|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
IP
|
$348.08
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.29 |
| Max. Negotiated Rate |
$313.27 |
| Rate for Payer: Aetna Commercial |
$295.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.25
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cofinity Advantage |
$243.66
|
| Rate for Payer: Cofinity Commercial |
$299.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.46
|
| Rate for Payer: Healthscope Commercial |
$313.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.06
|
| Rate for Payer: PHP Commercial |
$295.87
|
| Rate for Payer: Priority Health SBD |
$219.29
|
|
|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$348.08
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$336.87 |
| Rate for Payer: Aetna Commercial |
$295.87
|
| Rate for Payer: Aetna Medicare |
$108.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.21
|
| Rate for Payer: BCBS Complete |
$57.21
|
| Rate for Payer: BCBS MAPPO |
$104.17
|
| Rate for Payer: BCBS Trust/PPO |
$157.48
|
| Rate for Payer: BCN Commercial |
$157.48
|
| Rate for Payer: BCN Medicare Advantage |
$104.17
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cash Price |
$278.46
|
| Rate for Payer: Cofinity Advantage |
$243.66
|
| Rate for Payer: Cofinity Commercial |
$299.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.17
|
| Rate for Payer: Healthscope Commercial |
$313.27
|
| Rate for Payer: Mclaren Medicaid |
$54.48
|
| Rate for Payer: Mclaren Medicare |
$104.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.38
|
| Rate for Payer: Meridian Medicaid |
$109.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.87
|
| Rate for Payer: Nomi Health Commercial |
$312.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.06
|
| Rate for Payer: PACE Medicare |
$98.96
|
| Rate for Payer: PACE SWMI |
$104.17
|
| Rate for Payer: PHP Commercial |
$295.87
|
| Rate for Payer: PHP Medicare Advantage |
$104.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$336.87
|
| Rate for Payer: Priority Health Medicare |
$104.17
|
| Rate for Payer: Priority Health SBD |
$219.29
|
| Rate for Payer: Priority Health Tiered Network |
$269.50
|
| Rate for Payer: Railroad Medicare Medicare |
$104.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.25
|
| Rate for Payer: UHC Core |
$181.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.17
|
| Rate for Payer: UHC Exchange |
$136.80
|
| Rate for Payer: UHC Medicaid |
$54.48
|
| Rate for Payer: UHCCP Medicaid |
$54.48
|
| Rate for Payer: VA VA |
$104.17
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$443.93
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$279.68 |
| Max. Negotiated Rate |
$399.54 |
| Rate for Payer: Aetna Commercial |
$377.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.55
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cofinity Advantage |
$310.75
|
| Rate for Payer: Cofinity Commercial |
$381.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.14
|
| Rate for Payer: Healthscope Commercial |
$399.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.95
|
| Rate for Payer: PHP Commercial |
$377.34
|
| Rate for Payer: Priority Health SBD |
$279.68
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$443.93
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.69 |
| Max. Negotiated Rate |
$399.54 |
| Rate for Payer: Aetna Commercial |
$377.34
|
| Rate for Payer: Aetna Medicare |
$66.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.51
|
| Rate for Payer: BCBS Complete |
$35.37
|
| Rate for Payer: BCBS MAPPO |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$68.68
|
| Rate for Payer: BCN Medicare Advantage |
$64.41
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cash Price |
$355.14
|
| Rate for Payer: Cofinity Advantage |
$310.75
|
| Rate for Payer: Cofinity Commercial |
$381.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.41
|
| Rate for Payer: Healthscope Commercial |
$399.54
|
| Rate for Payer: Mclaren Medicaid |
$33.69
|
| Rate for Payer: Mclaren Medicare |
$64.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.63
|
| Rate for Payer: Meridian Medicaid |
$67.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.34
|
| Rate for Payer: Nomi Health Commercial |
$96.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.95
|
| Rate for Payer: PACE Medicare |
$61.19
|
| Rate for Payer: PACE SWMI |
$64.41
|
| Rate for Payer: PHP Commercial |
$377.34
|
| Rate for Payer: PHP Medicare Advantage |
$64.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$64.41
|
| Rate for Payer: Priority Health Medicare |
$64.41
|
| Rate for Payer: Priority Health SBD |
$279.68
|
| Rate for Payer: Priority Health Tiered Network |
$51.53
|
| Rate for Payer: Railroad Medicare Medicare |
$64.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.62
|
| Rate for Payer: UHC Core |
$96.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64.41
|
| Rate for Payer: UHC Exchange |
$96.62
|
| Rate for Payer: UHC Medicaid |
$33.69
|
| Rate for Payer: UHCCP Medicaid |
$33.69
|
| Rate for Payer: VA VA |
$64.41
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$311.37
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.16 |
| Max. Negotiated Rate |
$280.23 |
| Rate for Payer: Aetna Commercial |
$264.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.39
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Cofinity Advantage |
$217.96
|
| Rate for Payer: Cofinity Commercial |
$267.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.10
|
| Rate for Payer: Healthscope Commercial |
$280.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.53
|
| Rate for Payer: PHP Commercial |
$264.66
|
| Rate for Payer: Priority Health SBD |
$196.16
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$311.37
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.37 |
| Max. Negotiated Rate |
$280.23 |
| Rate for Payer: Aetna Commercial |
$264.66
|
| Rate for Payer: Aetna Medicare |
$155.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.39
|
