|
HC ZEVALIN IN-III PER STUDY
|
Facility
|
IP
|
$2,229.12
|
|
|
Service Code
|
HCPCS A9542
|
| Hospital Charge Code |
34300025
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,404.35 |
| Max. Negotiated Rate |
$2,006.21 |
| Rate for Payer: Aetna Commercial |
$1,894.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.93
|
| Rate for Payer: Cash Price |
$1,783.30
|
| Rate for Payer: Cofinity Commercial |
$1,560.38
|
| Rate for Payer: Cofinity Commercial |
$1,917.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,560.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,783.30
|
| Rate for Payer: Healthscope Commercial |
$2,006.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,894.75
|
| Rate for Payer: PHP Commercial |
$1,894.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.93
|
| Rate for Payer: Priority Health SBD |
$1,404.35
|
|
|
HC ZEVALIN Y-90 PER STUDY
|
Facility
|
IP
|
$61,963.39
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34400006
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$39,036.94 |
| Max. Negotiated Rate |
$55,767.05 |
| Rate for Payer: Aetna Commercial |
$52,668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,276.20
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cofinity Commercial |
$43,374.37
|
| Rate for Payer: Cofinity Commercial |
$53,288.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,374.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,570.71
|
| Rate for Payer: Healthscope Commercial |
$55,767.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,668.88
|
| Rate for Payer: PHP Commercial |
$52,668.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,276.20
|
| Rate for Payer: Priority Health SBD |
$39,036.94
|
|
|
HC ZEVALIN Y-90 PER STUDY
|
Facility
|
OP
|
$61,963.39
|
|
|
Service Code
|
HCPCS A9543
|
| Hospital Charge Code |
34400006
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$30,457.96 |
| Max. Negotiated Rate |
$159,955.43 |
| Rate for Payer: Aetna Commercial |
$52,668.88
|
| Rate for Payer: Aetna Medicare |
$59,097.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,276.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71,030.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71,030.69
|
| Rate for Payer: BCBS Complete |
$31,980.86
|
| Rate for Payer: BCBS MAPPO |
$56,824.55
|
| Rate for Payer: BCN Medicare Advantage |
$56,824.55
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cash Price |
$49,570.71
|
| Rate for Payer: Cofinity Commercial |
$53,288.52
|
| Rate for Payer: Cofinity Commercial |
$43,374.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$43,374.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,570.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,824.55
|
| Rate for Payer: Healthscope Commercial |
$55,767.05
|
| Rate for Payer: Mclaren Medicaid |
$30,457.96
|
| Rate for Payer: Mclaren Medicare |
$56,824.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,665.78
|
| Rate for Payer: Meridian Medicaid |
$31,980.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65,348.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,668.88
|
| Rate for Payer: PACE Medicare |
$53,983.32
|
| Rate for Payer: PACE SWMI |
$56,824.55
|
| Rate for Payer: PHP Commercial |
$52,668.88
|
| Rate for Payer: PHP Medicare Advantage |
$56,824.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,457.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40,276.20
|
| Rate for Payer: Priority Health Medicare |
$56,824.55
|
| Rate for Payer: Priority Health SBD |
$39,036.94
|
| Rate for Payer: Railroad Medicare Medicare |
$56,824.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159,955.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$56,824.55
|
| Rate for Payer: UHC Medicare Advantage |
$56,824.55
|
| Rate for Payer: UHCCP Medicaid |
$31,992.22
|
| Rate for Payer: VA VA |
$56,824.55
|
|
|
HC Z G J TUBE
|
Facility
|
IP
|
$1,530.89
|
|
| Hospital Charge Code |
27800048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.46 |
| Max. Negotiated Rate |
$1,377.80 |
| Rate for Payer: Aetna Commercial |
$1,301.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.08
|
| Rate for Payer: Cash Price |
$1,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,071.62
|
| Rate for Payer: Cofinity Commercial |
$1,316.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.71
|
| Rate for Payer: Healthscope Commercial |
$1,377.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.26
|
| Rate for Payer: PHP Commercial |
$1,301.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.08
|
| Rate for Payer: Priority Health SBD |
$964.46
|
|
|
HC Z G J TUBE
|
Facility
|
OP
|
$1,530.89
|
|
| Hospital Charge Code |
27800048
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$1,377.80 |
| Rate for Payer: Aetna Commercial |
$1,301.26
|
| Rate for Payer: Aetna Medicare |
$765.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.08
|
| Rate for Payer: BCBS Complete |
$612.36
|
| Rate for Payer: Cash Price |
$1,224.71
|
| Rate for Payer: Cofinity Commercial |
$1,071.62
|
| Rate for Payer: Cofinity Commercial |
$1,316.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.71
|
| Rate for Payer: Healthscope Commercial |
$1,377.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,301.26
|
| Rate for Payer: PHP Commercial |
$1,301.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$995.08
|
| Rate for Payer: Priority Health SBD |
$964.46
|
|
|
HC Z HEMODIALYSIS ANGIODYNAMIC
|
Facility
|
IP
|
$1,223.34
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.70 |
| Max. Negotiated Rate |
$1,101.01 |
| Rate for Payer: Aetna Commercial |
$1,039.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.17
|
| Rate for Payer: Cash Price |
$978.67
|
| Rate for Payer: Cofinity Commercial |
$1,052.07
|
| Rate for Payer: Cofinity Commercial |
