|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.61
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Advantage |
$192.35
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: Priority Health SBD |
$173.12
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$163.67
|
| Rate for Payer: BCN Commercial |
$163.67
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Advantage |
$192.35
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Mclaren Medicaid |
$80.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$230.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$153.50
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$173.12
|
| Rate for Payer: Priority Health Tiered Network |
$122.80
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.25
|
| Rate for Payer: UHC Core |
$230.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.50
|
| Rate for Payer: UHC Exchange |
$230.25
|
| Rate for Payer: UHC Medicaid |
$80.28
|
| Rate for Payer: UHCCP Medicaid |
$80.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$167.33
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.30 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Aetna Commercial |
$142.23
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.00
|
| Rate for Payer: BCBS Complete |
$54.92
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCBS Trust/PPO |
$106.62
|
| Rate for Payer: BCN Commercial |
$106.62
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cofinity Advantage |
$117.13
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$150.60
|
| Rate for Payer: Mclaren Medicaid |
$52.30
|
| Rate for Payer: Mclaren Medicare |
$100.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.00
|
| Rate for Payer: Meridian Medicaid |
$105.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.23
|
| Rate for Payer: Nomi Health Commercial |
$150.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.50
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$142.23
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$100.00
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health SBD |
$105.42
|
| Rate for Payer: Priority Health Tiered Network |
$80.00
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.00
|
| Rate for Payer: UHC Core |
$150.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.00
|
| Rate for Payer: UHC Exchange |
$150.00
|
| Rate for Payer: UHC Medicaid |
$52.30
|
| Rate for Payer: UHCCP Medicaid |
$52.30
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$167.33
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$150.60 |
| Rate for Payer: Aetna Commercial |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.76
|
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Cofinity Advantage |
$117.13
|
| Rate for Payer: Cofinity Commercial |
$143.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.86
|
| Rate for Payer: Healthscope Commercial |
$150.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.50
|
| Rate for Payer: PHP Commercial |
$142.23
|
| Rate for Payer: Priority Health SBD |
$105.42
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$119.71
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Medicare |
$64.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.47
|
| Rate for Payer: BCBS Complete |
$34.04
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCBS Trust/PPO |
$66.09
|
| Rate for Payer: BCN Commercial |
$66.09
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cofinity Advantage |
$83.80
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$107.74
|
| Rate for Payer: Mclaren Medicaid |
$32.42
|
| Rate for Payer: Mclaren Medicare |
$61.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.08
|
| Rate for Payer: Meridian Medicaid |
$65.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Nomi Health Commercial |
$92.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$61.98
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health SBD |
$75.42
|
| Rate for Payer: Priority Health Tiered Network |
$49.58
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.97
|
| Rate for Payer: UHC Core |
$92.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$61.98
|
| Rate for Payer: UHC Exchange |
$92.97
|
| Rate for Payer: UHC Medicaid |
$32.42
|
| Rate for Payer: UHCCP Medicaid |
$32.42
|
| Rate for Payer: VA VA |
$61.98
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$119.71
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$107.74 |
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Cash Price |
$95.77
|
| Rate for Payer: Cofinity Advantage |
$83.80
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.77
|
| Rate for Payer: Healthscope Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: Priority Health SBD |
$75.42
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: Priority Health SBD |
$36.70
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$52.43 |
| Rate for Payer: Aetna Commercial |
$49.52
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.57
|
| Rate for Payer: BCN Commercial |
$15.57
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cash Price |
$46.61
|
| Rate for Payer: Cofinity Advantage |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Mclaren Medicaid |
$7.64
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.52
|
