|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
OP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.71 |
| Max. Negotiated Rate |
$281.38 |
| Rate for Payer: Aetna Commercial |
$248.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.65
|
| Rate for Payer: BCBS Complete |
$116.71
|
| Rate for Payer: BCBS Trust/PPO |
$281.38
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$204.24
|
| Rate for Payer: Cofinity Commercial |
$250.92
|
| Rate for Payer: Healthscope Commercial |
$262.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: PHP Commercial |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: Priority Health SBD |
$183.82
|
|
|
HC EPIFIX 5X6 PER SQ CM
|
Facility
|
IP
|
$291.77
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
63600188
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.82 |
| Max. Negotiated Rate |
$262.59 |
| Rate for Payer: Aetna Commercial |
$248.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.65
|
| Rate for Payer: Cash Price |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$204.24
|
| Rate for Payer: Cofinity Commercial |
$250.92
|
| Rate for Payer: Healthscope Commercial |
$262.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.00
|
| Rate for Payer: PHP Commercial |
$248.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.24
|
| Rate for Payer: Priority Health SBD |
$183.82
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health SBD |
$257.04
|
|
|
HC EPIPEN EPINEPHRINE INJECTION .3MG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
63600228
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health SBD |
$257.04
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$577.56 |
| Max. Negotiated Rate |
$825.08 |
| Rate for Payer: Aetna Commercial |
$779.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.89
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$641.73
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Healthscope Commercial |
$825.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: PHP Commercial |
$779.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: Priority Health SBD |
$577.56
|
|
|
HC EP LOWER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$916.76
|
|
|
Service Code
|
CPT 95926
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$825.08 |
| Rate for Payer: Aetna Commercial |
$779.25
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$589.48
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cash Price |
$733.41
|
| Rate for Payer: Cofinity Commercial |
$641.73
|
| Rate for Payer: Cofinity Commercial |
$788.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$825.08
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$779.25
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$779.25
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.73
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$577.56
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$154.88
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,498.29 |
| Max. Negotiated Rate |
$7,854.70 |
| Rate for Payer: Aetna Commercial |
$7,418.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,672.84
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$6,109.22
|
| Rate for Payer: Cofinity Commercial |
$7,505.61
|
| Rate for Payer: Healthscope Commercial |
$7,854.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: PHP Commercial |
$7,418.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health SBD |
$5,498.29
|
|
|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,727.45
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$906.69 |
| Max. Negotiated Rate |
$26,416.19 |
| Rate for Payer: Aetna Commercial |
$7,418.33
|
| Rate for Payer: Aetna Medicare |
$21,978.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,672.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,416.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,416.19
|
| Rate for Payer: BCBS Complete |
$12,138.77
|
| Rate for Payer: BCBS MAPPO |
$21,132.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.86
|
| Rate for Payer: BCN Medicare Advantage |
$21,132.95
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cash Price |
$6,981.96
|
| Rate for Payer: Cofinity Commercial |
$6,109.22
|
| Rate for Payer: Cofinity Commercial |
$7,505.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,132.95
|
| Rate for Payer: Healthscope Commercial |
$7,854.70
|
| Rate for Payer: Mclaren Medicaid |
$11,559.72
|
| Rate for Payer: Mclaren Medicare |
$21,132.95
|
| Rate for Payer: Meridian Medicaid |
$12,138.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,189.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,302.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,418.33
|
| Rate for Payer: PACE Medicare |
$20,076.30
|
| Rate for Payer: PACE SWMI |
$21,132.95
|
| Rate for Payer: PHP Commercial |
$7,418.33
|
| Rate for Payer: PHP Medicare Advantage |
$21,132.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,559.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.22
|
| Rate for Payer: Priority Health Medicare |
$21,132.95
|
| Rate for Payer: Priority Health SBD |
$5,498.29
|
| Rate for Payer: Railroad Medicare Medicare |
$21,132.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$997.36
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,132.95
|
| Rate for Payer: UHC Exchange |
$906.69
|
| Rate for Payer: UHC Medicare Advantage |
$21,766.94
|
| Rate for Payer: VA VA |
$21,132.95
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Core |
$30.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.68
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.21
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Medicaid |
$10.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.77
|
| Rate for Payer: UHC Core |
$30.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Exchange |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.11
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$8.36
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Medicaid |
$8.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.35
|
| Rate for Payer: UHC Core |
$26.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Exchange |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.75
