|
HC ACCESS MAIN PULMONARY
|
Facility
|
IP
|
$436.13
|
|
|
Service Code
|
CPT 36013
|
| Hospital Charge Code |
36100099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$274.76 |
| Max. Negotiated Rate |
$392.52 |
| Rate for Payer: Aetna Commercial |
$370.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.48
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cofinity Advantage |
$305.29
|
| Rate for Payer: Cofinity Commercial |
$375.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.90
|
| Rate for Payer: Healthscope Commercial |
$392.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.10
|
| Rate for Payer: PHP Commercial |
$370.71
|
| Rate for Payer: Priority Health SBD |
$274.76
|
|
|
HC ACCESS VEIN
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.88 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$198.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: BCBS Complete |
$158.59
|
| Rate for Payer: BCBS Trust/PPO |
$105.88
|
| Rate for Payer: BCN Commercial |
$105.88
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC ACCESS VEIN
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
36100093
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.71
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Advantage |
$277.54
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health SBD |
$249.78
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
OP
|
$1,090.74
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.30 |
| Max. Negotiated Rate |
$1,433.76 |
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna Medicare |
$545.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: BCBS Complete |
$436.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,433.76
|
| Rate for Payer: BCN Commercial |
$1,433.76
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$872.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: Priority Health SBD |
$687.17
|
|
|
HC ACCESS VEIN ORGAN BLOOD SAMPLING
|
Facility
|
IP
|
$1,090.74
|
|
|
Service Code
|
CPT 36500
|
| Hospital Charge Code |
36100118
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$687.17 |
| Max. Negotiated Rate |
$981.67 |
| Rate for Payer: Aetna Commercial |
$927.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.98
|
| Rate for Payer: Cash Price |
$872.59
|
| Rate for Payer: Cofinity Advantage |
$763.52
|
| Rate for Payer: Cofinity Commercial |
$938.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$872.59
|
| Rate for Payer: Healthscope Commercial |
$981.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$927.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$818.05
|
| Rate for Payer: PHP Commercial |
$927.13
|
| Rate for Payer: Priority Health SBD |
$687.17
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
IP
|
$3,285.01
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,069.56 |
| Max. Negotiated Rate |
$2,956.51 |
| Rate for Payer: Aetna Commercial |
$2,792.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,135.26
|
| Rate for Payer: Cash Price |
$2,628.01
|
| Rate for Payer: Cofinity Advantage |
$2,299.51
|
| Rate for Payer: Cofinity Commercial |
$2,825.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,628.01
|
| Rate for Payer: Healthscope Commercial |
$2,956.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,463.76
|
| Rate for Payer: PHP Commercial |
$2,792.26
|
| Rate for Payer: Priority Health SBD |
$2,069.56
|
|
|
HC ACCESS VENA CAVA
|
Facility
|
OP
|
$3,285.01
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
36100096
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,273.37 |
| Max. Negotiated Rate |
$2,956.51 |
| Rate for Payer: Aetna Commercial |
$2,792.26
|
| Rate for Payer: Aetna Medicare |
$1,642.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,135.26
|
| Rate for Payer: BCBS Complete |
$1,314.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.37
|
| Rate for Payer: BCN Commercial |
$1,273.37
|
| Rate for Payer: Cash Price |
$2,628.01
|
| Rate for Payer: Cash Price |
$2,628.01
|
| Rate for Payer: Cofinity Advantage |
$2,299.51
|
| Rate for Payer: Cofinity Commercial |
$2,825.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,628.01
|
| Rate for Payer: Healthscope Commercial |
$2,956.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,792.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,463.76
|
| Rate for Payer: PHP Commercial |
