|
HC CANNULA VEN TRIPLE STAGE
|
Facility
|
OP
|
$74.91
|
|
| Hospital Charge Code |
27000035
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.44 |
| Max. Negotiated Rate |
$67.42 |
| Rate for Payer: Aetna Commercial |
$63.67
|
| Rate for Payer: Aetna Medicare |
$37.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.69
|
| Rate for Payer: BCBS Complete |
$29.96
|
| Rate for Payer: Cash Price |
$59.93
|
| Rate for Payer: Cofinity Advantage |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$64.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.93
|
| Rate for Payer: Healthscope Commercial |
$67.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.18
|
| Rate for Payer: PHP Commercial |
$63.67
|
| Rate for Payer: Priority Health SBD |
$47.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.69
|
| Rate for Payer: UHC Core |
$39.03
|
| Rate for Payer: UHC Exchange |
$29.44
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
IP
|
$45.66
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.77 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: Priority Health SBD |
$28.77
|
|
|
HC CARB 10,11 EPXID
|
Facility
|
OP
|
$45.66
|
|
|
Service Code
|
CPT 80161
|
| Hospital Charge Code |
30100742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$41.09 |
| Rate for Payer: Aetna Commercial |
$38.81
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cash Price |
$36.53
|
| Rate for Payer: Cofinity Advantage |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$41.09
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.81
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.24
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$38.81
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$28.77
|
| Rate for Payer: Priority Health Tiered Network |
$14.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.57
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$29.42
|
| Rate for Payer: Priority Health Tiered Network |
$11.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Core |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100022
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health SBD |
$29.42
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
OP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna Medicare |
$19.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$19.87
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Advantage |
$31.94
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Mclaren Medicaid |
$9.75
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$19.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Nomi Health Commercial |
$27.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health SBD |
$28.75
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.96
|
| Rate for Payer: UHC Core |
$27.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.64
|
| Rate for Payer: UHC Exchange |
$27.96
|
| Rate for Payer: UHC Medicaid |
$9.75
|
| Rate for Payer: UHCCP Medicaid |
$9.75
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC CARBAMAZEPINE 10 11 EPOXIDE CMPT
|
Facility
|
IP
|
$45.63
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$41.07 |
| Rate for Payer: Aetna Commercial |
$38.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.66
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cofinity Advantage |
$31.94
|
| Rate for Payer: Cofinity Commercial |
$39.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.50
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.22
|
| Rate for Payer: PHP Commercial |
$38.79
|
| Rate for Payer: Priority Health SBD |
$28.75
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
OP
|
$22.07
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Advantage |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$7.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.88
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health SBD |
$13.90
|
| Rate for Payer: Priority Health Tiered Network |
$3.90
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.32
|
| Rate for Payer: UHC Core |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.88
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicaid |
$2.55
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC CARBON DIOXIDE (BICARB)
|
Facility
|
IP
|
$22.07
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Advantage |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: Priority Health SBD |
$13.90
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
IP
|
$80.02
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$68.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.01
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Advantage |
$56.01
|
| Rate for Payer: Cofinity Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Healthscope Commercial |
$72.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PHP Commercial |
$68.02
|
| Rate for Payer: Priority Health SBD |
$50.41
|
|
|
HC CARBOXYHEMOGLOBIN
|
Facility
|
OP
|
$80.02
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
30100134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$72.02 |
| Rate for Payer: Aetna Commercial |
$68.02
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS MAPPO |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCN Commercial |
$13.14
|
| Rate for Payer: BCN Medicare Advantage |
$12.32
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cash Price |
$64.02
|
| Rate for Payer: Cofinity Advantage |
$56.01
|
| Rate for Payer: Cofinity Commercial |
$68.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$72.02
|
| Rate for Payer: Mclaren Medicaid |
$6.44
|
| Rate for Payer: Mclaren Medicare |
$12.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.94
|
| Rate for Payer: Meridian Medicaid |
