|
HC CBC INCLUDES DIFF & PLATELETS
|
Facility
|
IP
|
$30.45
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health SBD |
$19.18
|
|
|
HC CBC INCLUDES DIFF & PLATELETS
|
Facility
|
OP
|
$30.45
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
30500007
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.71
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.88
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: BCN Medicare Advantage |
$7.77
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Commercial |
$21.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Mclaren Medicaid |
$4.16
|
| Rate for Payer: Mclaren Medicare |
$7.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.16
|
| Rate for Payer: Meridian Medicaid |
$4.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.88
|
| Rate for Payer: Nomi Health Commercial |
$11.66
|
| Rate for Payer: PACE Medicare |
$7.38
|
| Rate for Payer: PACE SWMI |
$7.77
|
| Rate for Payer: PHP Commercial |
$25.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.99
|
| Rate for Payer: Priority Health Medicare |
$7.77
|
| Rate for Payer: Priority Health Narrow Network |
$6.39
|
| Rate for Payer: Priority Health SBD |
$19.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.77
|
| Rate for Payer: UHC Medicare Advantage |
$7.77
|
| Rate for Payer: UHCCP Medicaid |
$4.37
|
| Rate for Payer: VA VA |
$7.77
|
|
|
HC CBC NO DIFF INCLUDES PLATELETS
|
Facility
|
OP
|
$18.73
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
30500008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.72
|
| Rate for Payer: BCN Commercial |
$5.72
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: Nomi Health Commercial |
$9.70
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$5.18
|
| Rate for Payer: Priority Health SBD |
$11.80
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CBC NO DIFF INCLUDES PLATELETS
|
Facility
|
IP
|
$18.73
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
30500008
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.92
|
| Rate for Payer: PHP Commercial |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health SBD |
$11.80
|
|
|
HC C DIFFICILE PCR
|
Facility
|
IP
|
$140.66
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
30600183
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$88.62 |
| Max. Negotiated Rate |
$126.59 |
| Rate for Payer: Aetna Commercial |
$119.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.43
|
| Rate for Payer: Cash Price |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$120.97
|
| Rate for Payer: Cofinity Commercial |
$98.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.53
|
| Rate for Payer: Healthscope Commercial |
$126.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.56
|
| Rate for Payer: PHP Commercial |
$119.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.43
|
| Rate for Payer: Priority Health SBD |
$88.62
|
|
|
HC C DIFFICILE PCR
|
Facility
|
OP
|
$140.66
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
30600183
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$126.59 |
| Rate for Payer: Aetna Commercial |
$119.56
|
| Rate for Payer: Aetna Medicare |
$38.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.59
|
| Rate for Payer: BCBS Complete |
$20.98
|
| Rate for Payer: BCBS MAPPO |
$37.27
|
| Rate for Payer: BCBS Trust/PPO |
$32.99
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: BCN Medicare Advantage |
$37.27
|
| Rate for Payer: Cash Price |
$112.53
|
| Rate for Payer: Cash Price |
$112.53
|
| Rate for Payer: Cofinity Commercial |
$98.46
|
| Rate for Payer: Cofinity Commercial |
$120.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.27
|
| Rate for Payer: Healthscope Commercial |
$126.59
|
| Rate for Payer: Mclaren Medicaid |
$19.98
|
| Rate for Payer: Mclaren Medicare |
$37.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.13
|
| Rate for Payer: Meridian Medicaid |
$20.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.56
|
| Rate for Payer: Nomi Health Commercial |
$55.90
|
| Rate for Payer: PACE Medicare |
$35.41
|
| Rate for Payer: PACE SWMI |
$37.27
|
| Rate for Payer: PHP Commercial |
$119.56
|
| Rate for Payer: PHP Medicare Advantage |
$37.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$37.27
|
| Rate for Payer: Priority Health Narrow Network |
$29.82
|
| Rate for Payer: Priority Health SBD |
$88.62
|
| Rate for Payer: Railroad Medicare Medicare |
$37.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.27
|
| Rate for Payer: UHC Medicare Advantage |
$37.27
|
| Rate for Payer: UHCCP Medicaid |
$20.98
|
| Rate for Payer: VA VA |
$37.27
|
|
|
HC C DIFF TOXIN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
30600327
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$6.42
|
| Rate for Payer: Mclaren Medicare |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Meridian Medicaid |
$6.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$17.97
|
| Rate for Payer: PACE Medicare |
$11.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.33
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Priority Health SBD |
$26.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UHCCP Medicaid |
$6.74
|
| Rate for Payer: VA VA |
$11.98
|
|
|
HC C DIFF TOXIN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
30600327
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.05
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health SBD |
$26.22
|
|
|
HC CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
IP
|
$130.76
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.99
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$91.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health SBD |
$82.38
|
|
|
HC CEA (CARCINOEMBRYONIC ANTIGEN)
|
Facility
|
OP
|
$130.76
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100135
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$3,504.36 |
| Rate for Payer: Aetna Commercial |
$111.15
|
| Rate for Payer: Aetna Medicare |
$19.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.70
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS MAPPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.78
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.96
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cash Price |
$104.61
|
| Rate for Payer: Cofinity Commercial |