$856.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$856.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.67
|
| Rate for Payer: Healthscope Commercial |
$1,101.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.84
|
| Rate for Payer: PHP Commercial |
$1,039.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.17
|
| Rate for Payer: Priority Health SBD |
$770.70
|
|
|
HC Z HEMODIALYSIS ANGIODYNAMIC
|
Facility
|
OP
|
$1,223.34
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$1,101.01 |
| Rate for Payer: Aetna Commercial |
$1,039.84
|
| Rate for Payer: Aetna Medicare |
$611.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.17
|
| Rate for Payer: BCBS Complete |
$489.34
|
| Rate for Payer: Cash Price |
$978.67
|
| Rate for Payer: Cofinity Commercial |
$1,052.07
|
| Rate for Payer: Cofinity Commercial |
$856.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$856.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$978.67
|
| Rate for Payer: Healthscope Commercial |
$1,101.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,039.84
|
| Rate for Payer: PHP Commercial |
$1,039.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.17
|
| Rate for Payer: Priority Health SBD |
$770.70
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
IP
|
$1,583.13
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.37 |
| Max. Negotiated Rate |
$1,424.82 |
| Rate for Payer: Aetna Commercial |
$1,345.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.03
|
| Rate for Payer: Cash Price |
$1,266.50
|
| Rate for Payer: Cofinity Commercial |
$1,108.19
|
| Rate for Payer: Cofinity Commercial |
$1,361.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,108.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.50
|
| Rate for Payer: Healthscope Commercial |
$1,424.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.66
|
| Rate for Payer: PHP Commercial |
$1,345.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.03
|
| Rate for Payer: Priority Health SBD |
$997.37
|
|
|
HC Z HEMODIALYSIS BARD
|
Facility
|
OP
|
$1,583.13
|
|
|
Service Code
|
HCPCS C1881
|
| Hospital Charge Code |
27200088
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.25 |
| Max. Negotiated Rate |
$1,424.82 |
| Rate for Payer: Aetna Commercial |
$1,345.66
|
| Rate for Payer: Aetna Medicare |
$791.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.03
|
| Rate for Payer: BCBS Complete |
$633.25
|
| Rate for Payer: Cash Price |
$1,266.50
|
| Rate for Payer: Cofinity Commercial |
$1,108.19
|
| Rate for Payer: Cofinity Commercial |
$1,361.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,108.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,266.50
|
| Rate for Payer: Healthscope Commercial |
$1,424.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,345.66
|
| Rate for Payer: PHP Commercial |
$1,345.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.03
|
| Rate for Payer: Priority Health SBD |
$997.37
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
IP
|
$2,218.93
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,397.93 |
| Max. Negotiated Rate |
$1,997.04 |
| Rate for Payer: Aetna Commercial |
$1,886.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.30
|
| Rate for Payer: Cash Price |
$1,775.14
|
| Rate for Payer: Cofinity Commercial |
$1,553.25
|
| Rate for Payer: Cofinity Commercial |
$1,908.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,553.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.14
|
| Rate for Payer: Healthscope Commercial |
$1,997.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.09
|
| Rate for Payer: PHP Commercial |
$1,886.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.30
|
| Rate for Payer: Priority Health SBD |
$1,397.93
|
|
|
HC Z HYPERGLIDE OCCL BALLOON C
|
Facility
|
OP
|
$2,218.93
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200089
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.57 |
| Max. Negotiated Rate |
$1,997.04 |
| Rate for Payer: Aetna Commercial |
$1,886.09
|
| Rate for Payer: Aetna Medicare |
$1,109.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.30
|
| Rate for Payer: BCBS Complete |
$887.57
|
| Rate for Payer: Cash Price |
$1,775.14
|
| Rate for Payer: Cofinity Commercial |
$1,553.25
|
| Rate for Payer: Cofinity Commercial |
$1,908.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,553.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,775.14
|
| Rate for Payer: Healthscope Commercial |
$1,997.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.09
|
| Rate for Payer: PHP Commercial |
$1,886.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,442.30
|
| Rate for Payer: Priority Health SBD |
$1,397.93
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
OP
|
$187.68
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$168.91 |
| Rate for Payer: Aetna Commercial |
$159.53
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cofinity Commercial |
$161.40
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$168.91
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$9.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.53
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$159.53
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.99
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$118.24
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.85
|
| Rate for Payer: UHC Medicare Advantage |
$16.85
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC ZIKA VIRUS MAC ELISA IGM
|
Facility
|
IP
|
$187.68
|
|
|
Service Code
|
CPT 86794
|
| Hospital Charge Code |
30000148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.24 |
| Max. Negotiated Rate |
$168.91 |
| Rate for Payer: Aetna Commercial |
$159.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.99
|
| Rate for Payer: Cash Price |
$150.14
|
| Rate for Payer: Cofinity Commercial |
$131.38
|
