|
HC CHOLETEC PER STUDY
|
Facility
|
OP
|
$454.84
|
|
|
Service Code
|
HCPCS A9537
|
| Hospital Charge Code |
34300003
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$409.36 |
| Rate for Payer: Aetna Commercial |
$386.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.65
|
| Rate for Payer: BCBS Complete |
$181.94
|
| Rate for Payer: BCBS Trust/PPO |
$72.87
|
| Rate for Payer: Cash Price |
$363.87
|
| Rate for Payer: Cash Price |
$363.87
|
| Rate for Payer: Cofinity Commercial |
$318.39
|
| Rate for Payer: Cofinity Commercial |
$391.16
|
| Rate for Payer: Healthscope Commercial |
$409.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.61
|
| Rate for Payer: PHP Commercial |
$386.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.39
|
| Rate for Payer: Priority Health SBD |
$286.55
|
|
|
HC CHOLINESTERASE RBC
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
30100157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.37 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.26
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$9.81
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.81
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.81
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$5.37
|
| Rate for Payer: Mclaren Medicare |
$9.81
|
| Rate for Payer: Meridian Medicaid |
$5.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Medicare |
$9.32
|
| Rate for Payer: PACE SWMI |
$9.81
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$9.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$9.81
|
| Rate for Payer: Priority Health SBD |
$40.95
|
| Rate for Payer: Railroad Medicare Medicare |
$9.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.77
|
| Rate for Payer: UHC Core |
$13.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.81
|
| Rate for Payer: UHC Exchange |
$9.81
|
| Rate for Payer: UHC Medicare Advantage |
$10.10
|
| Rate for Payer: VA VA |
$9.81
|
|
|
HC CHOLINESTERASE RBC
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 82482
|
| Hospital Charge Code |
30100157
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.50
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health SBD |
$40.95
|
|
|
HC CHORIONIC VILLUS SAMPLING
|
Facility
|
OP
|
$667.08
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.34 |
| Max. Negotiated Rate |
$894.14 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: Aetna Medicare |
$743.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$894.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$894.14
|
| Rate for Payer: BCBS Complete |
$410.87
|
| Rate for Payer: BCBS MAPPO |
$715.31
|
| Rate for Payer: BCBS Trust/PPO |
$439.74
|
| Rate for Payer: BCN Medicare Advantage |
$715.31
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Cofinity Commercial |
$466.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.31
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Mclaren Medicaid |
$391.27
|
| Rate for Payer: Mclaren Medicare |
$715.31
|
| Rate for Payer: Meridian Medicaid |
$410.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$822.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PACE Medicare |
$679.54
|
| Rate for Payer: PACE SWMI |
$715.31
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: PHP Medicare Advantage |
$715.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health Medicare |
$715.31
|
| Rate for Payer: Priority Health SBD |
$420.26
|
| Rate for Payer: Railroad Medicare Medicare |
$715.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.31
|
| Rate for Payer: UHC Exchange |
$129.34
|
| Rate for Payer: UHC Medicare Advantage |
$736.77
|
| Rate for Payer: VA VA |
$715.31
|
|
|
HC CHORIONIC VILLUS SAMPLING
|
Facility
|
IP
|
$667.08
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
40200003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$420.26 |
| Max. Negotiated Rate |
$600.37 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.60
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$466.96
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health SBD |
$420.26
|
|
|
HC CHROM ANALYSIS METAPHASE <20 AND 20 TO 25
|
Facility
|
IP
|
$222.01
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
31000020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$139.87 |
| Max. Negotiated Rate |
$199.81 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.31
|
| Rate for Payer: Cash Price |
$177.61
|
| Rate for Payer: Cofinity Commercial |
$155.41
|
| Rate for Payer: Cofinity Commercial |
$190.93
|
| Rate for Payer: Healthscope Commercial |
$199.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.71
|
| Rate for Payer: PHP Commercial |
$188.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.41
|
| Rate for Payer: Priority Health SBD |
$139.87
|
|
|
HC CHROM ANALYSIS METAPHASE <20 AND 20 TO 25
|
Facility
|
OP
|
$222.01
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
31000020
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Medicare |
$150.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.76
|
| Rate for Payer: BCBS Complete |
$83.06
|
| Rate for Payer: BCBS MAPPO |
$144.61
|
| Rate for Payer: BCBS Trust/PPO |
$113.24
|
| Rate for Payer: BCN Medicare Advantage |
$144.61
|
| Rate for Payer: Cash Price |
$177.61
|
| Rate for Payer: Cash Price |
$177.61
|
| Rate for Payer: Cofinity Commercial |
$190.93
|
| Rate for Payer: Cofinity Commercial |
$155.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.61
|
| Rate for Payer: Healthscope Commercial |
$199.81
|
| Rate for Payer: Mclaren Medicaid |
