|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
IP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$270.56 |
| Max. Negotiated Rate |
$386.51 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.15
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Advantage |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$369.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Healthscope Commercial |
$386.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: PHP Commercial |
$365.04
|
| Rate for Payer: Priority Health SBD |
$270.56
|
|
|
HC THERASKIN 2.5X2.5 PER SQ CM
|
Facility
|
OP
|
$429.46
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$85.47
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cash Price |
$343.57
|
| Rate for Payer: Cofinity Advantage |
$300.62
|
| Rate for Payer: Cofinity Commercial |
$369.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$386.51
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.04
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.10
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$365.04
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$270.56
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
IP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.32 |
| Max. Negotiated Rate |
$169.03 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.08
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Advantage |
$131.47
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Healthscope Commercial |
$169.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: PHP Commercial |
$159.64
|
| Rate for Payer: Priority Health SBD |
$118.32
|
|
|
HC THERASKIN 2.5X5.1 PER SQ CM
|
Facility
|
OP
|
$187.81
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$159.64
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$85.47
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cash Price |
$150.25
|
| Rate for Payer: Cofinity Advantage |
$131.47
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$169.03
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.64
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.86
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$159.64
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$118.32
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
OP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$73.30
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$85.47
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Advantage |
$60.37
|
| Rate for Payer: Cofinity Commercial |
$74.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$73.30
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$54.33
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 5.1X7.6 PER SQ CM
|
Facility
|
IP
|
$86.24
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.33 |
| Max. Negotiated Rate |
$77.62 |
| Rate for Payer: Aetna Commercial |
$73.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.06
|
| Rate for Payer: Cash Price |
$68.99
|
| Rate for Payer: Cofinity Advantage |
$60.37
|
| Rate for Payer: Cofinity Commercial |
$74.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.99
|
| Rate for Payer: Healthscope Commercial |
$77.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.68
|
| Rate for Payer: PHP Commercial |
$73.30
|
| Rate for Payer: Priority Health SBD |
$54.33
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
OP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.62 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$68.10
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.62
|
| Rate for Payer: BCN Commercial |
$85.47
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Advantage |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$52.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Mclaren Medicaid |
$64.85
|
| Rate for Payer: Mclaren Medicare |
$124.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$130.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Nomi Health Commercial |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: PACE Medicare |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$51.53
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$401.00
|
| Rate for Payer: Priority Health Medicare |
$124.00
|
| Rate for Payer: Priority Health SBD |
$38.19
|
| Rate for Payer: Priority Health Tiered Network |
$320.80
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.78
|
| Rate for Payer: UHC Core |
$209.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.00
|
| Rate for Payer: UHC Exchange |
$209.78
|
| Rate for Payer: UHC Medicaid |
$64.85
|
| Rate for Payer: UHCCP Medicaid |
$64.85
|
| Rate for Payer: VA VA |
$124.00
|
|
|
HC THERASKIN 7.6X15.24 PER SQ CM
|
Facility
|
IP
|
$60.62
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$54.56 |
| Rate for Payer: Aetna Commercial |
$51.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.40
|
| Rate for Payer: Cash Price |
$48.50
|
| Rate for Payer: Cofinity Advantage |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$52.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.47
|
| Rate for Payer: PHP Commercial |
$51.53
|
| Rate for Payer: Priority Health SBD |
$38.19
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$93.19 |
| Rate for Payer: Aetna Commercial |
$76.02
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Advantage |
$62.60
|
| Rate for Payer: Cofinity Commercial |
$76.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$80.49
|
| Rate for Payer: Mclaren Medicaid |
$15.07
|
| Rate for Payer: Mclaren Medicare |
$28.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$30.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Nomi Health Commercial |
$86.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: PACE Medicare |
$27.38
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$76.02
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.19
|
| Rate for Payer: Priority Health Medicare |
$28.82
|
| Rate for Payer: Priority Health SBD |
$56.34
|
| Rate for Payer: Priority Health Tiered Network |
$74.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.13
|
| Rate for Payer: UHC Core |
$46.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.82
|
| Rate for Payer: UHC Exchange |
$35.15
|
| Rate for Payer: UHC Medicaid |
$15.07
|
| Rate for Payer: UHCCP Medicaid |
$15.07
|
| Rate for Payer: VA VA |
$28.82
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$89.43
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$80.49 |
| Rate for Payer: Aetna Commercial |
$76.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.13
|
| Rate for Payer: Cash Price |
$71.54
|
| Rate for Payer: Cofinity Advantage |
$62.60
|
| Rate for Payer: Cofinity Commercial |
$76.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.54
|
| Rate for Payer: Healthscope Commercial |
$80.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.07
|
| Rate for Payer: PHP Commercial |
$76.02
|
| Rate for Payer: Priority Health SBD |
$56.34
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.54
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$22.63
|
| Rate for Payer: BCN Commercial |
$22.63
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Mclaren Medicaid |
$11.10
|
| Rate for Payer: Mclaren Medicare |
$21.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: Meridian Medicaid |
