|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| 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 |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$9.49
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: Priority Health Tiered Network |
$14.51
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.21
|
| Rate for Payer: UHC Core |
$27.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$27.21
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| 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 |
$9.96
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$9.49
|
| Rate for Payer: Mclaren Medicare |
$18.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.05
|
| Rate for Payer: Meridian Medicaid |
$19.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$27.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.14
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: Priority Health Tiered Network |
$14.51
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.21
|
| Rate for Payer: UHC Core |
$27.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.14
|
| Rate for Payer: UHC Exchange |
$27.21
|
| Rate for Payer: UHC Medicaid |
$9.49
|
| Rate for Payer: UHCCP Medicaid |
$9.49
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| 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 |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCBS Trust/PPO |
$16.31
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$8.00
|
| Rate for Payer: Mclaren Medicare |
$15.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.05
|
| Rate for Payer: Meridian Medicaid |
$16.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$22.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.29
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: Priority Health Tiered Network |
$12.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Core |
$22.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.29
|
| Rate for Payer: UHC Exchange |
$22.94
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$38.20
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: Priority Health SBD |
$24.07
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$38.20
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$34.38 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.83
|
| 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 |
$7.21
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cash Price |
$30.56
|
| Rate for Payer: Cofinity Advantage |
$26.74
|
| Rate for Payer: Cofinity Commercial |
$32.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$34.38
|
| Rate for Payer: Mclaren Medicaid |
$6.86
|
| Rate for Payer: Mclaren Medicare |
$13.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.78
|
| Rate for Payer: Meridian Medicaid |
$13.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.47
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.65
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$32.47
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.12
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health SBD |
$24.07
|
| Rate for Payer: Priority Health Tiered Network |
$10.50
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.68
|
| Rate for Payer: UHC Core |
$19.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.12
|
| Rate for Payer: UHC Exchange |
$19.68
|
| Rate for Payer: UHC Medicaid |
$6.86
|
| Rate for Payer: UHCCP Medicaid |
$6.86
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.22 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Advantage |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: Priority Health SBD |
$78.22
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$124.16
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| 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 |
$19.27
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$37.42
|
| Rate for Payer: BCN Commercial |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Advantage |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Mclaren Medicaid |
$18.35
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Meridian Medicaid |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$52.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.35
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$78.22
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$52.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.09
|
| Rate for Payer: UHC Exchange |
$52.64
|
| Rate for Payer: UHC Medicaid |
$18.35
|
| Rate for Payer: UHCCP Medicaid |
$18.35
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$124.16
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| 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 |
$23.53
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCBS Trust/PPO |
$45.68
|
| Rate for Payer: BCN Commercial |
$45.68
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Advantage |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Mclaren Medicaid |
$22.41
|
| Rate for Payer: Mclaren Medicare |
$42.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.98
|
| Rate for Payer: Meridian Medicaid |
$44.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Nomi Health Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.41
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$78.22
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.26
|
| Rate for Payer: UHC Core |
$64.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.84
|
| Rate for Payer: UHC Exchange |
$64.26
|
| Rate for Payer: UHC Medicaid |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$22.41
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$78.22 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna Commercial |
$105.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.70
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Cofinity Advantage |
$86.91
|
| Rate for Payer: Cofinity Commercial |
$106.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.33
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.12
|
| Rate for Payer: PHP Commercial |
$105.54
|
| Rate for Payer: Priority Health SBD |
$78.22
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,142.70
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$1,028.43 |
| Rate for Payer: Aetna Commercial |
$971.29
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.75
|
| 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 |
$561.11
|
| Rate for Payer: BCN Commercial |
$561.11
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cofinity Advantage |
$799.89
|
| Rate for Payer: Cofinity Commercial |
$982.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$1,028.43
|
| 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 |
$971.29
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.02
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$971.29
|
| 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 |
$719.90
|
| 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) |
$742.75
|
| Rate for Payer: UHC Core |
$595.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$449.08
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,142.70
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$719.90 |
| Max. Negotiated Rate |
$1,028.43 |
| Rate for Payer: Aetna Commercial |
$971.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.75
|
| Rate for Payer: Cash Price |
$914.16
|
| Rate for Payer: Cofinity Advantage |
$799.89
|
| Rate for Payer: Cofinity Commercial |
$982.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$914.16
|
| Rate for Payer: Healthscope Commercial |
$1,028.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$971.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$857.02
|
| Rate for Payer: PHP Commercial |
$971.29
|
| Rate for Payer: Priority Health SBD |
$719.90
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,557.06
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,610.95 |
| Max. Negotiated Rate |
$2,301.35 |
| Rate for Payer: Aetna Commercial |
$2,173.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,662.09
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cofinity Advantage |
$1,789.94
|
| Rate for Payer: Cofinity Commercial |
$2,199.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.65
|
| Rate for Payer: Healthscope Commercial |