$12.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.02
|
| Rate for Payer: Nomi Health Commercial |
$18.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.02
|
| Rate for Payer: PACE Medicare |
$11.70
|
| Rate for Payer: PACE SWMI |
$12.32
|
| Rate for Payer: PHP Commercial |
$68.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.32
|
| Rate for Payer: Priority Health Medicare |
$12.32
|
| Rate for Payer: Priority Health SBD |
$50.41
|
| Rate for Payer: Priority Health Tiered Network |
$9.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.48
|
| Rate for Payer: UHC Core |
$18.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.32
|
| Rate for Payer: UHC Exchange |
$18.48
|
| Rate for Payer: UHC Medicaid |
$6.44
|
| Rate for Payer: UHCCP Medicaid |
$6.44
|
| Rate for Payer: VA VA |
$12.32
|
|
|
HC CARDIAC PET CT STRESS TEST
|
Facility
|
OP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$167.28
|
| Rate for Payer: BCN Commercial |
$167.28
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$609.35
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.70
|
| Rate for Payer: UHC Core |
$503.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$380.12
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC CARDIAC PET CT STRESS TEST
|
Facility
|
IP
|
$967.23
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$609.35 |
| Max. Negotiated Rate |
$870.51 |
| Rate for Payer: Aetna Commercial |
$822.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.70
|
| Rate for Payer: Cash Price |
$773.78
|
| Rate for Payer: Cofinity Advantage |
$677.06
|
| Rate for Payer: Cofinity Commercial |
$831.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$773.78
|
| Rate for Payer: Healthscope Commercial |
$870.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$822.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.42
|
| Rate for Payer: PHP Commercial |
$822.15
|
| Rate for Payer: Priority Health SBD |
$609.35
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
OP
|
$201.87
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$415.38 |
| Rate for Payer: Aetna Commercial |
$171.59
|
| Rate for Payer: Aetna Medicare |
$133.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.55
|
| Rate for Payer: BCBS Complete |
$70.54
|
| Rate for Payer: BCBS MAPPO |
$128.44
|
| Rate for Payer: BCBS Trust/PPO |
$47.37
|
| Rate for Payer: BCN Commercial |
$47.37
|
| Rate for Payer: BCN Medicare Advantage |
$128.44
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cofinity Advantage |
$141.31
|
| Rate for Payer: Cofinity Commercial |
$173.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.44
|
| Rate for Payer: Healthscope Commercial |
$181.68
|
| Rate for Payer: Mclaren Medicaid |
$67.17
|
| Rate for Payer: Mclaren Medicare |
$128.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Medicaid |
$134.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$141.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.59
|
| Rate for Payer: Nomi Health Commercial |
$385.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.40
|
| Rate for Payer: PACE Medicare |
$122.02
|
| Rate for Payer: PACE SWMI |
$128.44
|
| Rate for Payer: PHP Commercial |
$171.59
|
| Rate for Payer: PHP Medicare Advantage |
$128.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$415.38
|
| Rate for Payer: Priority Health Medicare |
$128.44
|
| Rate for Payer: Priority Health SBD |
$127.18
|
| Rate for Payer: Priority Health Tiered Network |
$332.30
|
| Rate for Payer: Railroad Medicare Medicare |
$128.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.22
|
| Rate for Payer: UHC Core |
$105.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.44
|
| Rate for Payer: UHC Exchange |
$79.33
|
| Rate for Payer: UHC Medicaid |
$67.17
|
| Rate for Payer: UHCCP Medicaid |
$67.17
|
| Rate for Payer: VA VA |
$128.44
|
|
|
HC CARDIAC REH OP PH 2 WO MONITOR
|
Facility
|
IP
|
$201.87
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
94300007
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$181.68 |
| Rate for Payer: Aetna Commercial |
$171.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.22
|
| Rate for Payer: Cash Price |
$161.50
|
| Rate for Payer: Cofinity Advantage |
$141.31
|
| Rate for Payer: Cofinity Commercial |
$173.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.50
|
| Rate for Payer: Healthscope Commercial |
$181.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.40
|
| Rate for Payer: PHP Commercial |
$171.59
|
| Rate for Payer: Priority Health SBD |
$127.18
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
IP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: Priority Health SBD |
$32.88
|
|
|
HC CARDIOLIPIN AB IGA
|
Facility
|
OP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200146
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Mclaren Medicaid |
$13.31
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.45
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.88
|
| Rate for Payer: Priority Health Tiered Network |
$20.36
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.18
|
| Rate for Payer: UHC Core |
$38.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$38.18
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
IP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: Priority Health SBD |
$32.88
|
|
|
HC CARDIOLIPIN AB IGG
|
Facility
|
OP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200144
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Mclaren Medicaid |
$13.31
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.45
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.88
|
| Rate for Payer: Priority Health Tiered Network |
$20.36
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.18
|
| Rate for Payer: UHC Core |