$112.45
|
| Rate for Payer: Cofinity Commercial |
$91.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$117.68
|
| Rate for Payer: Mclaren Medicaid |
$10.16
|
| Rate for Payer: Mclaren Medicare |
$18.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.91
|
| Rate for Payer: Meridian Medicaid |
$10.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PACE Medicare |
$18.01
|
| Rate for Payer: PACE SWMI |
$18.96
|
| Rate for Payer: PHP Commercial |
$111.15
|
| Rate for Payer: PHP Medicare Advantage |
$18.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Medicare |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Priority Health SBD |
$82.38
|
| Rate for Payer: Railroad Medicare Medicare |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$3,504.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.96
|
| Rate for Payer: UHC Exchange |
$3,504.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.96
|
| Rate for Payer: UHCCP Medicaid |
$10.67
|
| Rate for Payer: VA VA |
$18.96
|
|
|
HC CEA PANCREATIC CYST
|
Facility
|
IP
|
$184.37
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.15 |
| Max. Negotiated Rate |
$165.93 |
| Rate for Payer: Aetna Commercial |
$156.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.84
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cofinity Commercial |
$129.06
|
| Rate for Payer: Cofinity Commercial |
$158.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.50
|
| Rate for Payer: Healthscope Commercial |
$165.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.71
|
| Rate for Payer: PHP Commercial |
$156.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.84
|
| Rate for Payer: Priority Health SBD |
$116.15
|
|
|
HC CEA PANCREATIC CYST
|
Facility
|
OP
|
$184.37
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
30100712
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$3,504.36 |
| Rate for Payer: Aetna Commercial |
$156.71
|
| Rate for Payer: Aetna Medicare |
$19.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.70
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: BCBS MAPPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.78
|
| Rate for Payer: BCN Commercial |
$16.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.96
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cash Price |
$147.50
|
| Rate for Payer: Cofinity Commercial |
$129.06
|
| Rate for Payer: Cofinity Commercial |
$158.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$165.93
|
| Rate for Payer: Mclaren Medicaid |
$10.16
|
| Rate for Payer: Mclaren Medicare |
$18.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.91
|
| Rate for Payer: Meridian Medicaid |
$10.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.71
|
| Rate for Payer: Nomi Health Commercial |
$28.44
|
| Rate for Payer: PACE Medicare |
$18.01
|
| Rate for Payer: PACE SWMI |
$18.96
|
| Rate for Payer: PHP Commercial |
$156.71
|
| Rate for Payer: PHP Medicare Advantage |
$18.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.51
|
| Rate for Payer: Priority Health Medicare |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.61
|
| Rate for Payer: Priority Health SBD |
$116.15
|
| Rate for Payer: Railroad Medicare Medicare |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.75
|
| Rate for Payer: UHC Core |
$3,504.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.96
|
| Rate for Payer: UHC Exchange |
$3,504.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.96
|
| Rate for Payer: UHCCP Medicaid |
$10.67
|
| Rate for Payer: VA VA |
$18.96
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
IP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.96 |
| Max. Negotiated Rate |
$179.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health SBD |
$125.96
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
OP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000097
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$366.66 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Medicare |
$127.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: BCBS Complete |
$68.79
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCBS Trust/PPO |
$108.20
|
| Rate for Payer: BCN Commercial |
$108.20
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Mclaren Medicaid |
$65.51
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: Meridian Medicaid |
$68.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: Nomi Health Commercial |
$366.66
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.75
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health Narrow Network |
$100.60
|
| Rate for Payer: Priority Health SBD |
$125.96
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Core |
$164.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.22
|
| Rate for Payer: UHC Exchange |
$164.40
|
| Rate for Payer: UHC Medicare Advantage |
$122.22
|
| Rate for Payer: UHCCP Medicaid |
$68.81
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
OP
|
$190.74
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$171.67 |
| Rate for Payer: Aetna Commercial |
$162.13
|
| Rate for Payer: Aetna Medicare |
$26.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.26
|
| Rate for Payer: BCBS Complete |
$14.53
|
| Rate for Payer: BCBS MAPPO |
$25.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.85
|
| Rate for Payer: BCN Commercial |
$22.85
|
| Rate for Payer: BCN Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$171.67
|
| Rate for Payer: Mclaren Medicaid |
$13.83
|
| Rate for Payer: Mclaren Medicare |
$25.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Medicaid |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.13
|
| Rate for Payer: Nomi Health Commercial |
$38.72
|
| Rate for Payer: PACE Medicare |
$24.52
|
| Rate for Payer: PACE SWMI |
$25.81
|
| Rate for Payer: PHP Commercial |
$162.13
|
| Rate for Payer: PHP Medicare Advantage |
$25.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.55
|
| Rate for Payer: Priority Health Medicare |
$25.81
|
| Rate for Payer: Priority Health Narrow Network |
$21.24
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.81
|
| Rate for Payer: UHC Medicare Advantage |
$25.81
|
| Rate for Payer: UHCCP Medicaid |
$14.53
|
| Rate for Payer: VA VA |
$25.81
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING
|
Facility
