|
HC ANGLE TOLERANCE TEST 60 MINUTES
|
Facility
|
OP
|
$66.79
|
|
|
Service Code
|
CPT 94780
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$56.77
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.85
|
| Rate for Payer: BCBS Complete |
$21.54
|
| Rate for Payer: BCBS MAPPO |
$38.28
|
| Rate for Payer: BCN Medicare Advantage |
$38.28
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cash Price |
$53.43
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$60.11
|
| Rate for Payer: Mclaren Medicaid |
$20.52
|
| Rate for Payer: Mclaren Medicare |
$38.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.19
|
| Rate for Payer: Meridian Medicaid |
$21.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.77
|
| Rate for Payer: PACE Medicare |
$36.37
|
| Rate for Payer: PACE SWMI |
$38.28
|
| Rate for Payer: PHP Commercial |
$56.77
|
| Rate for Payer: PHP Medicare Advantage |
$38.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.41
|
| Rate for Payer: Priority Health Medicare |
$38.28
|
| Rate for Payer: Priority Health SBD |
$42.08
|
| Rate for Payer: Railroad Medicare Medicare |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.28
|
| Rate for Payer: UHC Medicare Advantage |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$21.55
|
| Rate for Payer: VA VA |
$38.28
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
OP
|
$33.41
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna Medicare |
$16.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.72
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$28.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.73
|
| Rate for Payer: Healthscope Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.40
|
| Rate for Payer: PHP Commercial |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.72
|
| Rate for Payer: Priority Health SBD |
$21.05
|
|
|
HC ANGLE TOLERANCE TEST EACH ADDL 30 MIN
|
Facility
|
IP
|
$33.41
|
|
|
Service Code
|
CPT 94781
|
| Hospital Charge Code |
51000088
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$30.07 |
| Rate for Payer: Aetna Commercial |
$28.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.72
|
| Rate for Payer: Cash Price |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$28.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.73
|
| Rate for Payer: Healthscope Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.40
|
| Rate for Payer: PHP Commercial |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.72
|
| Rate for Payer: Priority Health SBD |
$21.05
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$459.00 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health SBD |
$321.30
|
|
|
HC ANOGENITAL EXAM CHILD/SUSPECT TRAUMA W IMAG
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 99170
|
| Hospital Charge Code |
76100440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Commercial |
$433.50
|
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$438.60
|
| Rate for Payer: Cofinity Commercial |
$357.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Healthscope Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.50
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Commercial |
$433.50
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Priority Health SBD |
$321.30
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$110.46
|
| Rate for Payer: VA VA |
$196.20
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
IP
|
$1,040.62
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$655.59 |
| Max. Negotiated Rate |
$936.56 |
| Rate for Payer: Aetna Commercial |
$884.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.40
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cofinity Commercial |
$728.43
|
| Rate for Payer: Cofinity Commercial |
$894.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.50
|
| Rate for Payer: Healthscope Commercial |
$936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.53
|
| Rate for Payer: PHP Commercial |
$884.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.40
|
| Rate for Payer: Priority Health SBD |
$655.59
|
|
|
HC ANORECTAL MANOMETRY
|
Facility
|
OP
|
$1,040.62
|
|
| Hospital Charge Code |
75000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$416.25 |
| Max. Negotiated Rate |
$936.56 |
| Rate for Payer: Aetna Commercial |
$884.53
|
| Rate for Payer: Aetna Medicare |
$520.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.40
|
| Rate for Payer: BCBS Complete |
$416.25
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cofinity Commercial |
$728.43
|
| Rate for Payer: Cofinity Commercial |
$894.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$728.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$832.50
|
| Rate for Payer: Healthscope Commercial |
$936.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$884.53
|
| Rate for Payer: PHP Commercial |
$884.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.40
|
| Rate for Payer: Priority Health SBD |
$655.59
|
|
|
HC ANOSCOPY
|
Facility
|
IP
|
$162.92
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.64 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: Aetna Commercial |
$138.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$140.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.48
|
| Rate for Payer: PHP Commercial |
$138.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.90
|
| Rate for Payer: Priority Health SBD |
$102.64
|
|
|
HC ANOSCOPY
|
Facility
|
OP
|
$162.92
|
|
| Hospital Charge Code |
36000005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$146.63 |
| Rate for Payer: Aetna Commercial |
$138.48
|
| Rate for Payer: Aetna Medicare |
$81.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: BCBS Complete |
$65.17
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Commercial |
$114.04
|
| Rate for Payer: Cofinity Commercial |
$140.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$114.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.48
|
| Rate for Payer: PHP Commercial |
$138.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.90
|
| Rate for Payer: Priority Health SBD |
$102.64
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.54 |
| Max. Negotiated Rate |
$322.20 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.70
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Commercial |
$307.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.40
|
| Rate for Payer: Healthscope Commercial |
$322.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.30
|
| Rate for Payer: PHP Commercial |
$304.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health SBD |
$225.54
|
|
|
HC ANOSCOPY DIAGNOSTIC
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