$2,792.26
|
| Rate for Payer: Priority Health SBD |
$2,069.56
|
|
|
HC ACCESS WINDOW
|
Facility
|
OP
|
$39.71
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.61 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Aetna Commercial |
$33.75
|
| Rate for Payer: Aetna Medicare |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.81
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Advantage |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$34.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$35.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.78
|
| Rate for Payer: PHP Commercial |
$33.75
|
| Rate for Payer: Priority Health SBD |
$25.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$20.69
|
| Rate for Payer: UHC Exchange |
$15.61
|
|
|
HC ACCESS WINDOW
|
Facility
|
IP
|
$39.71
|
|
| Hospital Charge Code |
27000624
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Aetna Commercial |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.81
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Advantage |
$27.80
|
| Rate for Payer: Cofinity Commercial |
$34.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$35.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.78
|
| Rate for Payer: PHP Commercial |
$33.75
|
| Rate for Payer: Priority Health SBD |
$25.02
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
IP
|
$4,091.82
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,577.85 |
| Max. Negotiated Rate |
$3,682.64 |
| Rate for Payer: Aetna Commercial |
$3,478.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,659.68
|
| Rate for Payer: Cash Price |
$3,273.46
|
| Rate for Payer: Cofinity Advantage |
$2,864.27
|
| Rate for Payer: Cofinity Commercial |
$3,518.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.46
|
| Rate for Payer: Healthscope Commercial |
$3,682.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.86
|
| Rate for Payer: PHP Commercial |
$3,478.05
|
| Rate for Payer: Priority Health SBD |
$2,577.85
|
|
|
HC ACCUNET EMBOLIC PROTECTION
|
Facility
|
OP
|
$4,091.82
|
|
| Hospital Charge Code |
27200110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,608.09 |
| Max. Negotiated Rate |
$3,682.64 |
| Rate for Payer: Aetna Commercial |
$3,478.05
|
| Rate for Payer: Aetna Medicare |
$2,045.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,659.68
|
| Rate for Payer: BCBS Complete |
$1,636.73
|
| Rate for Payer: Cash Price |
$3,273.46
|
| Rate for Payer: Cofinity Advantage |
$2,864.27
|
| Rate for Payer: Cofinity Commercial |
$3,518.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,273.46
|
| Rate for Payer: Healthscope Commercial |
$3,682.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,273.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,478.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,068.86
|
| Rate for Payer: PHP Commercial |
$3,478.05
|
| Rate for Payer: Priority Health SBD |
$2,577.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,659.68
|
| Rate for Payer: UHC Core |
$2,131.84
|
| Rate for Payer: UHC Exchange |
$1,608.09
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
OP
|
$131.69
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$118.52 |
| Rate for Payer: Aetna Commercial |
$111.94
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.13
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.26
|
| Rate for Payer: BCN Commercial |
$66.26
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cofinity Advantage |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$113.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$118.52
|
| Rate for Payer: Mclaren Medicaid |
$32.50
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.94
|
| Rate for Payer: Nomi Health Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.77
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$111.94
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.14
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$82.96
|
| Rate for Payer: Priority Health Tiered Network |
$49.71
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.21
|
| Rate for Payer: UHC Core |
$93.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.14
|
| Rate for Payer: UHC Exchange |
$93.21
|
| Rate for Payer: UHC Medicaid |
$32.50
|
| Rate for Payer: UHCCP Medicaid |
$32.50
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC ACETAMINOPHEN LVL.
