|
HC SWEAT COLLECTION
|
Facility
|
OP
|
$101.12
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Aetna Commercial |
$85.95
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$5.10
|
| Rate for Payer: BCN Commercial |
$5.10
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cofinity Advantage |
$70.78
|
| Rate for Payer: Cofinity Commercial |
$86.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$91.01
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.95
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.84
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$85.95
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health SBD |
$63.71
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$80.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.15
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC SWEAT COLLECTION
|
Facility
|
IP
|
$101.12
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.71 |
| Max. Negotiated Rate |
$91.01 |
| Rate for Payer: Aetna Commercial |
$85.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.73
|
| Rate for Payer: Cash Price |
$80.90
|
| Rate for Payer: Cofinity Advantage |
$70.78
|
| Rate for Payer: Cofinity Commercial |
$86.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.90
|
| Rate for Payer: Healthscope Commercial |
$91.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.84
|
| Rate for Payer: PHP Commercial |
$85.95
|
| Rate for Payer: Priority Health SBD |
$63.71
|
|
|
HC SWEET VERNAL IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
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 SWEET VERNAL IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200103
|
|
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 SYCAMORE IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
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 SYCAMORE IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200104
|
|
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 SYPHILIS ANTIBODY CMPT
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health SBD |
$20.73
|
|
|
HC SYPHILIS ANTIBODY CMPT
|
Facility
|
OP
|
$32.90
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200215
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.39
|
| 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 |
$26.32
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Advantage |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| 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 |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.68
|
| Rate for Payer: PACE Medicare |
$4.06
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$27.96
|
| 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 |
$20.73
|
| 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 SYPHILLIS AB TP-PA REFLEX
|
Facility
|
OP
|
$83.23
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$6.92
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$39.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.24
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$52.43
|
| Rate for Payer: Priority Health Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.86
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$19.86
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC SYPHILLIS AB TP-PA REFLEX
|
Facility
|
IP
|
$83.23
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.10
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Advantage |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health SBD |
$52.43
|
|
|
HC SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| 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 Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| 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: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health SBD |
$32.77
|
|
|
HC SYPHYLIS NON-TREPONEMAL AB (RPR)
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 0065U
|
| Hospital Charge Code |
30200437
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$18.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.61
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: BCBS MAPPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.29
|
| Rate for Payer: BCN Commercial |
$19.29
|
| Rate for Payer: BCN Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Advantage |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$9.46
|
| Rate for Payer: Mclaren Medicare |
$18.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.99
|
| Rate for Payer: Meridian Medicaid |
$18.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$27.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.02
|
| Rate for Payer: PACE Medicare |
$17.19
|
| Rate for Payer: PACE SWMI |
$18.09
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$18.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$18.09
|
| Rate for Payer: Priority Health SBD |
$32.77
|
| Rate for Payer: Priority Health Tiered Network |
$14.47
|
| Rate for Payer: Railroad Medicare Medicare |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.14
|
| Rate for Payer: UHC Core |
$27.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.09
|
| Rate for Payer: UHC Exchange |
$27.14
|
| Rate for Payer: UHC Medicaid |
$9.46
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$18.09
|
|
|
HC T3 FREE
|
Facility
|
IP
|
$134.83
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.94 |
| Max. Negotiated Rate |
$121.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.64
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cofinity Advantage |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$115.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.86
|
| Rate for Payer: Healthscope Commercial |
$121.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.12
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: Priority Health SBD |
$84.94
|
|
|
HC T3 FREE
|
Facility
|
OP
|
$134.83
|
|
|
Service Code
|
CPT 84481
|
| Hospital Charge Code |
30100448
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$121.35 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCN Commercial |
$18.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cash Price |
$107.86
|
| Rate for Payer: Cofinity Advantage |
$94.38
|
| Rate for Payer: Cofinity Commercial |
$115.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$121.35
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.61
|
| Rate for Payer: Nomi Health Commercial |
$25.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.12
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$114.61
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.94
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health SBD |
$84.94
|
| Rate for Payer: Priority Health Tiered Network |
$13.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.41
|
| Rate for Payer: UHC Core |
$25.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC T3 REVERSE
|
Facility
|
IP
|
$59.30
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
30100660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.36 |
| Max. Negotiated Rate |
$53.37 |
| Rate for Payer: Aetna Commercial |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.55
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Advantage |
$41.51
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: PHP Commercial |
$50.41
|
| Rate for Payer: Priority Health SBD |
$37.36
|
|
|
HC T3 REVERSE
|
Facility
|
OP
|
$59.30
|
|
|
Service Code
|
CPT 84482
|
| Hospital Charge Code |
30100660
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$53.37 |
| Rate for Payer: Aetna Commercial |
$50.41
|
| Rate for Payer: Aetna Medicare |
$16.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.70
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS MAPPO |
$15.76
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCN Commercial |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$15.76
