|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.96
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$59.19
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health SBD |
$53.27
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$210.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.26 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health SBD |
$265.26
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Priority Health SBD |
$55.24
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Core |
$64.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$64.88
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$13.44
|
| Rate for Payer: VA VA |
$23.88
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.24 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.99
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$61.38
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health SBD |
$55.24
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$59.76 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| 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 |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| 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 |
$11.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: PACE Medicare |
$20.17
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health SBD |
$38.67
|
| Rate for Payer: Railroad Medicare Medicare |
$21.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.23
|
| Rate for Payer: UHC Medicare Advantage |
$21.23
|
| Rate for Payer: UHCCP Medicaid |
$11.95
|
| Rate for Payer: VA VA |
$21.23
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health SBD |
$38.67
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$10.86
|
| 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 |
$11.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
| Rate for Payer: UHCCP Medicaid |
$11.41
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$74.90 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$14.98
|
| Rate for Payer: BCBS MAPPO |
$26.61
|
| Rate for Payer: BCN Medicare Advantage |
$26.61
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.61
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.26
|
| 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 |
$14.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$25.28
|
| Rate for Payer: PACE SWMI |
$26.61
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$26.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$26.61
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.61
|
| Rate for Payer: UHC Medicare Advantage |
$26.61
|
| Rate for Payer: UHCCP Medicaid |
$14.98
|
| Rate for Payer: VA VA |
$26.61
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$10.86
|
| 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 |
$11.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
| Rate for Payer: UHCCP Medicaid |
$11.41
|
| Rate for Payer: VA VA |
$20.26
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$74.57 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| 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 |
$14.91
|
| Rate for Payer: BCBS MAPPO |
$26.49
|
| Rate for Payer: BCN Medicare Advantage |
$26.49
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$14.20
|
| 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 |
$14.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PACE Medicare |
$25.17
|
| Rate for Payer: PACE SWMI |
$26.49
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$26.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$26.49
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Railroad Medicare Medicare |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.49
|
| Rate for Payer: UHC Medicare Advantage |
$26.49
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: VA VA |
$26.49
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
IP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$186.35 |
| Max. Negotiated Rate |
$266.22 |
| Rate for Payer: Aetna Commercial |
$251.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.27
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$207.06
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Healthscope Commercial |
$266.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: PHP Commercial |
$251.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: Priority Health SBD |
$186.35
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$266.22 |
| Rate for Payer: Aetna Commercial |
$251.43
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.27
|
| 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 |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Commercial |
$207.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$266.22
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| 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 |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$251.43
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$186.35
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$10.49
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
IP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$208.20 |
| Max. Negotiated Rate |
$297.43 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.81
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$231.34
|
| Rate for Payer: Cofinity Commercial |
$284.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Healthscope Commercial |
$297.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: PHP Commercial |
$280.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: Priority Health SBD |
$208.20
|
|
|
HC THIOPURINE METHYLTRANSFERASE RBC
|
Facility
|
OP
|
$330.48
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$297.43 |
| Rate for Payer: Aetna Commercial |
$280.91
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.81
|
| 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 |
$12.48
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cash Price |
$264.38
|
| Rate for Payer: Cofinity Commercial |
$284.21
|
| Rate for Payer: Cofinity Commercial |
$231.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$231.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$297.43
|
| Rate for Payer: Mclaren Medicaid |
$11.88
|
| 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 |
$12.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.91
|
| Rate for Payer: PACE Medicare |
$21.06
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$280.91
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.81
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health SBD |
$208.20
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.17
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$12.48
|
| Rate for Payer: VA VA |
$22.17
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
OP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$99.96
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$24.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: PACE Medicare |
$22.89
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health Medicare |
$24.09
|
| Rate for Payer: Priority Health SBD |
$89.96
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: UHCCP Medicaid |
$13.56
|
| Rate for Payer: VA VA |
$24.09
|
|
|
HC THIOPURINE METHYLTRANSFERASE T
|
Facility
|
IP
|
$142.80
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100290
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$121.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.82
|
| Rate for Payer: Cash Price |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$122.81
|
| Rate for Payer: Cofinity Commercial |
$99.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.24
|
| Rate for Payer: Healthscope Commercial |
$128.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.38
|
| Rate for Payer: PHP Commercial |
$121.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.82
|
| Rate for Payer: Priority Health SBD |
$89.96
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
IP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$62.81 |
| Rate for Payer: Aetna Commercial |
$59.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.36
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$48.85
|
| Rate for Payer: Cofinity Commercial |
$60.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: PHP Commercial |
$59.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: Priority Health SBD |
$43.97
|
|
|
HC THIRD STEP GEL 8 OZ
|
Facility
|
OP
|
$69.79
|
|
| Hospital Charge Code |
27100018
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$62.81 |
| Rate for Payer: Aetna Commercial |
$59.32
|
| Rate for Payer: Aetna Medicare |
$34.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.36
|
| Rate for Payer: BCBS Complete |
$27.92
|
| Rate for Payer: Cash Price |
$55.83
|
| Rate for Payer: Cofinity Commercial |
$48.85
|
| Rate for Payer: Cofinity Commercial |
$60.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.83
|
| Rate for Payer: Healthscope Commercial |
$62.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.32
|
| Rate for Payer: PHP Commercial |
$59.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.36
|
| Rate for Payer: Priority Health SBD |
$43.97
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
OP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.16 |
| Max. Negotiated Rate |
$763.11 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna Medicare |
$423.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.13
|
| Rate for Payer: BCBS Complete |
$339.16
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$593.53
|
| Rate for Payer: Cofinity Commercial |
$729.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$593.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Healthscope Commercial |
$763.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: PHP Commercial |
$720.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.13
|
| Rate for Payer: Priority Health SBD |
$534.18
|
|
|
HC THORACENTESIS/PARACENTESIS
|
Facility
|
IP
|
$847.90
|
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$534.18 |
| Max. Negotiated Rate |
$763.11 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.13
|
| Rate for Payer: Cash Price |
$678.32
|
| Rate for Payer: Cofinity Commercial |
$593.53
|
| Rate for Payer: Cofinity Commercial |
$729.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$593.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$678.32
|
| Rate for Payer: Healthscope Commercial |
$763.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.72
|
| Rate for Payer: PHP Commercial |
$720.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.13
|
| Rate for Payer: Priority Health SBD |
$534.18
|
|
