|
HC MGLUR1 AB IFA TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$53.55
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$48.20
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$20.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC M. GRAVIS EVAL, ADULT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC M. GRAVIS EVAL, ADULT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health SBD |
$44.34
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$19.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: BCBS Complete |
$10.57
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$14.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$10.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.08
|
| Rate for Payer: UHC Core |
$22.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$18.40
|
| Rate for Payer: UHC Medicare Advantage |
$18.95
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health SBD |
$44.34
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT2
|
Facility
|
OP
|
$70.38
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.52
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC Core |
$22.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.79
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT2
|
Facility
|
IP
|
$70.38
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$63.34 |
| Rate for Payer: Aetna Commercial |
$59.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.75
|
| Rate for Payer: Cash Price |
$56.30
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Cofinity Commercial |
$60.53
|
| Rate for Payer: Healthscope Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.82
|
| Rate for Payer: PHP Commercial |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.27
|
| Rate for Payer: Priority Health SBD |
$44.34
|
|
|
HC MIC BY AGAR DILUTION
|
Facility
|
OP
|
$44.88
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.81
|
| Rate for Payer: BCBS Complete |
$4.97
|
| Rate for Payer: BCBS MAPPO |
$8.65
|
| Rate for Payer: BCBS Trust/PPO |
$6.78
|
| Rate for Payer: BCN Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.65
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Mclaren Medicaid |
$4.73
|
| Rate for Payer: Mclaren Medicare |
$8.65
|
| Rate for Payer: Meridian Medicaid |
$4.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PACE Medicare |
$8.22
|
| Rate for Payer: PACE SWMI |
$8.65
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: PHP Medicare Advantage |
$8.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$8.65
|
| Rate for Payer: Priority Health SBD |
$28.27
|
| Rate for Payer: Railroad Medicare Medicare |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.38
|
| Rate for Payer: UHC Core |
$14.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.65
|
| Rate for Payer: UHC Exchange |
$8.65
|
| Rate for Payer: UHC Medicare Advantage |
$8.91
|
| Rate for Payer: VA VA |
$8.65
|
|
|
HC MIC BY AGAR DILUTION
|
Facility
|
IP
|
$44.88
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
30600101
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$40.39 |
| Rate for Payer: Aetna Commercial |
$38.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Cash Price |
$35.90
|
| Rate for Payer: Cofinity Commercial |
$31.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Healthscope Commercial |
$40.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.15
|
| Rate for Payer: PHP Commercial |
$38.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.42
|
| Rate for Payer: Priority Health SBD |
$28.27
|
|
|
HC MICRA AR LEADLESS PACEMAKER
|
Facility
|
IP
|
$16,893.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500013
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,643.06 |
| Max. Negotiated Rate |
$15,204.38 |
| Rate for Payer: Aetna Commercial |
$14,359.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,980.94
|
| Rate for Payer: Cash Price |
$13,515.00
|
| Rate for Payer: Cofinity Commercial |
$11,825.62
|
| Rate for Payer: Cofinity Commercial |
$14,528.62
|
| Rate for Payer: Healthscope Commercial |
$15,204.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,359.69
|
| Rate for Payer: PHP Commercial |
$14,359.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,825.62
|
| Rate for Payer: Priority Health SBD |
$10,643.06
|
|
|
HC MICRA AR LEADLESS PACEMAKER
|
Facility
|
OP
|
$16,893.75
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500013
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,757.50 |
| Max. Negotiated Rate |
$15,204.38 |
| Rate for Payer: Aetna Commercial |
$14,359.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,980.94
|
| Rate for Payer: BCBS Complete |
$6,757.50
|
| Rate for Payer: Cash Price |
$13,515.00
|
| Rate for Payer: Cofinity Commercial |
$11,825.62
|
| Rate for Payer: Cofinity Commercial |
$14,528.62
|
| Rate for Payer: Healthscope Commercial |
$15,204.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,359.69
|
| Rate for Payer: PHP Commercial |
$14,359.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,825.62
|
| Rate for Payer: Priority Health SBD |
$10,643.06
|
|
|
HC MICRA VV LEADLESS PACEMAKER
|
Facility
|
OP
|
$17,269.88
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500012
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$6,907.95 |
| Max. Negotiated Rate |
$15,542.89 |
| Rate for Payer: Aetna Commercial |
$14,679.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,225.42
|
| Rate for Payer: BCBS Complete |
$6,907.95
|
| Rate for Payer: Cash Price |
$13,815.90
|
| Rate for Payer: Cofinity Commercial |
$12,088.92
|
| Rate for Payer: Cofinity Commercial |
$14,852.10
|
| Rate for Payer: Healthscope Commercial |
$15,542.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,679.40
|
| Rate for Payer: PHP Commercial |
$14,679.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,088.92
|
| Rate for Payer: Priority Health SBD |
$10,880.02
|
|
|
HC MICRA VV LEADLESS PACEMAKER
