|
HC APTT MIXING STUDY
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$6.89
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$3.38
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$9.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Priority Health Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.47
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Medicaid |
$3.38
|
| Rate for Payer: UHCCP Medicaid |
$3.38
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC APTT MIXING STUDY
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
30500064
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Advantage |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.47
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
IP
|
$95.51
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.17 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health SBD |
$60.17
|
|
|
HC AQUATIC THERAPY EA 15 MIN
|
Facility
|
OP
|
$95.51
|
|
|
Service Code
|
CPT 97113
|
| Hospital Charge Code |
42000022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$81.18
|
| Rate for Payer: Aetna Medicare |
$47.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.08
|
| Rate for Payer: BCBS Complete |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$34.42
|
| Rate for Payer: BCN Commercial |
$34.42
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cash Price |
$76.41
|
| Rate for Payer: Cofinity Advantage |
$66.86
|
| Rate for Payer: Cofinity Commercial |
$82.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.41
|
| Rate for Payer: Healthscope Commercial |
$85.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.18
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.63
|
| Rate for Payer: PHP Commercial |
$81.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.00
|
| Rate for Payer: Priority Health SBD |
$60.17
|
| Rate for Payer: Priority Health Tiered Network |
$26.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Core |
$49.76
|
| Rate for Payer: UHC Exchange |
$37.54
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS CALIF CMPT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200388
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS E EQUINE CMPT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
30200389
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS IGG/IGM PNL, CSF
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
30200387
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS T LOUIS CMPT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
30200390
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
OP
|
$26.53
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.49
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$13.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$13.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PACE Medicare |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.19
|
| Rate for Payer: Priority Health Medicare |
$13.19
|
| Rate for Payer: Priority Health SBD |
$16.71
|
| Rate for Payer: Priority Health Tiered Network |
$10.55
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$19.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.19
|
| Rate for Payer: UHC Exchange |
$19.79
|
| Rate for Payer: UHC Medicaid |
$6.90
|
| Rate for Payer: UHCCP Medicaid |
$6.90
|
| Rate for Payer: VA VA |
$13.19
|
|
|
HC ARBOVIRUS W EQUINE CMPT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
30200391
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
OP
|
$2,632.46
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,034.56 |
| Max. Negotiated Rate |
$2,369.21 |
| Rate for Payer: Aetna Commercial |
$2,237.59
|
| Rate for Payer: Aetna Medicare |
$1,316.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.10
|
| Rate for Payer: BCBS Complete |
$1,052.98
|
| Rate for Payer: Cash Price |
$2,105.97
|
| Rate for Payer: Cofinity Advantage |
$1,842.72
|
| Rate for Payer: Cofinity Commercial |
$2,263.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.97
|
| Rate for Payer: Healthscope Commercial |
$2,369.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,974.35
|
| Rate for Payer: PHP Commercial |
$2,237.59
|
| Rate for Payer: Priority Health SBD |
$1,658.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,711.10
|
| Rate for Payer: UHC Core |
$1,371.51
|
| Rate for Payer: UHC Exchange |
$1,034.56
|
|
|
HC ARCTIC SUN TORSO/LEG PADS
|
Facility
|
IP
|
$2,632.46
|
|
| Hospital Charge Code |
27000610
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,658.45 |
| Max. Negotiated Rate |
$2,369.21 |
| Rate for Payer: Aetna Commercial |
$2,237.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.10
|
| Rate for Payer: Cash Price |
$2,105.97
|
| Rate for Payer: Cofinity Advantage |
