|
HC TREPONEMA PALLIDUM ANTIBODY
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$37.27 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| 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 |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$15.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.45
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30000057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.91
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health SBD |
$15.42
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY FT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| 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 |
$7.45
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| 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 |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.24
|
| Rate for Payer: UHC Medicare Advantage |
$13.24
|
| Rate for Payer: UHCCP Medicaid |
$7.45
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC TREPONEMA PALLIDUM ANTIBODY FT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200325
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.30
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.75
|
| Rate for Payer: Priority Health SBD |
$44.34
|
|
|
HC TRIAD CREAM
|
Facility
|
OP
|
$27.70
|
|
| Hospital Charge Code |
27000605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health SBD |
$17.45
|
|
|
HC TRIAD CREAM
|
Facility
|
IP
|
$27.70
|
|
| Hospital Charge Code |
27000605
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health SBD |
$17.45
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30600206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
30600222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$98.77 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
30600222
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC TRICHOMONAS VAGINALIS AMPLIFIED DNA PROBE
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
30600206
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC TRIGGER POINT INJ
|
Facility
|
IP
|
$447.35
|
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.83 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
|
|
HC TRIGGER POINT INJ
|
Facility
|
OP
|
$447.35
|
|
| Hospital Charge Code |
45000088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.94 |
| Max. Negotiated Rate |
$402.62 |
| Rate for Payer: Aetna Commercial |
$380.25
|
| Rate for Payer: Aetna Medicare |
$223.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.78
|
| Rate for Payer: BCBS Complete |
$178.94
|
| Rate for Payer: Cash Price |
$357.88
|
| Rate for Payer: Cofinity Commercial |
$313.14
|
| Rate for Payer: Cofinity Commercial |
$384.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.88
|
| Rate for Payer: Healthscope Commercial |
$402.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.25
|
| Rate for Payer: PHP Commercial |
$380.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.78
|
| Rate for Payer: Priority Health SBD |
$281.83
|
|
|
HC TRIGLYCERIDES
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health SBD |
$13.65
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$21.66
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100444
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.17
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: UHCCP Medicaid |
$3.23
|
| Rate for Payer: VA VA |
$5.74
|
|
|
HC TRIGLYCERIDES LMPP
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health SBD |
$9.83
|
|
|
HC TRIGLYCERIDES LMPP
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
30100689
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$5.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.17
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.74
|
| Rate for Payer: BCN Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$10.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.74
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicare |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: PACE Medicare |
$5.45
|
| Rate for Payer: PACE SWMI |
$5.74
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Medicare |
$5.74
|
| Rate for Payer: Priority Health SBD |
$9.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.74
|
| Rate for Payer: UHCCP Medicaid |
$3.23
|
| Rate for Payer: VA VA |
$5.74
|
|
|
HC TRIM DYSTROPHIC NAIL(S)
|
Facility
|
IP
|
$173.40
|
|
|
Service Code
|
CPT G0127
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.24 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health SBD |
$109.24
|
|
|
HC TRIM DYSTROPHIC NAIL(S)
|
Facility
|
OP
|
$173.40
|
|
|
Service Code
|
CPT G0127
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$147.39
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cash Price |
$138.72
|
| Rate for Payer: Cofinity Commercial |
$149.12
|
| Rate for Payer: Cofinity Commercial |
$121.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$156.06
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.39
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$147.39
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.71
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$109.24
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC TRIMMING NONDYSTROPHIC NAILS
|
Facility
|
IP
|
