|
HC ENCEPHALOPATHY EVAL, CSF CMPT 1
|
Facility
|
OP
|
$65.71
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200485
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$59.14 |
| Rate for Payer: Aetna Commercial |
$55.85
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.71
|
| 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 |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cash Price |
$52.57
|
| Rate for Payer: Cofinity Commercial |
$56.51
|
| Rate for Payer: Cofinity Commercial |
$46.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$59.14
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.85
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$55.85
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.00
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$41.40
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENCEPHALOPATHY EVAL, S CMPT 1
|
Facility
|
IP
|
$151.46
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$136.31 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.45
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$130.26
|
| Rate for Payer: Healthscope Commercial |
$136.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.74
|
| Rate for Payer: PHP Commercial |
$128.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health SBD |
$95.42
|
|
|
HC ENCEPHALOPATHY EVAL, S CMPT 1
|
Facility
|
OP
|
$151.46
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$136.31 |
| Rate for Payer: Aetna Commercial |
$128.74
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.45
|
| 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 |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cash Price |
$121.17
|
| Rate for Payer: Cofinity Commercial |
$130.26
|
| Rate for Payer: Cofinity Commercial |
$106.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$136.31
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.74
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$128.74
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.02
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$95.42
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC ENCEPHALOPATHY EVAL, S CMPT 2
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.59 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health SBD |
$58.59
|
|
|
HC ENCEPHALOPATHY EVAL, S CMPT 2
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200484
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| 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 |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Cofinity Commercial |
$65.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$58.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENCEPHALOPATHY EVAL, SERUM
|
Facility
|
OP
|
$205.21
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$184.69 |
| Rate for Payer: Aetna Commercial |
$174.43
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cofinity Commercial |
$176.48
|
| Rate for Payer: Cofinity Commercial |
$143.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$184.69
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.43
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$174.43
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ENCEPHALOPATHY EVAL, SERUM
|
Facility
|
IP
|
$205.21
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30100721
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$129.28 |
| Max. Negotiated Rate |
$184.69 |
| Rate for Payer: Aetna Commercial |
$174.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.39
|
| Rate for Payer: Cash Price |
$164.17
|
| Rate for Payer: Cofinity Commercial |
$143.65
|
| Rate for Payer: Cofinity Commercial |
$176.48
|
| Rate for Payer: Healthscope Commercial |
$184.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.43
|
| Rate for Payer: PHP Commercial |
$174.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health SBD |
$129.28
|
|
|
HC ENCEPH AUTOIMMUNE EVAL
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$130.72
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.20
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health SBD |
$95.76
|
|
|
HC ENCEPH AUTOIMMUNE EVAL
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200468
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$24.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.54
|
| Rate for Payer: BCBS MAPPO |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.57
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$130.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.57
|
| Rate for Payer: Healthscope Commercial |
$136.80
|
| Rate for Payer: Mclaren Medicaid |
$12.89
|
| Rate for Payer: Mclaren Medicare |
$23.57
|
| Rate for Payer: Meridian Medicaid |
$13.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.20
|
| Rate for Payer: PACE Medicare |
$22.39
|
| Rate for Payer: PACE SWMI |
$23.57
|
| Rate for Payer: PHP Commercial |
$129.20
|
| Rate for Payer: PHP Medicare Advantage |
$23.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health Medicare |
$23.57
|
| Rate for Payer: Priority Health SBD |
$95.76
|
| Rate for Payer: Railroad Medicare Medicare |
$23.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.28
|
| Rate for Payer: UHC Core |
$33.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.57
|
| Rate for Payer: UHC Exchange |
$23.57
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: VA VA |
$23.57
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200469
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health SBD |
$46.27
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200469
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.74
|
| 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 |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Cofinity Commercial |
$51.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.42
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.41
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$46.27
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.17
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.05
|
| Rate for Payer: UHC Core |
$30.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.21
|
| Rate for Payer: UHC Exchange |
$29.21
|
| Rate for Payer: UHC Medicare Advantage |
$30.09
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC ENCEPH AUTOIMMUNE EVAL CMPT 2
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC ENDO BIOPSY
|
Facility
|
IP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$177.57 |
| Max. Negotiated Rate |
$253.66 |
| Rate for Payer: Aetna Commercial |
$239.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.20
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$242.39
|
| Rate for Payer: Cofinity Commercial |
$197.30
|
| Rate for Payer: Healthscope Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: PHP Commercial |
$239.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: Priority Health SBD |