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.40
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.27
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$7.18
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Medicaid |
$7.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.74
|
| Rate for Payer: UHC Core |
$22.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.12
|
| Rate for Payer: UHC Exchange |
$13.12
|
| Rate for Payer: UHC Medicare Advantage |
$13.51
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.70
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health SBD |
$75.18
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$75.18
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$119.34
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health SBD |
$75.18
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$107.41 |
| Rate for Payer: Aetna Commercial |
$101.44
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.55
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$33.55
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$102.63
|
| Rate for Payer: Cofinity Commercial |
$83.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$107.41
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$24.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.44
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$101.44
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.54
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$75.18
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.41
|
| Rate for Payer: UHC Core |
$72.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Exchange |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$44.13
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,098.32
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$691.94 |
| Max. Negotiated Rate |
$988.49 |
| Rate for Payer: Aetna Commercial |
$933.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.91
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cofinity Commercial |
$944.56
|
| Rate for Payer: Cofinity Commercial |
$768.82
|
| Rate for Payer: Healthscope Commercial |
$988.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$933.57
|
| Rate for Payer: PHP Commercial |
$933.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.82
|
| Rate for Payer: Priority Health SBD |
$691.94
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,098.32
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$152.77 |
| Max. Negotiated Rate |
$988.49 |
| Rate for Payer: Aetna Commercial |
$933.57
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$689.26
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cash Price |
$878.66
|
| Rate for Payer: Cofinity Commercial |
$944.56
|
| Rate for Payer: Cofinity Commercial |
$768.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Healthscope Commercial |
$988.49
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$933.57
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$933.57
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.82
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health SBD |
$691.94
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$172.89
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,457.76
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,548.39 |
| Max. Negotiated Rate |
$2,211.98 |
| Rate for Payer: Aetna Commercial |
$2,089.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.54
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cofinity Commercial |
$2,113.67
|
| Rate for Payer: Cofinity Commercial |
$1,720.43
|
| Rate for Payer: Healthscope Commercial |
$2,211.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,089.10
|
| Rate for Payer: PHP Commercial |
$2,089.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,720.43
|
| Rate for Payer: Priority Health SBD |
$1,548.39
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,457.76
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$260.87 |
| Max. Negotiated Rate |
$2,211.98 |
| Rate for Payer: Aetna Commercial |
$2,089.10
|
| Rate for Payer: Aetna Medicare |
$495.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$596.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$596.14
|
| Rate for Payer: BCBS Complete |
$273.94
|
| Rate for Payer: BCBS MAPPO |
$476.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.52
|
| Rate for Payer: BCN Medicare Advantage |
$476.91
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cash Price |
$1,966.21
|
| Rate for Payer: Cofinity Commercial |
$2,113.67
|
| Rate for Payer: Cofinity Commercial |
$1,720.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.91
|
| Rate for Payer: Healthscope Commercial |
$2,211.98
|
| Rate for Payer: Mclaren Medicaid |
$260.87
|
| Rate for Payer: Mclaren Medicare |
$476.91
|
| Rate for Payer: Meridian Medicaid |
$273.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$500.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$548.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,089.10
|
| Rate for Payer: PACE Medicare |
$453.06
|
| Rate for Payer: PACE SWMI |
$476.91
|
| Rate for Payer: PHP Commercial |
$2,089.10
|
| Rate for Payer: PHP Medicare Advantage |
$476.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,720.43
|
| Rate for Payer: Priority Health Medicare |
$476.91
|
| Rate for Payer: Priority Health SBD |
$1,548.39
|
| Rate for Payer: Railroad Medicare Medicare |
$476.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.91
|
| Rate for Payer: UHC Exchange |
$368.37
|
| Rate for Payer: UHC Medicare Advantage |
$491.22
|
| Rate for Payer: VA VA |
$476.91
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$770.51
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$485.42 |
| Max. Negotiated Rate |
$693.46 |
| Rate for Payer: Aetna Commercial |
$654.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.83
|
| Rate for Payer: Cash Price |
$616.41
|
| Rate for Payer: Cofinity Commercial |
$539.36
|
| Rate for Payer: Cofinity Commercial |
$662.64
|
| Rate for Payer: Healthscope Commercial |
$693.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.93
|
| Rate for Payer: PHP Commercial |
$654.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.36
|
| Rate for Payer: Priority Health SBD |
$485.42
|
|