$1,842.72
|
| Rate for Payer: Cofinity Commercial |
$2,263.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.97
|
| Rate for Payer: Healthscope Commercial |
$2,369.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,974.35
|
| Rate for Payer: PHP Commercial |
$2,237.59
|
| Rate for Payer: Priority Health SBD |
$1,658.45
|
|
|
HC ARCTIC SUN UNIVERSAL PAD
|
Facility
|
OP
|
$1,140.74
|
|
| Hospital Charge Code |
27000617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$448.31 |
| Max. Negotiated Rate |
$1,026.67 |
| Rate for Payer: Aetna Commercial |
$969.63
|
| Rate for Payer: Aetna Medicare |
$570.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$741.48
|
| Rate for Payer: BCBS Complete |
$456.30
|
| Rate for Payer: Cash Price |
$912.59
|
| Rate for Payer: Cofinity Advantage |
$798.52
|
| Rate for Payer: Cofinity Commercial |
$981.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$912.59
|
| Rate for Payer: Healthscope Commercial |
$1,026.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$912.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$969.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$855.55
|
| Rate for Payer: PHP Commercial |
$969.63
|
| Rate for Payer: Priority Health SBD |
$718.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$741.48
|
| Rate for Payer: UHC Core |
$594.33
|
| Rate for Payer: UHC Exchange |
$448.31
|
|
|
HC ARCTIC SUN UNIVERSAL PAD
|
Facility
|
IP
|
$1,140.74
|
|
| Hospital Charge Code |
27000617
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$718.67 |
| Max. Negotiated Rate |
$1,026.67 |
| Rate for Payer: Aetna Commercial |
$969.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$741.48
|
| Rate for Payer: Cash Price |
$912.59
|
| Rate for Payer: Cofinity Advantage |
$798.52
|
| Rate for Payer: Cofinity Commercial |
$981.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$912.59
|
| Rate for Payer: Healthscope Commercial |
$1,026.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$969.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$855.55
|
| Rate for Payer: PHP Commercial |
$969.63
|
| Rate for Payer: Priority Health SBD |
$718.67
|
|
|
HC ARGON PLASMA COAGULATION
|
Facility
|
IP
|
$1,897.29
|
|
| Hospital Charge Code |
36000007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,195.29 |
| Max. Negotiated Rate |
$1,707.56 |
| Rate for Payer: Aetna Commercial |
$1,612.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.24
|
| Rate for Payer: Cash Price |
$1,517.83
|
| Rate for Payer: Cofinity Advantage |
$1,328.10
|
| Rate for Payer: Cofinity Commercial |
$1,631.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,517.83
|
| Rate for Payer: Healthscope Commercial |
$1,707.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,612.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,422.97
|
| Rate for Payer: PHP Commercial |
$1,612.70
|
| Rate for Payer: Priority Health SBD |
$1,195.29
|
|
|
HC ARGON PLASMA COAGULATION
|
Facility
|
OP
|
$1,897.29
|
|
| Hospital Charge Code |
36000007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$758.92 |
| Max. Negotiated Rate |
$1,707.56 |
| Rate for Payer: Aetna Commercial |
$1,612.70
|
| Rate for Payer: Aetna Medicare |
$948.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,233.24
|
| Rate for Payer: BCBS Complete |
$758.92
|
| Rate for Payer: Cash Price |
$1,517.83
|
| Rate for Payer: Cofinity Advantage |
$1,328.10
|
| Rate for Payer: Cofinity Commercial |
$1,631.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,517.83
|
| Rate for Payer: Healthscope Commercial |
$1,707.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,517.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,612.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,422.97
|
| Rate for Payer: PHP Commercial |
$1,612.70
|
| Rate for Payer: Priority Health SBD |
$1,195.29
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
IP
|
$1,164.50
|
|
| Hospital Charge Code |
27200111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.63 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Aetna Commercial |
$989.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.92
|
| Rate for Payer: Cash Price |
$931.60
|
| Rate for Payer: Cofinity Advantage |
$815.15
|
| Rate for Payer: Cofinity Commercial |
$1,001.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$931.60
|
| Rate for Payer: Healthscope Commercial |
$1,048.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$989.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$873.38
|
| Rate for Payer: PHP Commercial |
$989.83
|
| Rate for Payer: Priority Health SBD |
$733.63
|
|
|
HC ARISTA HEMOSTAT
|
Facility
|
OP
|
$1,164.50
|
|
| Hospital Charge Code |