$38.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$38.18
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
OP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna Medicare |
$26.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.81
|
| Rate for Payer: BCBS Complete |
$13.98
|
| Rate for Payer: BCBS MAPPO |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$27.14
|
| Rate for Payer: BCN Commercial |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$25.45
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Mclaren Medicaid |
$13.31
|
| Rate for Payer: Mclaren Medicare |
$25.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.72
|
| Rate for Payer: Meridian Medicaid |
$26.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Nomi Health Commercial |
$38.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PACE Medicare |
$24.18
|
| Rate for Payer: PACE SWMI |
$25.45
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: PHP Medicare Advantage |
$25.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.45
|
| Rate for Payer: Priority Health Medicare |
$25.45
|
| Rate for Payer: Priority Health SBD |
$32.88
|
| Rate for Payer: Priority Health Tiered Network |
$20.36
|
| Rate for Payer: Railroad Medicare Medicare |
$25.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.18
|
| Rate for Payer: UHC Core |
$38.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25.45
|
| Rate for Payer: UHC Exchange |
$38.18
|
| Rate for Payer: UHC Medicaid |
$13.31
|
| Rate for Payer: UHCCP Medicaid |
$13.31
|
| Rate for Payer: VA VA |
$25.45
|
|
|
HC CARDIOLIPIN AB IGM
|
Facility
|
IP
|
$52.19
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
30200145
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$46.97 |
| Rate for Payer: Aetna Commercial |
$44.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.92
|
| Rate for Payer: Cash Price |
$41.75
|
| Rate for Payer: Cofinity Advantage |
$36.53
|
| Rate for Payer: Cofinity Commercial |
$44.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.75
|
| Rate for Payer: Healthscope Commercial |
$46.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.14
|
| Rate for Payer: PHP Commercial |
$44.36
|
| Rate for Payer: Priority Health SBD |
$32.88
|
|
|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
IP
|
$525.85
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$331.29 |
| Max. Negotiated Rate |
$473.26 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.80
|
| Rate for Payer: Cash Price |
$420.68
|
| Rate for Payer: Cofinity Advantage |
$368.10
|
| Rate for Payer: Cofinity Commercial |
$452.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.68
|
| Rate for Payer: Healthscope Commercial |
$473.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$394.39
|
| Rate for Payer: PHP Commercial |
$446.97
|
| Rate for Payer: Priority Health SBD |
$331.29
|
|
|
HC CARDIOLITE/MIRALUMA STUDY
|
Facility
|
OP
|
$525.85
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300001
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$182.11 |
| Max. Negotiated Rate |
$743.46 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna Medicare |
$262.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.80
|
| Rate for Payer: BCBS Complete |
$210.34
|
| Rate for Payer: BCBS Trust/PPO |
$182.11
|
| Rate for Payer: BCN Commercial |
$182.11
|
| Rate for Payer: Cash Price |
$420.68
|
| Rate for Payer: Cash Price |
$420.68
|
| Rate for Payer: Cofinity Advantage |
$368.10
|
| Rate for Payer: Cofinity Commercial |
$452.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.68
|
| Rate for Payer: Healthscope Commercial |
$473.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$420.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$446.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$394.39
|
| Rate for Payer: PHP Commercial |
$446.97
|
| Rate for Payer: Priority Health SBD |
$331.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$743.46
|
| Rate for Payer: UHC Core |
$743.46
|
| Rate for Payer: UHC Exchange |
$743.46
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
IP
|
$1,145.14
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$721.44 |
| Max. Negotiated Rate |
$1,030.63 |
| Rate for Payer: Aetna Commercial |
$973.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.34
|
| Rate for Payer: Cash Price |
$916.11
|
| Rate for Payer: Cofinity Advantage |
$801.60
|
| Rate for Payer: Cofinity Commercial |
$984.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.11
|
| Rate for Payer: Healthscope Commercial |
$1,030.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.86
|
| Rate for Payer: PHP Commercial |
$973.37
|
| Rate for Payer: Priority Health SBD |
$721.44
|
|
|
HC CARDIOPULMONARY EX TEST
|
Facility
|
OP
|
$1,145.14
|
|
|
Service Code
|
CPT 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$194.46 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$973.37
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCBS Trust/PPO |
$393.80
|
| Rate for Payer: BCN Commercial |
$393.80
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$916.11
|
| Rate for Payer: Cash Price |
$916.11
|
| Rate for Payer: Cofinity Advantage |
$801.60
|
| Rate for Payer: Cofinity Commercial |
$984.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$1,030.63
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.37
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.86
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$973.37
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$721.44
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.34
|
| Rate for Payer: UHC Core |
$596.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$450.04
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