$79.10
|
| Rate for Payer: Mclaren Medicare |
$144.61
|
| Rate for Payer: Meridian Medicaid |
$83.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.71
|
| Rate for Payer: PACE Medicare |
$137.38
|
| Rate for Payer: PACE SWMI |
$144.61
|
| Rate for Payer: PHP Commercial |
$188.71
|
| Rate for Payer: PHP Medicare Advantage |
$144.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.41
|
| Rate for Payer: Priority Health Medicare |
$144.61
|
| Rate for Payer: Priority Health SBD |
$139.87
|
| Rate for Payer: Railroad Medicare Medicare |
$144.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.53
|
| Rate for Payer: UHC Core |
$211.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.61
|
| Rate for Payer: UHC Exchange |
$144.61
|
| Rate for Payer: UHC Medicare Advantage |
$148.95
|
| Rate for Payer: VA VA |
$144.61
|
|
|
HC CHROMATIN DNP
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC CHROMATIN DNP
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200432
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC CHROMIUM
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
30100165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.35
|
| Rate for Payer: BCBS Complete |
$11.65
|
| Rate for Payer: BCBS MAPPO |
$20.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$20.28
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Mclaren Medicaid |
$11.09
|
| Rate for Payer: Mclaren Medicare |
$20.28
|
| Rate for Payer: Meridian Medicaid |
$11.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Medicare |
$19.27
|
| Rate for Payer: PACE SWMI |
$20.28
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$20.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health Medicare |
$20.28
|
| Rate for Payer: Priority Health SBD |
$38.43
|
| Rate for Payer: Railroad Medicare Medicare |
$20.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC Core |
$34.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.28
|
| Rate for Payer: UHC Exchange |
$20.28
|
| Rate for Payer: UHC Medicare Advantage |
$20.89
|
| Rate for Payer: VA VA |
$20.28
|
|
|
HC CHROMIUM
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82495
|
| Hospital Charge Code |
30100165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.43 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.65
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$42.70
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health SBD |
$38.43
|
|
|
HC CHROMOGRANIN A
|
Facility
|
IP
|
$60.18
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
30200187
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health SBD |
$37.91
|
|
|
HC CHROMOGRANIN A
|
Facility
|
OP
|
$60.18
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
30200187
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.38 |
| Max. Negotiated Rate |
$54.16 |
| Rate for Payer: Aetna Commercial |
$51.15
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.95
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.30
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cash Price |
$48.14
|
| Rate for Payer: Cofinity Commercial |
$51.75
|
| Rate for Payer: Cofinity Commercial |
$42.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$54.16
|
| Rate for Payer: Mclaren Medicaid |
$11.38
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Medicaid |
$11.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.15
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$51.15
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.13
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.97
|
| Rate for Payer: UHC Core |
$35.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.81
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicare Advantage |
$21.43
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CHROMOSOMAL MICROARRAY, CONGENITAL, BLOOD
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
31000150
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$2,040.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$1,680.00
|
| Rate for Payer: Cofinity Commercial |
$2,064.00
|
| Rate for Payer: Healthscope Commercial |
$2,160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: PHP Commercial |
$2,040.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health SBD |
$1,512.00
|
|
|
HC CHROMOSOMAL MICROARRAY, CONGENITAL, BLOOD
|
Facility
|
OP
|
$2,400.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
31000150
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$2,040.00
|
| Rate for Payer: Aetna Medicare |
$1,206.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,560.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,450.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,450.00
|
| Rate for Payer: BCBS Complete |
$666.30
|
| Rate for Payer: BCBS MAPPO |
$1,160.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,680.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.00
|
| Rate for Payer: Healthscope Commercial |
$2,160.00
|
| Rate for Payer: Mclaren Medicaid |
$634.52
|
| Rate for Payer: Mclaren Medicare |
$1,160.00
|
| Rate for Payer: Meridian Medicaid |
$666.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,218.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,334.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,040.00
|
| Rate for Payer: PACE Medicare |
$1,102.00
|
| Rate for Payer: PACE SWMI |
$1,160.00
|
| Rate for Payer: PHP Commercial |
$2,040.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health Medicare |
$1,160.00
|
| Rate for Payer: Priority Health SBD |