|
IP
|
$190.74
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
30200339
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$120.17 |
| Max. Negotiated Rate |
$171.67 |
| Rate for Payer: Aetna Commercial |
$162.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.98
|
| Rate for Payer: Cash Price |
$152.59
|
| Rate for Payer: Cofinity Commercial |
$133.52
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$171.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.13
|
| Rate for Payer: PHP Commercial |
$162.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.98
|
| Rate for Payer: Priority Health SBD |
$120.17
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
IP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.96 |
| Max. Negotiated Rate |
$179.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health SBD |
$125.96
|
|
|
HC CELIAC ASSOCIATED HLA DQ TYPING CMPT
|
Facility
|
OP
|
$199.93
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
31000105
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$366.66 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Medicare |
$127.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.78
|
| Rate for Payer: BCBS Complete |
$68.79
|
| Rate for Payer: BCBS MAPPO |
$122.22
|
| Rate for Payer: BCBS Trust/PPO |
$108.20
|
| Rate for Payer: BCN Commercial |
$108.20
|
| Rate for Payer: BCN Medicare Advantage |
$122.22
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cash Price |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$139.95
|
| Rate for Payer: Cofinity Commercial |
$171.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.22
|
| Rate for Payer: Healthscope Commercial |
$179.94
|
| Rate for Payer: Mclaren Medicaid |
$65.51
|
| Rate for Payer: Mclaren Medicare |
$122.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.33
|
| Rate for Payer: Meridian Medicaid |
$68.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.94
|
| Rate for Payer: Nomi Health Commercial |
$366.66
|
| Rate for Payer: PACE Medicare |
$116.11
|
| Rate for Payer: PACE SWMI |
$122.22
|
| Rate for Payer: PHP Commercial |
$169.94
|
| Rate for Payer: PHP Medicare Advantage |
$122.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.75
|
| Rate for Payer: Priority Health Medicare |
$122.22
|
| Rate for Payer: Priority Health Narrow Network |
$100.60
|
| Rate for Payer: Priority Health SBD |
$125.96
|
| Rate for Payer: Railroad Medicare Medicare |
$122.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Core |
$164.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.22
|
| Rate for Payer: UHC Exchange |
$164.40
|
| Rate for Payer: UHC Medicare Advantage |
$122.22
|
| Rate for Payer: UHCCP Medicaid |
$68.81
|
| Rate for Payer: VA VA |
$122.22
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC CELIAC DISEASE CASCADE
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200005
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.21
|
| Rate for Payer: BCN Commercial |
$10.21
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.87
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$9.50
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$11.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$11.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.21
|
| Rate for Payer: BCN Commercial |
$10.21
|
| Rate for Payer: BCN Medicare Advantage |
$11.53
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.53
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Mclaren Medicare |
$11.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$17.30
|
| Rate for Payer: PACE Medicare |
$10.95
|
| Rate for Payer: PACE SWMI |
$11.53
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.87
|
| Rate for Payer: Priority Health Medicare |
$11.53
|
| Rate for Payer: Priority Health Narrow Network |
$9.50
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.53
|
| Rate for Payer: UHC Medicare Advantage |
$11.53
|
| Rate for Payer: UHCCP Medicaid |
$6.49
|
| Rate for Payer: VA VA |
$11.53
|
|
|
HC CELIAC DISEASE CASCADE CMPT
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200006
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
IP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.10 |
| Max. Negotiated Rate |
$1,090.14 |
| Rate for Payer: Aetna Commercial |
$1,029.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.33
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$1,041.69
|
| Rate for Payer: Cofinity Commercial |
$847.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Healthscope Commercial |
$1,090.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: PHP Commercial |
$1,029.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: Priority Health SBD |
$763.10
|
|
|
HC CELIAC PLEXUS BLOCK
|
Facility
|
OP
|
$1,211.27
|
|
|
Service Code
|
CPT 64530
|
| Hospital Charge Code |
36100546
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna Commercial |
$1,029.58
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$669.94
|
| Rate for Payer: BCN Commercial |
$669.94
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cash Price |
$969.02
|
| Rate for Payer: Cofinity Commercial |
$1,041.69
|
| Rate for Payer: Cofinity Commercial |
$847.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$847.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$969.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$1,090.14
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,029.58
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$1,029.58
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$763.10
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.01
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$491.10
|
| Rate for Payer: VA VA |
$872.29
|
|
|
HC CELL BOUND PLATELET AB SCREEN, B
|
Facility
|
IP
|
$171.36
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
30200428
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$145.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.38
|
| Rate for Payer: Cash Price |
$137.09
|
| Rate for Payer: Cofinity Commercial |
$119.95
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.09
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.66
|
| Rate for Payer: PHP Commercial |
$145.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.38
|
| Rate for Payer: Priority Health SBD |
$107.96
|
|