|
Facility
|
IP
|
$131.69
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100648
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.96 |
| Max. Negotiated Rate |
$118.52 |
| Rate for Payer: Aetna Commercial |
$111.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.60
|
| Rate for Payer: Cash Price |
$105.35
|
| Rate for Payer: Cofinity Advantage |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$113.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.35
|
| Rate for Payer: Healthscope Commercial |
$118.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.77
|
| Rate for Payer: PHP Commercial |
$111.94
|
| Rate for Payer: Priority Health SBD |
$82.96
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| 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 |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$26.74
|
| Rate for Payer: Priority Health Tiered Network |
$14.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC ACETOMINOPHEN THERAPEUTIC DRUG ASSAY
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80143
|
| Hospital Charge Code |
30100729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Advantage |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health SBD |
$26.74
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
IP
|
$78.53
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.47 |
| Max. Negotiated Rate |
$70.68 |
| Rate for Payer: Aetna Commercial |
$66.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.04
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cofinity Advantage |
$54.97
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.82
|
| Rate for Payer: Healthscope Commercial |
$70.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.90
|
| Rate for Payer: PHP Commercial |
$66.75
|
| Rate for Payer: Priority Health SBD |
$49.47
|
|
|
HC ACETYLCHOLINE RECEPTOR AB
|
Facility
|
OP
|
$78.53
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
30100254
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$70.68 |
| Rate for Payer: Aetna Commercial |
$66.75
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cash Price |
$62.82
|
| Rate for Payer: Cofinity Advantage |
$54.97
|
| Rate for Payer: Cofinity Commercial |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$70.68
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.75
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.90
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$66.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.40
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$49.47
|
| Rate for Payer: Priority Health Tiered Network |
$14.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Core |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
OP
|
$110.78
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Aetna Medicare |
$12.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cofinity Advantage |
$77.55
|
| Rate for Payer: Cofinity Commercial |
$95.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Healthscope Commercial |
$99.70
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| Rate for Payer: Mclaren Medicare |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: Meridian Medicaid |
$12.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.16
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.08
|
| Rate for Payer: PACE Medicare |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Commercial |
$94.16
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health SBD |
$69.79
|
| Rate for Payer: Priority Health Tiered Network |
$9.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$18.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.29
|
| Rate for Payer: UHC Exchange |
$18.44
|
| Rate for Payer: UHC Medicaid |
$6.43
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$12.29
|
|
|
HC ACETYLCHOLINESTERASE AMNIOTIC
|
Facility
|
IP
|
$110.78
|
|
|
Service Code
|
CPT 82013
|
| Hospital Charge Code |
30100069
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.79 |
| Max. Negotiated Rate |
$99.70 |
| Rate for Payer: Aetna Commercial |
$94.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.01
|
| Rate for Payer: Cash Price |
$88.62
|
| Rate for Payer: Cofinity Advantage |
$77.55
|
| Rate for Payer: Cofinity Commercial |
$95.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.62
|
| Rate for Payer: Healthscope Commercial |
$99.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.08
|
| Rate for Payer: PHP Commercial |
$94.16
|
| Rate for Payer: Priority Health SBD |
$69.79
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.52 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health SBD |
$63.52
|
|
|
HC ACH RECEPTOR MUSCLE MOD AB
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30000061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Advantage |
$70.57
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.40
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$63.52
|
| Rate for Payer: Priority Health Tiered Network |
$14.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Core |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
OP
|
$91.26
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.11
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Nomi Health Commercial |
$27.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.40
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$57.49
|
| Rate for Payer: Priority Health Tiered Network |
$14.72
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.60
|
| Rate for Payer: UHC Core |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.40
|
| Rate for Payer: UHC Exchange |
$27.60
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ACHR GANGLIONIC NEURONAL AB
|
Facility
|
IP
|
$91.26
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100606
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.49 |
| Max. Negotiated Rate |
$82.13 |
| Rate for Payer: Aetna Commercial |
$77.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.32
|
| Rate for Payer: Cash Price |
$73.01
|
| Rate for Payer: Cofinity Advantage |
$63.88
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.01
|
| Rate for Payer: Healthscope Commercial |
$82.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.44
|
| Rate for Payer: PHP Commercial |
$77.57
|
| Rate for Payer: Priority Health SBD |
$57.49
|
|
|
HC ACHR MODULATING FLOW CYTOMETRY S
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
30200519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Advantage |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health SBD |
$50.40
|
|
|
HC ACHR MODULATING FLOW CYTOMETRY S
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
30200519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.85
|
| Rate for Payer: BCN Commercial |
$12.85
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Advantage |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.00
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$50.40
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