27200111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$457.65 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Aetna Commercial |
$989.83
|
| Rate for Payer: Aetna Medicare |
$582.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$756.92
|
| Rate for Payer: BCBS Complete |
$465.80
|
| Rate for Payer: Cash Price |
$931.60
|
| Rate for Payer: Cofinity Advantage |
$815.15
|
| Rate for Payer: Cofinity Commercial |
$1,001.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$931.60
|
| Rate for Payer: Healthscope Commercial |
$1,048.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$989.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$873.38
|
| Rate for Payer: PHP Commercial |
$989.83
|
| Rate for Payer: Priority Health SBD |
$733.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.92
|
| Rate for Payer: UHC Core |
$606.70
|
| Rate for Payer: UHC Exchange |
$457.65
|
|
|
HC ARRAY COMPARATIVE GENOMIC ACGH
|
Facility
|
IP
|
$1,628.95
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
31000094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,026.24 |
| Max. Negotiated Rate |
$1,466.06 |
| Rate for Payer: Aetna Commercial |
$1,384.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.82
|
| Rate for Payer: Cash Price |
$1,303.16
|
| Rate for Payer: Cofinity Advantage |
$1,140.27
|
| Rate for Payer: Cofinity Commercial |
$1,400.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.16
|
| Rate for Payer: Healthscope Commercial |
$1,466.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,221.71
|
| Rate for Payer: PHP Commercial |
$1,384.61
|
| Rate for Payer: Priority Health SBD |
$1,026.24
|
|
|
HC ARRAY COMPARATIVE GENOMIC ACGH
|
Facility
|
OP
|
$1,628.95
|
|
|
Service Code
|
CPT 81228
|
| Hospital Charge Code |
31000094
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$470.70 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$1,384.61
|
| Rate for Payer: Aetna Medicare |
$936.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,125.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,125.00
|
| Rate for Payer: BCBS Complete |
$494.28
|
| Rate for Payer: BCBS MAPPO |
$900.00
|
| Rate for Payer: BCBS Trust/PPO |
$696.26
|
| Rate for Payer: BCN Commercial |
$696.26
|
| Rate for Payer: BCN Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$1,303.16
|
| Rate for Payer: Cash Price |
$1,303.16
|
| Rate for Payer: Cofinity Advantage |
$1,140.27
|
| Rate for Payer: Cofinity Commercial |
$1,400.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.00
|
| Rate for Payer: Healthscope Commercial |
$1,466.06
|
| Rate for Payer: Mclaren Medicaid |
$470.70
|
| Rate for Payer: Mclaren Medicare |
$900.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$945.00
|
| Rate for Payer: Meridian Medicaid |
$945.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,035.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$990.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.61
|
| Rate for Payer: Nomi Health Commercial |
$2,700.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,221.71
|
| Rate for Payer: PACE Medicare |
$855.00
|
| Rate for Payer: PACE SWMI |
$900.00
|
| Rate for Payer: PHP Commercial |
$1,384.61
|
| Rate for Payer: PHP Medicare Advantage |
$900.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$900.00
|
| Rate for Payer: Priority Health Medicare |
$900.00
|
| Rate for Payer: Priority Health SBD |
$1,026.24
|
| Rate for Payer: Priority Health Tiered Network |
$720.00
|
| Rate for Payer: Railroad Medicare Medicare |
$900.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,350.00
|
| Rate for Payer: UHC Core |
$1,350.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$900.00
|
| Rate for Payer: UHC Exchange |
$1,350.00
|
| Rate for Payer: UHC Medicaid |
$470.70
|
| Rate for Payer: UHCCP Medicaid |
$470.70
|
| Rate for Payer: VA VA |
$900.00
|
|
|
HC ARRAY COMPARATIVE GENOMIC CMPT
|
Facility
|
OP
|
$1,440.95
|
|
|
Service Code
|
CPT 88399
|
| Hospital Charge Code |
31000061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$1,296.86 |
| Rate for Payer: Aetna Commercial |
$1,224.81
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$1,152.76
|
| Rate for Payer: Cash Price |
$1,152.76
|
| Rate for Payer: Cofinity Advantage |
$1,008.66
|
| Rate for Payer: Cofinity Commercial |
$1,239.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$1,296.86
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.81
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.71
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$1,224.81
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health SBD |
$907.80
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$80.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.15
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