| Rate for Payer: Nomi Health Commercial |
$21.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.70
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$49.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.60
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health Tiered Network |
$11.68
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.60
|
| Rate for Payer: UHC Exchange |
$21.90
|
| Rate for Payer: UHC Medicaid |
$7.64
|
| Rate for Payer: UHCCP Medicaid |
$7.64
|
| Rate for Payer: VA VA |
$14.60
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,057.98
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$666.53 |
| Max. Negotiated Rate |
$952.18 |
| Rate for Payer: Aetna Commercial |
$899.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.69
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cofinity Advantage |
$740.59
|
| Rate for Payer: Cofinity Commercial |
$909.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.38
|
| Rate for Payer: Healthscope Commercial |
$952.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.49
|
| Rate for Payer: PHP Commercial |
$899.28
|
| Rate for Payer: Priority Health SBD |
$666.53
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,057.98
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$1,070.18 |
| Rate for Payer: Aetna Commercial |
$899.28
|
| Rate for Payer: Aetna Medicare |
$327.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.02
|
| Rate for Payer: BCBS Complete |
$173.12
|
| Rate for Payer: BCBS MAPPO |
$315.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,070.18
|
| Rate for Payer: BCN Commercial |
$1,070.18
|
| Rate for Payer: BCN Medicare Advantage |
$315.22
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cash Price |
$846.38
|
| Rate for Payer: Cofinity Advantage |
$740.59
|
| Rate for Payer: Cofinity Commercial |
$909.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.22
|
| Rate for Payer: Healthscope Commercial |
$952.18
|
| Rate for Payer: Mclaren Medicaid |
$164.86
|
| Rate for Payer: Mclaren Medicare |
$315.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.98
|
| Rate for Payer: Meridian Medicaid |
$330.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$899.28
|
| Rate for Payer: Nomi Health Commercial |
$945.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$793.49
|
| Rate for Payer: PACE Medicare |
$299.46
|
| Rate for Payer: PACE SWMI |
$315.22
|
| Rate for Payer: PHP Commercial |
$899.28
|
| Rate for Payer: PHP Medicare Advantage |
$315.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.34
|
| Rate for Payer: Priority Health Medicare |
$315.22
|
| Rate for Payer: Priority Health SBD |
$666.53
|
| Rate for Payer: Priority Health Tiered Network |
$791.47
|
| Rate for Payer: Railroad Medicare Medicare |
$315.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.59
|
| Rate for Payer: UHC Core |
$527.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.22
|
| Rate for Payer: UHC Exchange |
$527.59
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
| Rate for Payer: VA VA |
$315.22
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$192.39
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$121.21 |
| Max. Negotiated Rate |
$173.15 |
| Rate for Payer: Aetna Commercial |
$163.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.05
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Advantage |
$134.67
|
| Rate for Payer: Cofinity Commercial |
$165.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Healthscope Commercial |
$173.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: PHP Commercial |
$163.53
|
| Rate for Payer: Priority Health SBD |
$121.21
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$192.39
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$173.15 |
| Rate for Payer: Aetna Commercial |
$163.53
|
| Rate for Payer: Aetna Medicare |
$96.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.05
|
| Rate for Payer: BCBS Complete |
$76.96
|
| Rate for Payer: Cash Price |
$153.91
|
| Rate for Payer: Cofinity Advantage |
$134.67
|
| Rate for Payer: Cofinity Commercial |
$165.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.91
|
| Rate for Payer: Healthscope Commercial |
$173.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.29
|
| Rate for Payer: PHP Commercial |
$163.53
|
| Rate for Payer: Priority Health SBD |
$121.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.05
|
| Rate for Payer: UHC Core |
$100.24
|
| Rate for Payer: UHC Exchange |
$75.61
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$438.28
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$276.12 |
| Max. Negotiated Rate |
$394.45 |
| Rate for Payer: Aetna Commercial |
$372.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.88
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cofinity Advantage |
$306.80
|
| Rate for Payer: Cofinity Commercial |
$376.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.62
|
| Rate for Payer: Healthscope Commercial |
$394.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.71
|
| Rate for Payer: PHP Commercial |
$372.54
|
| Rate for Payer: Priority Health SBD |
$276.12
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$438.28
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$433.11 |
| Rate for Payer: Aetna Commercial |
