|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.56 |
| Max. Negotiated Rate |
$183.66 |
| Rate for Payer: Aetna Commercial |
$173.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.65
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$175.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Healthscope Commercial |
$183.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: PHP Commercial |
$173.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: Priority Health SBD |
$128.56
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$204.07
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$183.66 |
| Rate for Payer: Aetna Commercial |
$173.46
|
| Rate for Payer: Aetna Medicare |
$102.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.65
|
| Rate for Payer: BCBS Complete |
$81.63
|
| Rate for Payer: Cash Price |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$175.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.26
|
| Rate for Payer: Healthscope Commercial |
$183.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.46
|
| Rate for Payer: PHP Commercial |
$173.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.65
|
| Rate for Payer: Priority Health SBD |
$128.56
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna Commercial |
$115.60
|
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.40
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$116.96
|
| Rate for Payer: Cofinity Commercial |
$95.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Healthscope Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: PHP Commercial |
$115.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health SBD |
$85.68
|
|
|
HC PURAPLY XT PER SQ CM
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS Q4197
|
| Hospital Charge Code |
63600245
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna Commercial |
$115.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$116.96
|
| Rate for Payer: Cofinity Commercial |
$95.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.80
|
| Rate for Payer: Healthscope Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.60
|
| Rate for Payer: PHP Commercial |
$115.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health SBD |
$85.68
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$141.24
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$149.55
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$141.24
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$104.69
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$122.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$122.97
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$166.17
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$104.69 |
| Max. Negotiated Rate |
$149.55 |
| Rate for Payer: Aetna Commercial |
$141.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.01
|
| Rate for Payer: Cash Price |
$132.94
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Cofinity Commercial |
$142.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.94
|
| Rate for Payer: Healthscope Commercial |
$149.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.24
|
| Rate for Payer: PHP Commercial |
$141.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.01
|
| Rate for Payer: Priority Health SBD |
$104.69
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$296.56 |
| Rate for Payer: Aetna Commercial |
$280.08
|
| Rate for Payer: Aetna Medicare |
$95.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.58
|
| Rate for Payer: BCBS Complete |
$51.59
|
| Rate for Payer: BCBS MAPPO |
$91.66
|
| Rate for Payer: BCN Medicare Advantage |
$91.66
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$283.38
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.66
|
| Rate for Payer: Healthscope Commercial |
$296.56
|
| Rate for Payer: Mclaren Medicaid |
$49.13
|
| Rate for Payer: Mclaren Medicare |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.24
|
| Rate for Payer: Meridian Medicaid |
$51.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: PACE Medicare |
$87.08
|
| Rate for Payer: PACE SWMI |
$91.66
|
| Rate for Payer: PHP Commercial |
$280.08
|
| Rate for Payer: PHP Medicare Advantage |
$91.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: Priority Health Medicare |
$91.66
|
| Rate for Payer: Priority Health SBD |
$207.59
|
| Rate for Payer: Railroad Medicare Medicare |
$91.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.66
|
| Rate for Payer: UHC Medicare Advantage |
$91.66
|
| Rate for Payer: UHCCP Medicaid |
$51.60
|
| Rate for Payer: VA VA |
$91.66
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$207.59 |
| Max. Negotiated Rate |
$296.56 |
| Rate for Payer: Aetna Commercial |
$280.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.18
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$230.66
|
| Rate for Payer: Cofinity Commercial |
$283.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Healthscope Commercial |
$296.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: PHP Commercial |
$280.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: Priority Health SBD |
$207.59
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: Priority Health SBD |
$59.76
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.80
|
| Rate for Payer: BCBS Complete |
$5.31
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Cofinity Commercial |
$66.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Mclaren Medicaid |
$5.06
|
| Rate for Payer: Mclaren Medicare |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: PACE Medicare |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health SBD |
$59.76
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$5.31
|
| Rate for Payer: VA VA |
$9.44
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$15.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.10
|
| Rate for Payer: BCBS Complete |
$8.15
|
| Rate for Payer: BCBS MAPPO |
$14.48
|
| Rate for Payer: BCN Medicare Advantage |
$14.48
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.48
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$7.76
|
| Rate for Payer: Mclaren Medicare |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$8.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PACE Medicare |
$13.76
|
| Rate for Payer: PACE SWMI |
$14.48
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$14.48
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Railroad Medicare Medicare |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.48
|
| Rate for Payer: UHC Medicare Advantage |
$14.48
|
| Rate for Payer: UHCCP Medicaid |
$8.15
|
| Rate for Payer: VA VA |
$14.48
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
OP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.15
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$12.12
|
| Rate for Payer: BCN Medicare Advantage |
$12.12
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Mclaren Medicaid |
$6.50
|
| Rate for Payer: Mclaren Medicare |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.73
|
| Rate for Payer: Meridian Medicaid |
$6.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: PACE Medicare |
$11.51
|
| Rate for Payer: PACE SWMI |
$12.12
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: PHP Medicare Advantage |