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cash Price |
$47.44
|
| Rate for Payer: Cofinity Advantage |
$41.51
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.76
|
| Rate for Payer: Healthscope Commercial |
$53.37
|
| Rate for Payer: Mclaren Medicaid |
$8.24
|
| Rate for Payer: Mclaren Medicare |
$15.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.55
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.41
|
| Rate for Payer: Nomi Health Commercial |
$23.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.48
|
| Rate for Payer: PACE Medicare |
$14.97
|
| Rate for Payer: PACE SWMI |
$15.76
|
| Rate for Payer: PHP Commercial |
$50.41
|
| Rate for Payer: PHP Medicare Advantage |
$15.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.76
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health SBD |
$37.36
|
| Rate for Payer: Priority Health Tiered Network |
$12.61
|
| Rate for Payer: Railroad Medicare Medicare |
$15.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.64
|
| Rate for Payer: UHC Core |
$23.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.76
|
| Rate for Payer: UHC Exchange |
$23.64
|
| Rate for Payer: UHC Medicaid |
$8.24
|
| Rate for Payer: UHCCP Medicaid |
$8.24
|
| Rate for Payer: VA VA |
$15.76
|
|
|
HC T3 UPTAKE
|
Facility
|
IP
|
$139.41
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
30100446
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$125.47 |
| Rate for Payer: Aetna Commercial |
$118.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.62
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cofinity Advantage |
$97.59
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.53
|
| Rate for Payer: Healthscope Commercial |
$125.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.56
|
| Rate for Payer: PHP Commercial |
$118.50
|
| Rate for Payer: Priority Health SBD |
$87.83
|
|
|
HC T3 UPTAKE
|
Facility
|
OP
|
$139.41
|
|
|
Service Code
|
CPT 84479
|
| Hospital Charge Code |
30100446
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$125.47 |
| Rate for Payer: Aetna Commercial |
$118.50
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$6.89
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cash Price |
$111.53
|
| Rate for Payer: Cofinity Advantage |
$97.59
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$125.47
|
| Rate for Payer: Mclaren Medicaid |
$3.38
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.50
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.56
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$118.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$87.83
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC T4 TOTAL
|
Facility
|
OP
|
$47.86
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
30100435
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: BCBS MAPPO |
$6.87
|
| Rate for Payer: BCBS Trust/PPO |
$7.32
|
| Rate for Payer: BCN Commercial |
$7.32
|
| Rate for Payer: BCN Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Advantage |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.87
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Mclaren Medicaid |
$3.59
|
| Rate for Payer: Mclaren Medicare |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.21
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.90
|
| Rate for Payer: PACE Medicare |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.87
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: Priority Health SBD |
$30.15
|
| Rate for Payer: Priority Health Tiered Network |
$5.50
|
| Rate for Payer: Railroad Medicare Medicare |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.31
|
| Rate for Payer: UHC Core |
$10.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.87
|
| Rate for Payer: UHC Exchange |
$10.31
|
| Rate for Payer: UHC Medicaid |
$3.59
|
| Rate for Payer: UHCCP Medicaid |
$3.59
|
| Rate for Payer: VA VA |
$6.87
|
|
|
HC T4 TOTAL
|
Facility
|
IP
|
$47.86
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
30100435
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: Cash Price |
$38.29
|
| Rate for Payer: Cofinity Advantage |
$33.50
|
| Rate for Payer: Cofinity Commercial |
$41.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.90
|
| Rate for Payer: PHP Commercial |
$40.68
|
| Rate for Payer: Priority Health SBD |
$30.15
|
|
|
HC T4 TOTAL ONLY
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
30100759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$3.77
|
| Rate for Payer: BCBS MAPPO |
$6.87
|
| Rate for Payer: BCBS Trust/PPO |
$7.32
|
| Rate for Payer: BCN Commercial |
$7.32
|
| Rate for Payer: BCN Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.87
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Mclaren Medicaid |
$3.59
|
| Rate for Payer: Mclaren Medicare |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.21
|
| Rate for Payer: Meridian Medicaid |
$7.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PACE Medicare |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.87
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$6.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: Priority Health SBD |
$29.50
|
| Rate for Payer: Priority Health Tiered Network |
$5.50
|
| Rate for Payer: Railroad Medicare Medicare |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.31
|
| Rate for Payer: UHC Core |
$10.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.87
|
| Rate for Payer: UHC Exchange |
$10.31
|
| Rate for Payer: UHC Medicaid |
$3.59
|
| Rate for Payer: UHCCP Medicaid |
$3.59
|
| Rate for Payer: VA VA |
$6.87
|
|
|
HC T4 TOTAL ONLY
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
30100759
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.43
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Advantage |
$32.77
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health SBD |
$29.50
|
|
|
HC TACROLIMUS LEVEL
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
30100047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.16
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.73
|
| Rate for Payer: BCBS Trust/PPO |
$14.64
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: BCN Medicare Advantage |
$13.73
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.73
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| Rate for Payer: Mclaren Medicare |
$13.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.42
|
| Rate for Payer: Meridian Medicaid |
$14.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$20.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PACE Medicare |
$13.04
|
| Rate for Payer: PACE SWMI |
$13.73
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Medicare Advantage |
$13.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.73
|
| Rate for Payer: Priority Health Medicare |
$13.73
|
| Rate for Payer: Priority Health SBD |
$42.12
|
| Rate for Payer: Priority Health Tiered Network |
$10.98
|
| Rate for Payer: Railroad Medicare Medicare |
$13.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.60
|
| Rate for Payer: UHC Core |
$20.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.73
|
| Rate for Payer: UHC Exchange |
$20.60
|
| Rate for Payer: UHC Medicaid |
$7.18
|
| Rate for Payer: UHCCP Medicaid |
$7.18
|
| Rate for Payer: VA VA |
$13.73
|
|
|
HC TACROLIMUS LEVEL
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
30100047
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.46
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Advantage |
$46.80
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: Priority Health SBD |
$42.12
|
|
|
HC T AND B CELL QUANTITATION
|
Facility
|
IP
|
$67.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200204
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.91
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Advantage |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: Priority Health SBD |
$42.56
|
|