$2,301.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.80
|
| Rate for Payer: PHP Commercial |
$2,173.50
|
| Rate for Payer: Priority Health SBD |
$1,610.95
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,557.06
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$2,767.09 |
| Rate for Payer: Aetna Commercial |
$2,173.50
|
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,662.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,456.79
|
| Rate for Payer: BCN Commercial |
$1,456.79
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cash Price |
$2,045.65
|
| Rate for Payer: Cofinity Advantage |
$1,789.94
|
| Rate for Payer: Cofinity Commercial |
$2,199.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$2,301.35
|
| Rate for Payer: Mclaren Medicaid |
$447.50
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,173.50
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.80
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$2,173.50
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health SBD |
$1,610.95
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.09
|
| Rate for Payer: UHC Core |
$1,332.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,004.92
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$801.64
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$505.03 |
| Max. Negotiated Rate |
$721.48 |
| Rate for Payer: Aetna Commercial |
$681.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.07
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cofinity Advantage |
$561.15
|
| Rate for Payer: Cofinity Commercial |
$689.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.31
|
| Rate for Payer: Healthscope Commercial |
$721.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$681.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.23
|
| Rate for Payer: PHP Commercial |
$681.39
|
| Rate for Payer: Priority Health SBD |
$505.03
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$801.64
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$721.48 |
| Rate for Payer: Aetna Commercial |
$681.39
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.07
|
| 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 |
$213.18
|
| Rate for Payer: BCN Commercial |
$213.18
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cash Price |
$641.31
|
| Rate for Payer: Cofinity Advantage |
$561.15
|
| Rate for Payer: Cofinity Commercial |
$689.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$641.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$721.48
|
| 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 |
$681.39
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$601.23
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$681.39
|
| 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 |
$505.03
|
| 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) |
$521.07
|
| Rate for Payer: UHC Core |
$417.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$315.04
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$412.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.65 |
| Max. Negotiated Rate |
$370.94 |
| Rate for Payer: Aetna Commercial |
$350.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.90
|
| Rate for Payer: Cash Price |
$329.72
|
| Rate for Payer: Cofinity Advantage |
$288.50
|
| Rate for Payer: Cofinity Commercial |
$354.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.72
|
| Rate for Payer: Healthscope Commercial |
$370.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.11
|
| Rate for Payer: PHP Commercial |
$350.33
|
| Rate for Payer: Priority Health SBD |
$259.65
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$412.15
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$370.94 |
| Rate for Payer: Aetna Commercial |
$350.33
|
| Rate for Payer: Aetna Medicare |
$206.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.90
|
| Rate for Payer: BCBS Complete |
$164.86
|
| Rate for Payer: Cash Price |
$329.72
|
| Rate for Payer: Cash Price |
$329.72
|
| Rate for Payer: Cofinity Advantage |
$288.50
|
| Rate for Payer: Cofinity Commercial |
$354.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.72
|
| Rate for Payer: Healthscope Commercial |
$370.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$350.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$309.11
|
| Rate for Payer: PHP Commercial |
$350.33
|
| Rate for Payer: Priority Health SBD |
$259.65
|
| Rate for Payer: UHCCP Medicaid |
$144.00
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,464.90
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,385.96 |
| Max. Negotiated Rate |
$3,118.41 |
| Rate for Payer: Aetna Commercial |
$2,945.16
|
| Rate for Payer: Aetna Medicare |
$1,732.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,252.18
|
| Rate for Payer: BCBS Complete |
$1,385.96
|
| Rate for Payer: Cash Price |
$2,771.92
|
| Rate for Payer: Cofinity Advantage |
$2,425.43
|
| Rate for Payer: Cofinity Commercial |
$2,979.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.92
|
| Rate for Payer: Healthscope Commercial |
$3,118.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,771.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,945.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.68
|
| Rate for Payer: PHP Commercial |
$2,945.16
|
| Rate for Payer: Priority Health SBD |
$2,182.89
|
|
|
HC ERCP
|
Facility
|
IP
|
$3,464.90
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,182.89 |
| Max. Negotiated Rate |
$3,118.41 |
| Rate for Payer: Aetna Commercial |
$2,945.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,252.18
|
| Rate for Payer: Cash Price |
$2,771.92
|
| Rate for Payer: Cofinity Advantage |
$2,425.43
|
| Rate for Payer: Cofinity Commercial |
$2,979.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,771.92
|
| Rate for Payer: Healthscope Commercial |
$3,118.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,945.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,598.68
|
| Rate for Payer: PHP Commercial |
$2,945.16
|
| Rate for Payer: Priority Health SBD |
$2,182.89
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
IP
|
$4,126.82
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,599.90 |
| Max. Negotiated Rate |
$3,714.14 |
| Rate for Payer: Aetna Commercial |
$3,507.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.43
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Advantage |
$2,888.77
|
| Rate for Payer: Cofinity Commercial |
$3,549.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$3,714.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: PHP Commercial |
$3,507.80
|
| Rate for Payer: Priority Health SBD |
$2,599.90
|
|
|
HC ERCP SPHINCTEROTOMY
|
Facility
|
OP
|
$4,126.82
|
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,650.73 |
| Max. Negotiated Rate |
$3,714.14 |
| Rate for Payer: Aetna Commercial |
$3,507.80
|
| Rate for Payer: Aetna Medicare |
$2,063.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,682.43
|
| Rate for Payer: BCBS Complete |
$1,650.73
|
| Rate for Payer: Cash Price |
$3,301.46
|
| Rate for Payer: Cofinity Advantage |
$2,888.77
|
| Rate for Payer: Cofinity Commercial |
$3,549.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,301.46
|
| Rate for Payer: Healthscope Commercial |
$3,714.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,301.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,507.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,095.11
|
| Rate for Payer: PHP Commercial |
$3,507.80
|
| Rate for Payer: Priority Health SBD |
$2,599.90
|
|
|
HC ER CRITICAL CARE EA ADDL 30 MIN
|
Facility
|
IP
|
$958.04
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
45000081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.57 |
| Max. Negotiated Rate |
$862.24 |
| Rate for Payer: Aetna Commercial |
$814.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.73
|
| Rate for Payer: Cash Price |
$766.43
|
| Rate for Payer: Cofinity Advantage |
$670.63
|
| Rate for Payer: Cofinity Commercial |
$823.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$766.43
|
| Rate for Payer: Healthscope Commercial |
$862.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.53
|
| Rate for Payer: PHP Commercial |
$814.33
|
| Rate for Payer: Priority Health SBD |
$603.57
|
|