$12.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health Medicare |
$12.12
|
| Rate for Payer: Priority Health SBD |
$59.15
|
| Rate for Payer: Railroad Medicare Medicare |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.12
|
| Rate for Payer: UHC Medicare Advantage |
$12.12
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: VA VA |
$12.12
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
IP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.03
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health SBD |
$59.15
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna Commercial |
$289.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.72
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$238.78
|
| Rate for Payer: Cofinity Commercial |
$293.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$307.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: PHP Commercial |
$289.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: Priority Health SBD |
$214.90
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.44 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna Commercial |
$289.94
|
| Rate for Payer: Aetna Medicare |
$170.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.72
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$238.78
|
| Rate for Payer: Cofinity Commercial |
$293.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$307.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: PHP Commercial |
$289.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: Priority Health SBD |
$214.90
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.93 |
| Max. Negotiated Rate |
$312.59 |
| Rate for Payer: Aetna Commercial |
$295.22
|
| Rate for Payer: Aetna Medicare |
$173.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.76
|
| Rate for Payer: BCBS Complete |
$138.93
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$243.12
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Healthscope Commercial |
$312.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: PHP Commercial |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health SBD |
$218.81
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.81 |
| Max. Negotiated Rate |
$312.59 |
| Rate for Payer: Aetna Commercial |
$295.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.76
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$243.12
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Healthscope Commercial |
$312.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: PHP Commercial |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health SBD |
$218.81
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$158.19 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$175.77
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health SBD |
$158.19
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$432.09 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.22
|
| 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 |
$86.39
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Cofinity Commercial |
$175.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Mclaren Medicaid |
$82.28
|
| 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 |
$86.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$158.19
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.50
|
| Rate for Payer: UHC Medicare Advantage |
$153.50
|
| Rate for Payer: UHCCP Medicaid |
$86.42
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$281.49 |
| Rate for Payer: Aetna Commercial |
$139.44
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.63
|
| 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 |
$56.28
|
| Rate for Payer: BCBS MAPPO |
$100.00
|
| Rate for Payer: BCN Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$141.08
|
| Rate for Payer: Cofinity Commercial |
$114.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$147.65
|
| Rate for Payer: Mclaren Medicaid |
$53.60
|
| 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 |
$56.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: PACE Medicare |
$95.00
|
| Rate for Payer: PACE SWMI |
$100.00
|
| Rate for Payer: PHP Commercial |
$139.44
|
| Rate for Payer: PHP Medicare Advantage |
$100.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: Priority Health Medicare |
$100.00
|
| Rate for Payer: Priority Health SBD |
$103.35
|
| Rate for Payer: Railroad Medicare Medicare |
$100.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.00
|
| Rate for Payer: UHC Medicare Advantage |
$100.00
|
| Rate for Payer: UHCCP Medicaid |
$56.30
|
| Rate for Payer: VA VA |
$100.00
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$147.65 |
| Rate for Payer: Aetna Commercial |
$139.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.63
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$114.83
|
| Rate for Payer: Cofinity Commercial |
$141.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Healthscope Commercial |
$147.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: PHP Commercial |
$139.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: Priority Health SBD |
$103.35
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.22 |
| Max. Negotiated Rate |
$174.47 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna Medicare |
$64.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.28
|
| 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 |
$34.88
|
| Rate for Payer: BCBS MAPPO |
$61.98
|
| Rate for Payer: BCN Medicare Advantage |
$61.98
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$105.62
|
| Rate for Payer: Mclaren Medicaid |
$33.22
|
| 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 |
$34.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: PACE Medicare |
$58.88
|
| Rate for Payer: PACE SWMI |
$61.98
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: PHP Medicare Advantage |
$61.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: Priority Health Medicare |
$61.98
|
| Rate for Payer: Priority Health SBD |
$73.94
|
| Rate for Payer: Railroad Medicare Medicare |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.98
|
| Rate for Payer: UHC Medicare Advantage |
$61.98
|
| Rate for Payer: UHCCP Medicaid |
$34.89
|
| Rate for Payer: VA VA |
$61.98
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.94 |
| Max. Negotiated Rate |
$105.62 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.28
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Cofinity Commercial |
$82.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Healthscope Commercial |
$105.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: Priority Health SBD |
$73.94
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.13
|
| 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 |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Cofinity Commercial |
$39.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$7.83
|
| 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 |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health SBD |
$35.99
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.60
|
| Rate for Payer: UHC Medicare Advantage |
$14.60
|
| Rate for Payer: UHCCP Medicaid |
$8.22
|
| Rate for Payer: VA VA |
$14.60
|
|