76100138
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$307.88
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Healthscope Commercial |
$322.20
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.30
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$304.30
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$225.54
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$70.77
|
| Rate for Payer: VA VA |
$125.71
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
IP
|
$1,567.19
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$987.33 |
| Max. Negotiated Rate |
$1,410.47 |
| Rate for Payer: Aetna Commercial |
$1,332.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.67
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,097.03
|
| Rate for Payer: Cofinity Commercial |
$1,347.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Healthscope Commercial |
$1,410.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: PHP Commercial |
$1,332.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: Priority Health SBD |
$987.33
|
|
|
HC ANOSCOPY W/CONTROL BLEEDING
|
Facility
|
OP
|
$1,567.19
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
76100276
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Commercial |
$1,332.11
|
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cash Price |
$1,253.75
|
| Rate for Payer: Cofinity Commercial |
$1,347.78
|
| Rate for Payer: Cofinity Commercial |
$1,097.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,097.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,253.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,410.47
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,332.11
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,332.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,018.67
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health SBD |
$987.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$647.41
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
IP
|
$2,074.35
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.84 |
| Max. Negotiated Rate |
$1,866.91 |
| Rate for Payer: Aetna Commercial |
$1,763.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.33
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cofinity Commercial |
$1,452.05
|
| Rate for Payer: Cofinity Commercial |
$1,783.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,452.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.48
|
| Rate for Payer: Healthscope Commercial |
$1,866.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.20
|
| Rate for Payer: PHP Commercial |
$1,763.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.33
|
| Rate for Payer: Priority Health SBD |
$1,306.84
|
|
|
HC ANOSCOPY WITH DILATION
|
Facility
|
OP
|
$2,074.35
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
76100139
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Commercial |
$1,763.20
|
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cash Price |
$1,659.48
|
| Rate for Payer: Cofinity Commercial |
$1,783.94
|
| Rate for Payer: Cofinity Commercial |
$1,452.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,452.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,659.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$1,866.91
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,763.20
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$1,763.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,348.33
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health SBD |
$1,306.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$647.41
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
OP
|
$117.81
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Commercial |
$100.14
|
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cofinity Commercial |
$82.47
|
| Rate for Payer: Cofinity Commercial |
$101.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Healthscope Commercial |
$106.03
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.14
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Commercial |
$100.14
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.58
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Priority Health SBD |
$74.22
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Core |
$87.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Exchange |
$87.18
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
HC ANTIBODY ABSORPTION
|
Facility
|
IP
|
$117.81
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
39000028
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.22 |
| Max. Negotiated Rate |
$106.03 |
| Rate for Payer: Aetna Commercial |
$100.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.58
|
| Rate for Payer: Cash Price |
$94.25
|
| Rate for Payer: Cofinity Commercial |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$82.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.25
|
| Rate for Payer: Healthscope Commercial |
$106.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.14
|
| Rate for Payer: PHP Commercial |
$100.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.58
|
| Rate for Payer: Priority Health SBD |
$74.22
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC ANTIBODY COXSACKIE A
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200261
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY COXSACKIE B
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200260
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
|
|
HC ANTIBODY ECHOVIRUS
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200262
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$13.03
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.42
|
|
|
HC ANTIBODY ECHOVIRUS CMPT
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
30200263
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$36.68 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.29
|
| Rate for Payer: BCBS Complete |
$7.33
|
| Rate for Payer: BCBS MAPPO |
$13.03
|
| Rate for Payer: BCN Medicare Advantage |
$13.03
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.03
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Mclaren Medicaid |
$6.98
|
| Rate for Payer: Mclaren Medicare |
$13.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: PACE Medicare |
$12.38
|
| Rate for Payer: PACE SWMI |
$13.03
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: PHP Medicare Advantage |
$13.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health Medicare |
$13.03
|
| Rate for Payer: Priority Health SBD |
$14.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.03
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$7.34
|
| Rate for Payer: VA VA |
$13.03
|
|
