|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$43.88
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$39.49 |
| Rate for Payer: Aetna Commercial |
$37.30
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.52
|
| 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 |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Cofinity Commercial |
$30.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$39.49
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.30
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$37.30
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$27.64
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$7.97
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Medicaid |
$8.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Core |
$24.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| 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 |
$10.71
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$14.60
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$10.20
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Medicaid |
$10.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.37
|
| Rate for Payer: UHC Core |
$23.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$18.64
|
| Rate for Payer: UHC Medicare Advantage |
$19.20
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.86
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$9.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Mclaren Medicaid |
$6.74
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Medicaid |
$7.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health SBD |
$48.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.78
|
| Rate for Payer: UHC Core |
$20.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.32
|
| Rate for Payer: UHC Exchange |
$12.32
|
| Rate for Payer: UHC Medicare Advantage |
$12.69
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.99
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$53.84
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: Priority Health SBD |
$48.45
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$194.03
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$122.24 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Aetna Commercial |
$164.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.12
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Cofinity Commercial |
$166.87
|
| Rate for Payer: Healthscope Commercial |
$174.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.93
|
| Rate for Payer: PHP Commercial |
$164.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.82
|
| Rate for Payer: Priority Health SBD |
$122.24
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
OP
|
$194.03
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$174.63 |
| Rate for Payer: Aetna Commercial |
$164.93
|
| Rate for Payer: Aetna Medicare |
$122.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.98
|
| Rate for Payer: BCBS Complete |
$67.54
|
| Rate for Payer: BCBS MAPPO |
$117.58
|
| Rate for Payer: BCBS Trust/PPO |
$47.60
|
| Rate for Payer: BCN Medicare Advantage |
$117.58
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cash Price |
$155.22
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Cofinity Commercial |
$166.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.58
|
| Rate for Payer: Healthscope Commercial |
$174.63
|
| Rate for Payer: Mclaren Medicaid |
$64.32
|
| Rate for Payer: Mclaren Medicare |
$117.58
|
| Rate for Payer: Meridian Medicaid |
$67.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.93
|
| Rate for Payer: PACE Medicare |
$111.70
|
| Rate for Payer: PACE SWMI |
$117.58
|
| Rate for Payer: PHP Commercial |
$164.93
|
| Rate for Payer: PHP Medicare Advantage |
$117.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.82
|
| Rate for Payer: Priority Health Medicare |
$117.58
|
| Rate for Payer: Priority Health SBD |
$122.24
|
| Rate for Payer: Railroad Medicare Medicare |
$117.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.58
|
| Rate for Payer: UHC Exchange |
$8.51
|
| Rate for Payer: UHC Medicare Advantage |
$121.11
|
| Rate for Payer: VA VA |
$117.58
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
IP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health SBD |
$31.61
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$31.61
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
OP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$31.61
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
IP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health SBD |
$31.61
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
OP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$31.61
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.54
|
| Rate for Payer: UHC Core |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.45
|
| Rate for Payer: UHC Exchange |
$25.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
IP
|
$50.17
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$42.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.61
|
| Rate for Payer: Cash Price |
$40.14
|
| Rate for Payer: Cofinity Commercial |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$35.12
|
| Rate for Payer: Healthscope Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.64
|
| Rate for Payer: PHP Commercial |
$42.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.12
|
| Rate for Payer: Priority Health SBD |
$31.61
|
|
|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
OP
|
$505.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$133.75 |
| Max. Negotiated Rate |
$454.89 |
| Rate for Payer: Aetna Commercial |
$429.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.53
|
| Rate for Payer: BCBS Complete |
$202.17
|
| Rate for Payer: BCBS Trust/PPO |
$133.75
|
| Rate for Payer: Cash Price |
$404.34
|
| Rate for Payer: Cash Price |
$404.34
