for Payer: Cash Price |
$80.23
|
| Rate for Payer: Cofinity Advantage |
$70.20
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.23
|
| Rate for Payer: Healthscope Commercial |
$90.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.22
|
| Rate for Payer: PHP Commercial |
$85.25
|
| Rate for Payer: Priority Health SBD |
$63.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.19
|
| Rate for Payer: UHC Core |
$52.25
|
| Rate for Payer: UHC Exchange |
$39.41
|
|
|
HC PICC INTRODUCER
|
Facility
|
IP
|
$100.29
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.18 |
| Max. Negotiated Rate |
$90.26 |
| Rate for Payer: Aetna Commercial |
$85.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.19
|
| Rate for Payer: Cash Price |
$80.23
|
| Rate for Payer: Cofinity Advantage |
$70.20
|
| Rate for Payer: Cofinity Commercial |
$86.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.23
|
| Rate for Payer: Healthscope Commercial |
$90.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.22
|
| Rate for Payer: PHP Commercial |
$85.25
|
| Rate for Payer: Priority Health SBD |
$63.18
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$114.84
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$72.35 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.65
|
| Rate for Payer: Cash Price |
$91.87
|
| Rate for Payer: Cofinity Advantage |
$80.39
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.87
|
| Rate for Payer: Healthscope Commercial |
$103.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.13
|
| Rate for Payer: PHP Commercial |
$97.61
|
| Rate for Payer: Priority Health SBD |
$72.35
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$114.84
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$103.36 |
| Rate for Payer: Aetna Commercial |
$97.61
|
| Rate for Payer: Aetna Medicare |
$57.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.65
|
| Rate for Payer: BCBS Complete |
$45.94
|
| Rate for Payer: Cash Price |
$91.87
|
| Rate for Payer: Cofinity Advantage |
$80.39
|
| Rate for Payer: Cofinity Commercial |
$98.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.87
|
| Rate for Payer: Healthscope Commercial |
$103.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.13
|
| Rate for Payer: PHP Commercial |
$97.61
|
| Rate for Payer: Priority Health SBD |
$72.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.65
|
| Rate for Payer: UHC Core |
$59.83
|
| Rate for Payer: UHC Exchange |
$45.13
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.98 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna Medicare |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.22
|
| Rate for Payer: BCBS Complete |
$81.98
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Advantage |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$176.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$184.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: PHP Commercial |
$174.22
|
| Rate for Payer: Priority Health SBD |
$129.12
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$204.96
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$129.12 |
| Max. Negotiated Rate |
$184.46 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.22
|
| Rate for Payer: Cash Price |
$163.97
|
| Rate for Payer: Cofinity Advantage |
$143.47
|
| Rate for Payer: Cofinity Commercial |
$176.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.97
|
| Rate for Payer: Healthscope Commercial |
$184.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.72
|
| Rate for Payer: PHP Commercial |
$174.22
|
| Rate for Payer: Priority Health SBD |
$129.12
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,957.94
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,013.50 |
| Max. Negotiated Rate |
$7,162.15 |
| Rate for Payer: Aetna Commercial |
$6,764.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,172.66
|
| Rate for Payer: Cash Price |
$6,366.35
|
| Rate for Payer: Cofinity Advantage |
$5,570.56
|
| Rate for Payer: Cofinity Commercial |
$6,843.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,366.35
|
| Rate for Payer: Healthscope Commercial |
$7,162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,764.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,968.45
|
| Rate for Payer: PHP Commercial |
$6,764.25
|
| Rate for Payer: Priority Health SBD |
$5,013.50
|
|
|
HC PICU OR PED INTERMEDIATE CARE R&B
|
Facility
|
IP
|
$6,640.46
|
|
| Hospital Charge Code |
20600002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,183.49 |
| Max. Negotiated Rate |
$5,976.41 |
| Rate for Payer: Aetna Commercial |
$5,644.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,316.30
|
| Rate for Payer: Cash Price |
$5,312.37
|
| Rate for Payer: Cofinity Advantage |
$4,648.32
|
| Rate for Payer: Cofinity Commercial |
$5,710.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,312.37
|
| Rate for Payer: Healthscope Commercial |
$5,976.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,644.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,980.35
|
| Rate for Payer: PHP Commercial |
$5,644.39
|
| Rate for Payer: Priority Health SBD |
$4,183.49
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
IP
|
$321.36
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$202.46 |
| Max. Negotiated Rate |
$289.22 |
| Rate for Payer: Aetna Commercial |
$273.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.88
|
| Rate for Payer: Cash Price |
$257.09
|
| Rate for Payer: Cofinity Advantage |
$224.95
|
| Rate for Payer: Cofinity Commercial |
$276.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.09
|
| Rate for Payer: Healthscope Commercial |
$289.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.02
|
| Rate for Payer: PHP Commercial |
$273.16
|
| Rate for Payer: Priority Health SBD |
$202.46
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
OP
|
$321.36
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$126.29 |
| Max. Negotiated Rate |
$289.22 |
| Rate for Payer: Aetna Commercial |
$273.16
|
| Rate for Payer: Aetna Medicare |
$160.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.88
|
| Rate for Payer: BCBS Complete |
$128.54
|
| Rate for Payer: Cash Price |
$257.09
|
| Rate for Payer: Cofinity Advantage |
$224.95
|
| Rate for Payer: Cofinity Commercial |
$276.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.09
|
| Rate for Payer: Healthscope Commercial |
$289.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.02
|
| Rate for Payer: PHP Commercial |
$273.16
|
| Rate for Payer: Priority Health SBD |