| Rate for Payer: Cofinity Commercial |
$161.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.14
|
| Rate for Payer: Healthscope Commercial |
$168.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.53
|
| Rate for Payer: PHP Commercial |
$159.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.99
|
| Rate for Payer: Priority Health SBD |
$118.24
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
|
HC ZIKA VIRUS, PCR, SERUM
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$28.89
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health SBD |
$163.86
|
|
|
HC ZIKA VIRUS, PCR, URINE
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
30000151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$28.88
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Cofinity Commercial |
$182.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$27.50
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Meridian Medicaid |
$28.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.06
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$163.86
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UHCCP Medicaid |
$28.89
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
IP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,952.00 |
| Max. Negotiated Rate |
$2,788.57 |
| Rate for Payer: Aetna Commercial |
$2,633.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,013.97
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,168.89
|
| Rate for Payer: Cofinity Commercial |
$2,664.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,168.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Healthscope Commercial |
$2,788.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: PHP Commercial |
$2,633.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: Priority Health SBD |
$1,952.00
|
|
|
HC Z IMPLANTABLE PORT
|
Facility
|
OP
|
$3,098.41
|
|
|
Service Code
|
HCPCS C1788
|
| Hospital Charge Code |
27800039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.36 |
| Max. Negotiated Rate |
$2,788.57 |
| Rate for Payer: Aetna Commercial |
$2,633.65
|
| Rate for Payer: Aetna Medicare |
$1,549.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,013.97
|
| Rate for Payer: BCBS Complete |
$1,239.36
|
| Rate for Payer: Cash Price |
$2,478.73
|
| Rate for Payer: Cofinity Commercial |
$2,168.89
|
| Rate for Payer: Cofinity Commercial |
$2,664.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,168.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,478.73
|
| Rate for Payer: Healthscope Commercial |
$2,788.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,633.65
|
| Rate for Payer: PHP Commercial |
$2,633.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.97
|
| Rate for Payer: Priority Health SBD |
$1,952.00
|
|
|
HC ZINC LEVEL
|
Facility
|
IP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health SBD |
$31.49
|
|
|
HC ZINC LEVEL
|
Facility
|
OP
|
$49.98
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$44.98 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cash Price |
$39.98
|
| Rate for Payer: Cofinity Commercial |
$42.98
|
| Rate for Payer: Cofinity Commercial |
$34.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$44.98
|
| Rate for Payer: Mclaren Medicaid |
$6.11
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.48
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$42.48
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.49
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health SBD |
$31.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Medicare Advantage |
$11.39
|
| Rate for Payer: UHCCP Medicaid |
$6.41
|
| Rate for Payer: VA VA |
$11.39
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.27
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Mclaren Medicaid |
$12.63
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: Meridian Medicaid |
$13.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$283.50
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$23.57
|
| Rate for Payer: UHCCP Medicaid |
$13.27
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ZINC TRANSPORTER T8
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200514
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC ZINC URINE
|
Facility
|
IP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.48
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Healthscope Commercial |
$62.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: PHP Commercial |
$59.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: Priority Health SBD |
$44.08
|
|
|
HC ZINC URINE
|
Facility
|
OP
|
$69.97
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
30100463
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$62.97 |
| Rate for Payer: Aetna Commercial |
$59.47
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.24
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$11.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.39
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Cofinity Commercial |
$48.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$62.97
|
| Rate for Payer: Mclaren Medicaid |
$6.11
|
| Rate for Payer: Mclaren Medicare |
$11.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.96
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.47
|
| Rate for Payer: PACE Medicare |
$10.82
|
| Rate for Payer: PACE SWMI |
$11.39
|
| Rate for Payer: PHP Commercial |
$59.47
|
| Rate for Payer: PHP Medicare Advantage |
$11.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.48
|
| Rate for Payer: Priority Health Medicare |
$11.39
|
| Rate for Payer: Priority Health SBD |
$44.08
|
| Rate for Payer: Railroad Medicare Medicare |
$11.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.39
|
| Rate for Payer: UHC Medicare Advantage |
$11.39
|
| Rate for Payer: UHCCP Medicaid |
$6.41
|
| Rate for Payer: VA VA |
$11.39
|
|