$177.57
|
|
|
HC ENDO BIOPSY
|
Facility
|
OP
|
$281.85
|
|
| Hospital Charge Code |
36000092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.74 |
| Max. Negotiated Rate |
$253.66 |
| Rate for Payer: Aetna Commercial |
$239.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.20
|
| Rate for Payer: BCBS Complete |
$112.74
|
| Rate for Payer: Cash Price |
$225.48
|
| Rate for Payer: Cofinity Commercial |
$197.30
|
| Rate for Payer: Cofinity Commercial |
$242.39
|
| Rate for Payer: Healthscope Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.57
|
| Rate for Payer: PHP Commercial |
$239.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.30
|
| Rate for Payer: Priority Health SBD |
$177.57
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.69 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$563.55
|
| Rate for Payer: PHP Commercial |
$563.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health SBD |
$417.69
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
76100071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.71 |
| Max. Negotiated Rate |
$894.14 |
| Rate for Payer: Aetna Commercial |
$563.55
|
| Rate for Payer: Aetna Medicare |
$743.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.95
|
| 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: BCCCP Commercial |
$162.36
|
| Rate for Payer: BCN Medicare Advantage |
$715.31
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cash Price |
$530.40
|
| Rate for Payer: Cofinity Commercial |
$570.18
|
| Rate for Payer: Cofinity Commercial |
$464.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.31
|
| Rate for Payer: Healthscope Commercial |
$596.70
|
| 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 |
$563.55
|
| Rate for Payer: PACE Medicare |
$679.54
|
| Rate for Payer: PACE SWMI |
$715.31
|
| Rate for Payer: PHP Commercial |
$563.55
|
| 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 |
$464.10
|
| Rate for Payer: Priority Health Medicare |
$715.31
|
| Rate for Payer: Priority Health SBD |
$417.69
|
| Rate for Payer: Railroad Medicare Medicare |
$715.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.31
|
| Rate for Payer: UHC Exchange |
$108.71
|
| Rate for Payer: UHC Medicare Advantage |
$736.77
|
| Rate for Payer: VA VA |
$715.31
|
|
|
HC ENDO CLIPPING
|
Facility
|
OP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$269.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.05
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Healthscope Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: PHP Commercial |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health SBD |
$199.71
|
|
|
HC ENDO CLIPPING
|
Facility
|
IP
|
$317.00
|
|
| Hospital Charge Code |
36000117
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$199.71 |
| Max. Negotiated Rate |
$285.30 |
| Rate for Payer: Aetna Commercial |
$269.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.05
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$221.90
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Healthscope Commercial |
$285.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.45
|
| Rate for Payer: PHP Commercial |
$269.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.90
|
| Rate for Payer: Priority Health SBD |
$199.71
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
IP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,115.14 |
| Max. Negotiated Rate |
$1,593.05 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.54
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,239.04
|
| Rate for Payer: Cofinity Commercial |
$1,522.25
|
| Rate for Payer: Healthscope Commercial |
$1,593.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: PHP Commercial |
$1,504.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: Priority Health SBD |
$1,115.14
|
|
|
HC ENDO CYTOLOGY/BRUSHING
|
Facility
|
OP
|
$1,770.06
|
|
| Hospital Charge Code |
36000012
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.02 |
| Max. Negotiated Rate |
$1,593.05 |
| Rate for Payer: Aetna Commercial |
$1,504.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.54
|
| Rate for Payer: BCBS Complete |
$708.02
|
| Rate for Payer: Cash Price |
$1,416.05
|
| Rate for Payer: Cofinity Commercial |
$1,239.04
|
| Rate for Payer: Cofinity Commercial |
$1,522.25
|
| Rate for Payer: Healthscope Commercial |
$1,593.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,504.55
|
| Rate for Payer: PHP Commercial |
$1,504.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,239.04
|
| Rate for Payer: Priority Health SBD |
$1,115.14
|
|
|
HC ENDO DILATATION
|
Facility
|
OP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.72 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.80
|
| Rate for Payer: BCBS Complete |
$521.72
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Cofinity Commercial |
$913.01
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health SBD |
$821.71
|
|
|
HC ENDO DILATATION
|
Facility
|
IP
|
$1,304.30
|
|
| Hospital Charge Code |
36000115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$821.71 |
| Max. Negotiated Rate |
$1,173.87 |
| Rate for Payer: Aetna Commercial |
$1,108.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.80
|
| Rate for Payer: Cash Price |
$1,043.44
|
| Rate for Payer: Cofinity Commercial |
$1,121.70
|
| Rate for Payer: Cofinity Commercial |
$913.01
|
| Rate for Payer: Healthscope Commercial |
$1,173.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,108.66
|
| Rate for Payer: PHP Commercial |
$1,108.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.01
|
| Rate for Payer: Priority Health SBD |
$821.71
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
IP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.68 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$895.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.75
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$737.42
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Healthscope Commercial |
$948.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: PHP Commercial |
$895.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: Priority Health SBD |
$663.68
|
|
|
HC ENDO FINE NEEDLE ASP/BIOPSY
|
Facility
|
OP
|
$1,053.46
|
|
| Hospital Charge Code |
36000103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.38 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$895.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.75
|
| Rate for Payer: BCBS Complete |
$421.38
|
| Rate for Payer: Cash Price |
$842.77
|
| Rate for Payer: Cofinity Commercial |
$737.42
|
| Rate for Payer: Cofinity Commercial |
$905.98
|
| Rate for Payer: Healthscope Commercial |
$948.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$895.44
|
| Rate for Payer: PHP Commercial |
$895.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.42
|
| Rate for Payer: Priority Health SBD |
$663.68
|
|