$22.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Nomi Health Commercial |
$31.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.23
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health SBD |
$39.44
|
| Rate for Payer: Priority Health Tiered Network |
$16.98
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.85
|
| Rate for Payer: UHC Core |
$31.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.23
|
| Rate for Payer: UHC Exchange |
$31.85
|
| Rate for Payer: UHC Medicaid |
$11.10
|
| Rate for Payer: UHCCP Medicaid |
$11.10
|
| Rate for Payer: VA VA |
$21.23
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$62.61
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.44 |
| Max. Negotiated Rate |
$56.35 |
| Rate for Payer: Aetna Commercial |
$53.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.70
|
| Rate for Payer: Cash Price |
$50.09
|
| Rate for Payer: Cofinity Advantage |
$43.83
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.09
|
| Rate for Payer: Healthscope Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.96
|
| Rate for Payer: PHP Commercial |
$53.22
|
| Rate for Payer: Priority Health SBD |
$39.44
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$21.61
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$21.61
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$30.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.26
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.39
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$30.39
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.26
|
| Rate for Payer: BCBS Complete |
$14.61
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$28.38
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$28.38
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$26.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.94
|
| Rate for Payer: Meridian Medicaid |
$27.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$39.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$25.28
|
| Rate for Payer: PACE SWMI |
$26.61
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$26.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.61
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$21.29
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$39.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.61
|
| Rate for Payer: UHC Exchange |
$39.92
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$26.61
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$21.61
|
| Rate for Payer: BCCCP Commercial |
$20.26
|
| Rate for Payer: BCN Commercial |
$21.61
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$60.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.26
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$16.21
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.39
|
| Rate for Payer: UHC Core |
$30.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$30.39
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$79.47 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.11
|
| Rate for Payer: BCBS Complete |
$14.55
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCBS Trust/PPO |
$28.25
|
| Rate for Payer: BCCCP Commercial |
$26.61
|
| Rate for Payer: BCN Commercial |
$28.25
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Mclaren Medicaid |
$13.85
|
| Rate for Payer: Mclaren Medicare |
$26.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.81
|
| Rate for Payer: Meridian Medicaid |
$27.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$79.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.49
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health SBD |
$50.14
|
| Rate for Payer: Priority Health Tiered Network |
$21.19
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.74
|
| Rate for Payer: UHC Core |
$39.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.49
|
| Rate for Payer: UHC Exchange |
$39.74
|
| Rate for Payer: UHC Medicaid |
$13.85
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.14 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Advantage |
$55.71
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health SBD |
$50.14
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Advantage |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$259.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$271.55
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$256.46
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$190.08
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$301.72
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$271.55 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.12
|
| Rate for Payer: Cash Price |
$241.38
|
| Rate for Payer: Cofinity Advantage |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$259.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.38
|
| Rate for Payer: Healthscope Commercial |
$271.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.29
|
| Rate for Payer: PHP Commercial |
$256.46
|
| Rate for Payer: Priority Health SBD |
$190.08
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$303.38 |
| Rate for Payer: Aetna Commercial |
$286.53
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.71
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.64
|
| Rate for Payer: BCN Commercial |
$23.64
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Advantage |
$235.96
|
| Rate for Payer: Cofinity Commercial |
$289.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$303.38
|
| Rate for Payer: Mclaren Medicaid |
$11.59
|
| Rate for Payer: Mclaren Medicare |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$23.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Nomi Health Commercial |
$33.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$286.53
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.17
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health SBD |
$212.37
|
| Rate for Payer: Priority Health Tiered Network |
$17.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.26
|
| Rate for Payer: UHC Core |
$33.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$33.26
|
| Rate for Payer: UHC Medicaid |
$11.59
|
| Rate for Payer: UHCCP Medicaid |
$11.59
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$337.09
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$212.37 |
| Max. Negotiated Rate |
$303.38 |
| Rate for Payer: Aetna Commercial |
$286.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.11
|
| Rate for Payer: Cash Price |
$269.67
|
| Rate for Payer: Cofinity Advantage |
$235.96
|
| Rate for Payer: Cofinity Commercial |
$289.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.67
|
| Rate for Payer: Healthscope Commercial |
$303.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.82
|
| Rate for Payer: PHP Commercial |
$286.53
|
| Rate for Payer: Priority Health SBD |
$212.37
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$145.66
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$123.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.68
|
| Rate for Payer: Cash Price |
$116.53
|
| Rate for Payer: Cofinity Advantage |
$101.96
|
| Rate for Payer: Cofinity Commercial |
$125.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.53
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.25
|
| Rate for Payer: PHP Commercial |
$123.81
|
| Rate for Payer: Priority Health SBD |
$91.77
|
|