|
Facility
|
IP
|
$17,269.88
|
|
|
Service Code
|
HCPCS C1786
|
| Hospital Charge Code |
27500012
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$10,880.02 |
| Max. Negotiated Rate |
$15,542.89 |
| Rate for Payer: Aetna Commercial |
$14,679.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,225.42
|
| Rate for Payer: Cash Price |
$13,815.90
|
| Rate for Payer: Cofinity Commercial |
$12,088.92
|
| Rate for Payer: Cofinity Commercial |
$14,852.10
|
| Rate for Payer: Healthscope Commercial |
$15,542.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,679.40
|
| Rate for Payer: PHP Commercial |
$14,679.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,088.92
|
| Rate for Payer: Priority Health SBD |
$10,880.02
|
|
|
HC MICRO ALBUMIN URINE
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
30100075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC MICRO ALBUMIN URINE
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
30100075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.22
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Mclaren Medicare |
$5.78
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PACE Medicare |
$5.49
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.94
|
| Rate for Payer: UHC Core |
$9.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.78
|
| Rate for Payer: UHC Exchange |
$5.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.95
|
| Rate for Payer: VA VA |
$5.78
|
|
|
HC MICROSPORIDIA DETECTION
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.35
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Mclaren Medicare |
$6.68
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PACE Medicare |
$6.35
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.02
|
| Rate for Payer: UHC Core |
$11.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: VA VA |
$6.68
|
|
|
HC MICROSPORIDIA DETECTION
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
30600070
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC MICROSPORIDIA DETECTION CMPT
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600107
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health SBD |
$20.16
|
|
|
HC MICROSPORIDIA DETECTION CMPT
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600107
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$27.20
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.49
|
| Rate for Payer: BCBS Complete |
$3.44
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Cofinity Commercial |
$22.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$28.80
|
| Rate for Payer: Mclaren Medicaid |
$3.28
|
| Rate for Payer: Mclaren Medicare |
$5.99
|
| Rate for Payer: Meridian Medicaid |
$3.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.20
|
| Rate for Payer: PACE Medicare |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$27.20
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Medicare |
$5.99
|
| Rate for Payer: Priority Health SBD |
$20.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.19
|
| Rate for Payer: UHC Core |
$10.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.99
|
| Rate for Payer: UHC Exchange |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: VA VA |
$5.99
|
|
|
HC MICROSPORIDIA PCR
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.86
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Mclaren Medicaid |
$19.19
|
| Rate for Payer: Mclaren Medicare |
$35.09
|
| Rate for Payer: Meridian Medicaid |
$20.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$231.84
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC MICROSPORIDIA PCR
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600285
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$312.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$316.48
|
| Rate for Payer: Healthscope Commercial |
$331.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.80
|
| Rate for Payer: PHP Commercial |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.60
|
| Rate for Payer: Priority Health SBD |
$231.84
|
|
|
HC MICROVENTION LVIS
|
Facility
|
OP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,498.20 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.58
|
| Rate for Payer: BCBS Complete |
$4,498.20
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
|
|
HC MICROVENTION LVIS
|
Facility
|
IP
|
$11,245.50
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27200303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,084.66 |
| Max. Negotiated Rate |
$10,120.95 |
| Rate for Payer: Aetna Commercial |
$9,558.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,309.58
|
| Rate for Payer: Cash Price |
$8,996.40
|
| Rate for Payer: Cofinity Commercial |
$7,871.85
|
| Rate for Payer: Cofinity Commercial |
$9,671.13
|
| Rate for Payer: Healthscope Commercial |
$10,120.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,558.68
|
| Rate for Payer: PHP Commercial |
$9,558.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,871.85
|
| Rate for Payer: Priority Health SBD |
$7,084.66
|
|
|
HC MICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$74.42 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: BCBS Complete |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
|
|
HC MICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$186.06
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200005
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$117.22 |
| Max. Negotiated Rate |
$167.45 |
| Rate for Payer: Aetna Commercial |
$158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.94
|
| Rate for Payer: Cash Price |
$148.85
|
| Rate for Payer: Cofinity Commercial |
$130.24
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Healthscope Commercial |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.15
|
| Rate for Payer: PHP Commercial |
$158.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.24
|
| Rate for Payer: Priority Health SBD |
$117.22
|
|