$1,512.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,160.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,392.00
|
| Rate for Payer: UHC Core |
$1,392.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.00
|
| Rate for Payer: UHC Exchange |
$1,160.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,194.80
|
| Rate for Payer: VA VA |
$1,160.00
|
|
|
HC CHROMOSOMAL MICROARRAY, PRENATAL
|
Facility
|
IP
|
$1,617.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
31000141
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,018.71 |
| Max. Negotiated Rate |
$1,455.30 |
| Rate for Payer: Aetna Commercial |
$1,374.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.05
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,390.62
|
| Rate for Payer: Cofinity Commercial |
$1,131.90
|
| Rate for Payer: Healthscope Commercial |
$1,455.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,374.45
|
| Rate for Payer: PHP Commercial |
$1,374.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.90
|
| Rate for Payer: Priority Health SBD |
$1,018.71
|
|
|
HC CHROMOSOMAL MICROARRAY, PRENATAL
|
Facility
|
OP
|
$1,617.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
31000141
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$634.52 |
| Max. Negotiated Rate |
$1,455.30 |
| Rate for Payer: Aetna Commercial |
$1,374.45
|
| Rate for Payer: Aetna Medicare |
$1,206.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,450.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,450.00
|
| Rate for Payer: BCBS Complete |
$666.30
|
| Rate for Payer: BCBS MAPPO |
$1,160.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,390.62
|
| Rate for Payer: Cofinity Commercial |
$1,131.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.00
|
| Rate for Payer: Healthscope Commercial |
$1,455.30
|
| Rate for Payer: Mclaren Medicaid |
$634.52
|
| Rate for Payer: Mclaren Medicare |
$1,160.00
|
| Rate for Payer: Meridian Medicaid |
$666.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,218.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,334.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,374.45
|
| Rate for Payer: PACE Medicare |
$1,102.00
|
| Rate for Payer: PACE SWMI |
$1,160.00
|
| Rate for Payer: PHP Commercial |
$1,374.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.90
|
| Rate for Payer: Priority Health Medicare |
$1,160.00
|
| Rate for Payer: Priority Health SBD |
$1,018.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,160.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,392.00
|
| Rate for Payer: UHC Core |
$1,392.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.00
|
| Rate for Payer: UHC Exchange |
$1,160.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,194.80
|
| Rate for Payer: VA VA |
$1,160.00
|
|
|
HC CHROMOSOME ADDITIONAL KARYOTYPES
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
31000044
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC CHROMOSOME ADDITIONAL KARYOTYPES
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
31000044
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$42.66 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$34.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.84
|
| Rate for Payer: BCBS Complete |
$19.23
|
| Rate for Payer: BCBS MAPPO |
$33.47
|
| Rate for Payer: BCBS Trust/PPO |
$26.21
|
| Rate for Payer: BCN Medicare Advantage |
$33.47
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.47
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$18.31
|
| Rate for Payer: Mclaren Medicare |
$33.47
|
| Rate for Payer: Meridian Medicaid |
$19.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PACE Medicare |
$31.80
|
| Rate for Payer: PACE SWMI |
$33.47
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$33.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health Medicare |
$33.47
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$33.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.16
|
| Rate for Payer: UHC Core |
$42.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.47
|
| Rate for Payer: UHC Exchange |
$33.47
|
| Rate for Payer: UHC Medicare Advantage |
$34.47
|
| Rate for Payer: VA VA |
$33.47
|
|
|
HC CHROMOSOME ANALYSIS AMNIOTIC
|
Facility
|
IP
|
$202.98
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
31000022
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.88 |
| Max. Negotiated Rate |
$182.68 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.53
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.09
|
| Rate for Payer: Priority Health SBD |
$127.88
|
|
|
HC CHROMOSOME ANALYSIS AMNIOTIC
|
Facility
|
OP
|
$202.98
|
|
|
Service Code
|
CPT 88269
|
| Hospital Charge Code |
31000022
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$94.99 |
| Max. Negotiated Rate |
$282.70 |
| Rate for Payer: Aetna Commercial |
$172.53
|
| Rate for Payer: Aetna Medicare |
$180.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$217.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$217.08
|
| Rate for Payer: BCBS Complete |
$99.75
|
| Rate for Payer: BCBS MAPPO |
$173.66
|
| Rate for Payer: BCBS Trust/PPO |
$135.99
|
| Rate for Payer: BCN Medicare Advantage |
$173.66
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cash Price |
$162.38
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Commercial |
$142.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.66
|
| Rate for Payer: Healthscope Commercial |
$182.68
|
| Rate for Payer: Mclaren Medicaid |
$94.99
|
| Rate for Payer: Mclaren Medicare |
$173.66
|