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Cofinity Commercial |
$434.67
|
| Rate for Payer: Healthscope Commercial |
$454.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.62
|
| Rate for Payer: PHP Commercial |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.80
|
| Rate for Payer: Priority Health SBD |
$318.42
|
|
|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
IP
|
$505.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$318.42 |
| Max. Negotiated Rate |
$454.89 |
| Rate for Payer: Aetna Commercial |
$429.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.53
|
| Rate for Payer: Cash Price |
$404.34
|
| Rate for Payer: Cofinity Commercial |
$353.80
|
| Rate for Payer: Cofinity Commercial |
$434.67
|
| Rate for Payer: Healthscope Commercial |
$454.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.62
|
| Rate for Payer: PHP Commercial |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.80
|
| Rate for Payer: Priority Health SBD |
$318.42
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
OP
|
$1,100.68
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$151.93 |
| Max. Negotiated Rate |
$990.61 |
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$394.51
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$693.43
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$151.93
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
IP
|
$1,100.68
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$693.43 |
| Max. Negotiated Rate |
$990.61 |
| Rate for Payer: Aetna Commercial |
$935.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.44
|
| Rate for Payer: Cash Price |
$880.54
|
| Rate for Payer: Cofinity Commercial |
$770.48
|
| Rate for Payer: Cofinity Commercial |
$946.58
|
| Rate for Payer: Healthscope Commercial |
$990.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.58
|
| Rate for Payer: PHP Commercial |
$935.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.48
|
| Rate for Payer: Priority Health SBD |
$693.43
|
|
|
HC CARDIOVERSION
|
Facility
|
OP
|
$1,174.36
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$104.13 |
| Max. Negotiated Rate |
$1,749.11 |
| Rate for Payer: Aetna Commercial |
$998.21
|
| Rate for Payer: Aetna Medicare |
$602.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$723.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$723.88
|
| Rate for Payer: BCBS Complete |
$332.64
|
| Rate for Payer: BCBS MAPPO |
$579.10
|
| Rate for Payer: BCBS Trust/PPO |
$349.37
|
| Rate for Payer: BCN Medicare Advantage |
$579.10
|
| Rate for Payer: Cash Price |
$939.49
|
| Rate for Payer: Cash Price |
$939.49
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Cofinity Commercial |
$1,009.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.10
|
| Rate for Payer: Healthscope Commercial |
$1,056.92
|
| Rate for Payer: Mclaren Medicaid |
$316.77
|
| Rate for Payer: Mclaren Medicare |
$579.10
|
| Rate for Payer: Meridian Medicaid |
$332.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$608.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$665.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$998.21
|
| Rate for Payer: PACE Medicare |
$550.14
|
| Rate for Payer: PACE SWMI |
$579.10
|
| Rate for Payer: PHP Commercial |
$998.21
|
| Rate for Payer: PHP Medicare Advantage |
$579.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,749.11
|
| Rate for Payer: Priority Health Medicare |
$579.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,399.29
|
| Rate for Payer: Priority Health SBD |
$739.85
|
| Rate for Payer: Railroad Medicare Medicare |
$579.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$579.10
|
| Rate for Payer: UHC Exchange |
$104.13
|
| Rate for Payer: UHC Medicare Advantage |
$596.47
|
| Rate for Payer: VA VA |
$579.10
|
|
|
HC CARDIOVERSION
|
Facility
|
IP
|
$1,174.36
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
48000002
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$739.85 |
| Max. Negotiated Rate |
$1,056.92 |
| Rate for Payer: Aetna Commercial |
$998.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.33
|
| Rate for Payer: Cash Price |
$939.49
|
| Rate for Payer: Cofinity Commercial |
$1,009.95
|
| Rate for Payer: Cofinity Commercial |
$822.05
|
| Rate for Payer: Healthscope Commercial |
$1,056.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$998.21
|
| Rate for Payer: PHP Commercial |
$998.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.05
|
| Rate for Payer: Priority Health SBD |
$739.85
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
IP
|
$978.63
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$616.54 |
| Max. Negotiated Rate |
$880.77 |
| Rate for Payer: Aetna Commercial |
$831.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.11
|
| Rate for Payer: Cash Price |
$782.90
|
| Rate for Payer: Cofinity Commercial |
$841.62
|
| Rate for Payer: Cofinity Commercial |
$685.04
|
| Rate for Payer: Healthscope Commercial |
$880.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$831.84
|
| Rate for Payer: PHP Commercial |
$831.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.04
|
| Rate for Payer: Priority Health SBD |
$616.54
|
|
|
HC CARDIOVERSION EXT
|
Facility
|
OP
|
$978.63
|
|
| Hospital Charge Code |
45000034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.45 |
| Max. Negotiated Rate |
$880.77 |
| Rate for Payer: Aetna Commercial |
$831.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.11
|
| Rate for Payer: BCBS Complete |
$391.45
|
| Rate for Payer: Cash Price |
$782.90
|
| Rate for Payer: Cofinity Commercial |
$685.04
|
| Rate for Payer: Cofinity Commercial |
$841.62
|
| Rate for Payer: Healthscope Commercial |
$880.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$831.84
|
| Rate for Payer: PHP Commercial |
$831.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.04
|
| Rate for Payer: Priority Health SBD |
$616.54
|
|