$76.83
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
76100042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.94
|
| Rate for Payer: Priority Health SBD |
$48.40
|
|
|
HC TRIMMING NONDYSTROPHIC NAILS
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
76100042
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Cofinity Commercial |
$53.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.94
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$48.40
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC TRIVISC FOR INTRA-ARTICULAR INJ, 1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7329
|
| Hospital Charge Code |
63600237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$13.20 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.86
|
| Rate for Payer: BCBS Complete |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$4.69
|
| Rate for Payer: BCN Medicare Advantage |
$4.69
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.69
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Mclaren Medicaid |
$2.51
|
| Rate for Payer: Mclaren Medicare |
$4.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.92
|
| Rate for Payer: Meridian Medicaid |
$2.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PACE Medicare |
$4.46
|
| Rate for Payer: PACE SWMI |
$4.69
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$4.69
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.69
|
| Rate for Payer: UHC Medicare Advantage |
$4.69
|
| Rate for Payer: UHCCP Medicaid |
$2.64
|
| Rate for Payer: VA VA |
$4.69
|
|
|
HC TRIVISC FOR INTRA-ARTICULAR INJ, 1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7329
|
| Hospital Charge Code |
63600237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
|
|
HC TRMT DEVICE - C
|
Facility
|
IP
|
$949.89
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$598.43 |
| Max. Negotiated Rate |
$854.90 |
| Rate for Payer: Aetna Commercial |
$807.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.43
|
| Rate for Payer: Cash Price |
$759.91
|
| Rate for Payer: Cofinity Commercial |
$664.92
|
| Rate for Payer: Cofinity Commercial |
$816.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$664.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.91
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.41
|
| Rate for Payer: PHP Commercial |
$807.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.43
|
| Rate for Payer: Priority Health SBD |
$598.43
|
|
|
HC TRMT DEVICE - C
|
Facility
|
OP
|
$949.89
|
|
|
Service Code
|
CPT 77334
|
| Hospital Charge Code |
33300014
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$191.36 |
| Max. Negotiated Rate |
$1,004.98 |
| Rate for Payer: Aetna Commercial |
$807.41
|
| Rate for Payer: Aetna Medicare |
$371.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.27
|
| Rate for Payer: BCBS Complete |
$200.93
|
| Rate for Payer: BCBS MAPPO |
$357.02
|
| Rate for Payer: BCN Medicare Advantage |
$357.02
|
| Rate for Payer: Cash Price |
$759.91
|
| Rate for Payer: Cash Price |
$759.91
|
| Rate for Payer: Cofinity Commercial |
$816.91
|
| Rate for Payer: Cofinity Commercial |
$664.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$664.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$759.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.02
|
| Rate for Payer: Healthscope Commercial |
$854.90
|
| Rate for Payer: Mclaren Medicaid |
$191.36
|
| Rate for Payer: Mclaren Medicare |
$357.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.87
|
| Rate for Payer: Meridian Medicaid |
$200.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.41
|
| Rate for Payer: PACE Medicare |
$339.17
|
| Rate for Payer: PACE SWMI |
$357.02
|
| Rate for Payer: PHP Commercial |
$807.41
|
| Rate for Payer: PHP Medicare Advantage |
$357.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.43
|
| Rate for Payer: Priority Health Medicare |
$357.02
|
| Rate for Payer: Priority Health SBD |
$598.43
|
| Rate for Payer: Railroad Medicare Medicare |
$357.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.98
|
| Rate for Payer: UHC Core |
$702.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.02
|
| Rate for Payer: UHC Exchange |
$702.92
|
| Rate for Payer: UHC Medicare Advantage |
$357.02
|
| Rate for Payer: UHCCP Medicaid |
$201.00
|
| Rate for Payer: VA VA |
$357.02
|
|
|
HC TROFILE
|
Facility
|
OP
|
$2,050.20
|
|
|
Service Code
|
CPT 87999
|
| Hospital Charge Code |
30600179
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$820.08 |
| Max. Negotiated Rate |
$1,845.18 |
| Rate for Payer: Aetna Commercial |
$1,742.67
|
| Rate for Payer: Aetna Medicare |
$1,025.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.63
|
| Rate for Payer: BCBS Complete |
$820.08
|
| Rate for Payer: Cash Price |
$1,640.16
|
| Rate for Payer: Cofinity Commercial |
$1,435.14
|
| Rate for Payer: Cofinity Commercial |
$1,763.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,435.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,640.16
|
| Rate for Payer: Healthscope Commercial |
$1,845.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,742.67
|
| Rate for Payer: PHP Commercial |
$1,742.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.63
|
| Rate for Payer: Priority Health SBD |
$1,291.63
|
|