$372.54
|
| Rate for Payer: Aetna Medicare |
$139.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.41
|
| Rate for Payer: BCBS Complete |
$73.55
|
| Rate for Payer: BCBS MAPPO |
$133.93
|
| Rate for Payer: BCN Medicare Advantage |
$133.93
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cash Price |
$350.62
|
| Rate for Payer: Cofinity Advantage |
$306.80
|
| Rate for Payer: Cofinity Commercial |
$376.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.93
|
| Rate for Payer: Healthscope Commercial |
$394.45
|
| Rate for Payer: Mclaren Medicaid |
$70.05
|
| Rate for Payer: Mclaren Medicare |
$133.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.63
|
| Rate for Payer: Meridian Medicaid |
$140.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.54
|
| Rate for Payer: Nomi Health Commercial |
$401.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.71
|
| Rate for Payer: PACE Medicare |
$127.23
|
| Rate for Payer: PACE SWMI |
$133.93
|
| Rate for Payer: PHP Commercial |
$372.54
|
| Rate for Payer: PHP Medicare Advantage |
$133.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$433.11
|
| Rate for Payer: Priority Health Medicare |
$133.93
|
| Rate for Payer: Priority Health SBD |
$276.12
|
| Rate for Payer: Priority Health Tiered Network |
$346.49
|
| Rate for Payer: Railroad Medicare Medicare |
$133.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.88
|
| Rate for Payer: UHC Core |
$228.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Exchange |
$172.24
|
| Rate for Payer: UHC Medicaid |
$70.05
|
| Rate for Payer: UHCCP Medicaid |
$70.05
|
| Rate for Payer: VA VA |
$133.93
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
OP
|
$291.91
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$543.17 |
| Rate for Payer: Aetna Commercial |
$248.12
|
| Rate for Payer: Aetna Medicare |
$177.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$213.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$213.86
|
| Rate for Payer: BCBS Complete |
$93.96
|
| Rate for Payer: BCBS MAPPO |
$171.09
|
| Rate for Payer: BCBS Trust/PPO |
$416.19
|
| Rate for Payer: BCN Commercial |
$416.19
|
| Rate for Payer: BCN Medicare Advantage |
$171.09
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cofinity Advantage |
$204.34
|
| Rate for Payer: Cofinity Commercial |
$251.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.09
|
| Rate for Payer: Healthscope Commercial |
$262.72
|
| Rate for Payer: Mclaren Medicaid |
$89.48
|
| Rate for Payer: Mclaren Medicare |
$171.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.64
|
| Rate for Payer: Meridian Medicaid |
$179.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.12
|
| Rate for Payer: Nomi Health Commercial |
$513.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.93
|
| Rate for Payer: PACE Medicare |
$162.54
|
| Rate for Payer: PACE SWMI |
$171.09
|
| Rate for Payer: PHP Commercial |
$248.12
|
| Rate for Payer: PHP Medicare Advantage |
$171.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.17
|
| Rate for Payer: Priority Health Medicare |
$171.09
|
| Rate for Payer: Priority Health SBD |
$183.90
|
| Rate for Payer: Priority Health Tiered Network |
$434.54
|
| Rate for Payer: Railroad Medicare Medicare |
$171.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.67
|
| Rate for Payer: UHC Core |
$283.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$171.09
|
| Rate for Payer: UHC Exchange |
$283.67
|
| Rate for Payer: UHC Medicaid |
$89.48
|
| Rate for Payer: UHCCP Medicaid |
$89.48
|
| Rate for Payer: VA VA |
$171.09
|
|
|
HC RADIUM RA223 DICHLORIDE XOFIGO PER MICROCURIE
|
Facility
|
IP
|
$291.91
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
63600051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.90 |
| Max. Negotiated Rate |
$262.72 |
| Rate for Payer: Aetna Commercial |
$248.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.74
|
| Rate for Payer: Cash Price |
$233.53
|
| Rate for Payer: Cofinity Advantage |
$204.34
|
| Rate for Payer: Cofinity Commercial |
$251.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.53
|
| Rate for Payer: Healthscope Commercial |
$262.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.93
|
| Rate for Payer: PHP Commercial |
$248.12
|
| Rate for Payer: Priority Health SBD |
$183.90
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
|
|
HC RAD TX BREAST CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1081
|
| Hospital Charge Code |
33300067
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX CERVIAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1085
|
| Hospital Charge Code |
33300069
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX CNS TUMOR ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1083
|
| Hospital Charge Code |
33300068
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Exchange |
$0.00
|
|
|
HC RAD TX COLORECTAL CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1087
|
| Hospital Charge Code |
33300070
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC RAD TX HEAD & NECK CA ROM 90 DAY EP
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS M1089
|
| Hospital Charge Code |
33300071
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Advantage |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