| Rate for Payer: Meridian Medicaid |
$99.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$182.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.53
|
| Rate for Payer: PACE Medicare |
$164.98
|
| Rate for Payer: PACE SWMI |
$173.66
|
| Rate for Payer: PHP Commercial |
$172.53
|
| Rate for Payer: PHP Medicare Advantage |
$173.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.09
|
| Rate for Payer: Priority Health Medicare |
$173.66
|
| Rate for Payer: Priority Health SBD |
$127.88
|
| Rate for Payer: Railroad Medicare Medicare |
$173.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.39
|
| Rate for Payer: UHC Core |
$282.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.66
|
| Rate for Payer: UHC Exchange |
$173.66
|
| Rate for Payer: UHC Medicare Advantage |
$178.87
|
| Rate for Payer: VA VA |
$173.66
|
|
|
HC CHROMOSOME ANALYSIS CHORIONIC VILLUS
|
Facility
|
OP
|
$368.22
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
31000021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$103.15 |
| Max. Negotiated Rate |
$331.40 |
| Rate for Payer: Aetna Commercial |
$312.99
|
| Rate for Payer: Aetna Medicare |
$196.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$235.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$235.71
|
| Rate for Payer: BCBS Complete |
$108.31
|
| Rate for Payer: BCBS MAPPO |
$188.57
|
| Rate for Payer: BCBS Trust/PPO |
$147.67
|
| Rate for Payer: BCN Medicare Advantage |
$188.57
|
| Rate for Payer: Cash Price |
$294.58
|
| Rate for Payer: Cash Price |
$294.58
|
| Rate for Payer: Cofinity Commercial |
$257.75
|
| Rate for Payer: Cofinity Commercial |
$316.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.57
|
| Rate for Payer: Healthscope Commercial |
$331.40
|
| Rate for Payer: Mclaren Medicaid |
$103.15
|
| Rate for Payer: Mclaren Medicare |
$188.57
|
| Rate for Payer: Meridian Medicaid |
$108.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.99
|
| Rate for Payer: PACE Medicare |
$179.14
|
| Rate for Payer: PACE SWMI |
$188.57
|
| Rate for Payer: PHP Commercial |
$312.99
|
| Rate for Payer: PHP Medicare Advantage |
$188.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.75
|
| Rate for Payer: Priority Health Medicare |
$188.57
|
| Rate for Payer: Priority Health SBD |
$231.98
|
| Rate for Payer: Railroad Medicare Medicare |
$188.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.28
|
| Rate for Payer: UHC Core |
$305.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.57
|
| Rate for Payer: UHC Exchange |
$188.57
|
| Rate for Payer: UHC Medicare Advantage |
$194.23
|
| Rate for Payer: VA VA |
$188.57
|
|
|
HC CHROMOSOME ANALYSIS CHORIONIC VILLUS
|
Facility
|
IP
|
$368.22
|
|
|
Service Code
|
CPT 88267
|
| Hospital Charge Code |
31000021
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$231.98 |
| Max. Negotiated Rate |
$331.40 |
| Rate for Payer: Aetna Commercial |
$312.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.34
|
| Rate for Payer: Cash Price |
$294.58
|
| Rate for Payer: Cofinity Commercial |
$257.75
|
| Rate for Payer: Cofinity Commercial |
$316.67
|
| Rate for Payer: Healthscope Commercial |
$331.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.99
|
| Rate for Payer: PHP Commercial |
$312.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.75
|
| Rate for Payer: Priority Health SBD |
$231.98
|
|
|
HC CHROMOSOME ANALYSIS CONGENITAL
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
31000013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$198.01 |
| Rate for Payer: Aetna Commercial |
$184.67
|
| Rate for Payer: Aetna Medicare |
$121.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.61
|
| Rate for Payer: BCBS Complete |
$66.91
|
| Rate for Payer: BCBS MAPPO |
$116.49
|
| Rate for Payer: BCBS Trust/PPO |
$91.22
|
| Rate for Payer: BCN Medicare Advantage |
$116.49
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Cofinity Commercial |
$152.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.49
|
| Rate for Payer: Healthscope Commercial |
$195.53
|
| Rate for Payer: Mclaren Medicaid |
$63.72
|
| Rate for Payer: Mclaren Medicare |
$116.49
|
| Rate for Payer: Meridian Medicaid |
$66.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.67
|
| Rate for Payer: PACE Medicare |
$110.67
|
| Rate for Payer: PACE SWMI |
$116.49
|
| Rate for Payer: PHP Commercial |
$184.67
|
| Rate for Payer: PHP Medicare Advantage |
$116.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.08
|
| Rate for Payer: Priority Health Medicare |
$116.49
|
| Rate for Payer: Priority Health SBD |
$136.87
|
| Rate for Payer: Railroad Medicare Medicare |
$116.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.79
|
| Rate for Payer: UHC Core |
$198.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.49
|
| Rate for Payer: UHC Exchange |
$116.49
|
| Rate for Payer: UHC Medicare Advantage |
$119.98
|
| Rate for Payer: VA VA |
$116.49
|
|
|
HC CHROMOSOME ANALYSIS CONGENITAL
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
31000013
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$136.87 |
| Max. Negotiated Rate |
$195.53 |
| Rate for Payer: Aetna Commercial |
$184.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.22
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$152.08
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Healthscope Commercial |
$195.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.67
|
| Rate for Payer: PHP Commercial |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.08
|
| Rate for Payer: Priority Health SBD |
$136.87
|
|