$202.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.88
|
| Rate for Payer: UHC Core |
$167.43
|
| Rate for Payer: UHC Exchange |
$126.29
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
OP
|
$1,591.81
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$1,432.63 |
| Rate for Payer: Aetna Commercial |
$1,353.04
|
| Rate for Payer: Aetna Medicare |
$360.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$433.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$433.11
|
| Rate for Payer: BCBS Complete |
$190.29
|
| Rate for Payer: BCBS MAPPO |
$346.49
|
| Rate for Payer: BCBS Trust/PPO |
$472.60
|
| Rate for Payer: BCN Commercial |
$472.60
|
| Rate for Payer: BCN Medicare Advantage |
$346.49
|
| Rate for Payer: Cash Price |
$1,273.45
|
| Rate for Payer: Cash Price |
$1,273.45
|
| Rate for Payer: Cofinity Advantage |
$1,114.27
|
| Rate for Payer: Cofinity Commercial |
$1,368.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.49
|
| Rate for Payer: Healthscope Commercial |
$1,432.63
|
| Rate for Payer: Mclaren Medicaid |
$181.21
|
| Rate for Payer: Mclaren Medicare |
$346.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.81
|
| Rate for Payer: Meridian Medicaid |
$363.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$398.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$381.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.04
|
| Rate for Payer: Nomi Health Commercial |
$1,039.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.86
|
| Rate for Payer: PACE Medicare |
$329.17
|
| Rate for Payer: PACE SWMI |
$346.49
|
| Rate for Payer: PHP Commercial |
$1,353.04
|
| Rate for Payer: PHP Medicare Advantage |
$346.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,092.82
|
| Rate for Payer: Priority Health Medicare |
$346.49
|
| Rate for Payer: Priority Health SBD |
$1,002.84
|
| Rate for Payer: Priority Health Tiered Network |
$874.26
|
| Rate for Payer: Railroad Medicare Medicare |
$346.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.71
|
| Rate for Payer: UHC Core |
$571.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$346.49
|
| Rate for Payer: UHC Exchange |
$571.71
|
| Rate for Payer: UHC Medicaid |
$181.21
|
| Rate for Payer: UHCCP Medicaid |
$181.21
|
| Rate for Payer: VA VA |
$346.49
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
IP
|
$1,591.81
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,002.84 |
| Max. Negotiated Rate |
$1,432.63 |
| Rate for Payer: Aetna Commercial |
$1,353.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.68
|
| Rate for Payer: Cash Price |
$1,273.45
|
| Rate for Payer: Cofinity Advantage |
$1,114.27
|
| Rate for Payer: Cofinity Commercial |
$1,368.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,273.45
|
| Rate for Payer: Healthscope Commercial |
$1,432.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.86
|
| Rate for Payer: PHP Commercial |
$1,353.04
|
| Rate for Payer: Priority Health SBD |
$1,002.84
|
|
|
HC PIGWEED IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 PIGWEED IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 PI LINKED ANTIGEN
|
Facility
|
IP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| 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 PI LINKED ANTIGEN
|
Facility
|
OP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| 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 PI LINKED ANTIGEN CMPT
|
Facility
|
IP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| 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 PI LINKED ANTIGEN CMPT
|
Facility
|
OP
|
$204.94
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000005
|
|
Hospital Revenue Code
|
310
|
| 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 PI LINKED ANTIGEN CMPT2
|
Facility
|
IP
|
$64.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$58.37 |
| Rate for Payer: Aetna Commercial |
$55.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.15
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cofinity Advantage |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$55.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.88
|
| Rate for Payer: Healthscope Commercial |
$58.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.64
|
| Rate for Payer: PHP Commercial |
$55.12
|
| Rate for Payer: Priority Health SBD |
$40.86
|
|
|
HC PI LINKED ANTIGEN CMPT2
|
Facility
|
OP
|
$64.85
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000011
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$58.37 |
| Rate for Payer: Aetna Commercial |
$55.12
|
| Rate for Payer: Aetna Medicare |
$32.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.15
|
| Rate for Payer: BCBS Complete |
$25.94
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cash Price |
$51.88
|
| Rate for Payer: Cofinity Advantage |
$45.40
|
| Rate for Payer: Cofinity Commercial |
$55.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.88
|
| Rate for Payer: Healthscope Commercial |
$58.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.64
|
| Rate for Payer: PHP Commercial |
$55.12
|
| Rate for Payer: Priority Health SBD |
$40.86
|
| 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 PINWORM EXAM
|
Facility
|
OP
|
$56.60
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| 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 |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Advantage |
$39.62
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Mclaren Medicaid |
$2.23
|
| 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 |
$4.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$6.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.45
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.27
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$35.66
|
| Rate for Payer: Priority Health Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$6.41
|
| Rate for Payer: UHC Medicaid |
$2.23
|
| Rate for Payer: UHCCP Medicaid |
$2.23
|
| Rate for Payer: VA VA |
$4.27
|
|
|
HC PINWORM EXAM
|
Facility
|
IP
|
$56.60
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
30600094
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$50.94 |
| Rate for Payer: Aetna Commercial |
$48.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.79
|
| Rate for Payer: Cash Price |
$45.28
|
| Rate for Payer: Cofinity Advantage |
$39.62
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.28
|
| Rate for Payer: Healthscope Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.45
|
| Rate for Payer: PHP Commercial |
$48.11
|
| Rate for Payer: Priority Health SBD |
$35.66
|
|