| Rate for Payer: BCBS Complete |
$124.55
|
| Rate for Payer: Cash Price |
$249.10
|
| Rate for Payer: Cofinity Advantage |
$217.96
|
| Rate for Payer: Cofinity Commercial |
$267.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.10
|
| Rate for Payer: Healthscope Commercial |
$280.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.53
|
| Rate for Payer: PHP Commercial |
$264.66
|
| Rate for Payer: Priority Health SBD |
$196.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.39
|
| Rate for Payer: UHC Core |
$162.22
|
| Rate for Payer: UHC Exchange |
$122.37
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$75.53
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$67.98 |
| Rate for Payer: Aetna Commercial |
$64.20
|
| Rate for Payer: Aetna Medicare |
$9.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.70
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$9.98
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: BCN Medicare Advantage |
$9.36
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Advantage |
$52.87
|
| Rate for Payer: Cofinity Commercial |
$64.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$67.98
|
| Rate for Payer: Mclaren Medicaid |
$4.90
|
| Rate for Payer: Mclaren Medicare |
$9.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.83
|
| Rate for Payer: Meridian Medicaid |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.20
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.65
|
| Rate for Payer: PACE Medicare |
$8.89
|
| Rate for Payer: PACE SWMI |
$9.36
|
| Rate for Payer: PHP Commercial |
$64.20
|
| Rate for Payer: PHP Medicare Advantage |
$9.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.36
|
| Rate for Payer: Priority Health Medicare |
$9.36
|
| Rate for Payer: Priority Health SBD |
$47.58
|
| Rate for Payer: Priority Health Tiered Network |
$7.49
|
| Rate for Payer: Railroad Medicare Medicare |
$9.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.04
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.36
|
| Rate for Payer: UHC Exchange |
$14.04
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: VA VA |
$9.36
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$75.53
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.58 |
| Max. Negotiated Rate |
$67.98 |
| Rate for Payer: Aetna Commercial |
$64.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.09
|
| Rate for Payer: Cash Price |
$60.42
|
| Rate for Payer: Cofinity Advantage |
$52.87
|
| Rate for Payer: Cofinity Commercial |
$64.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$67.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.65
|
| Rate for Payer: PHP Commercial |
$64.20
|
| Rate for Payer: Priority Health SBD |
$47.58
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$210.77
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$189.69 |
| Rate for Payer: Aetna Commercial |
$179.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.00
|
| Rate for Payer: Cash Price |
$168.62
|
| Rate for Payer: Cofinity Advantage |
$147.54
|
| Rate for Payer: Cofinity Commercial |
$181.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.62
|
| Rate for Payer: Healthscope Commercial |
$189.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.08
|
| Rate for Payer: PHP Commercial |
$179.15
|
| Rate for Payer: Priority Health SBD |
$132.79
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$210.77
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$82.83 |
| Max. Negotiated Rate |
$258.94 |
| Rate for Payer: Aetna Commercial |
$179.15
|
| Rate for Payer: Aetna Medicare |
$105.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.00
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCBS Trust/PPO |
$258.94
|
| Rate for Payer: BCN Commercial |
$258.94
|
| Rate for Payer: Cash Price |
$168.62
|
| Rate for Payer: Cash Price |
$168.62
|
| Rate for Payer: Cofinity Advantage |
$147.54
|
| Rate for Payer: Cofinity Commercial |
$181.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.62
|
| Rate for Payer: Healthscope Commercial |
$189.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.08
|
| Rate for Payer: PHP Commercial |
$179.15
|
| Rate for Payer: Priority Health SBD |
$132.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.00
|
| Rate for Payer: UHC Core |
$109.81
|
| Rate for Payer: UHC Exchange |
$82.83
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$374.54
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$768.83 |
| Rate for Payer: Aetna Commercial |
$318.36
|
| Rate for Payer: Aetna Medicare |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.18
|
| Rate for Payer: BCBS Complete |
$130.57
|
| Rate for Payer: BCBS MAPPO |
$237.74
|
| Rate for Payer: BCBS Trust/PPO |
$618.58
|
| Rate for Payer: BCN Commercial |
$618.58
|
| Rate for Payer: BCN Medicare Advantage |
$237.74
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cofinity Advantage |
$262.18
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.74
|
| Rate for Payer: Healthscope Commercial |
$337.09
|
| Rate for Payer: Mclaren Medicaid |
$124.34
|
| Rate for Payer: Mclaren Medicare |
$237.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.63
|
| Rate for Payer: Meridian Medicaid |
$249.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.36
|
| Rate for Payer: Nomi Health Commercial |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.90
|
| Rate for Payer: PACE Medicare |
$225.85
|
| Rate for Payer: PACE SWMI |
$237.74
|
| Rate for Payer: PHP Commercial |
$318.36
|
| Rate for Payer: PHP Medicare Advantage |
$237.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$768.83
|
| Rate for Payer: Priority Health Medicare |
$237.74
|
| Rate for Payer: Priority Health SBD |
$235.96
|
| Rate for Payer: Priority Health Tiered Network |
$615.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.45
|
| Rate for Payer: UHC Core |
$195.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.74
|
| Rate for Payer: UHC Exchange |
$147.19
|
| Rate for Payer: UHC Medicaid |
$124.34
|
| Rate for Payer: UHCCP Medicaid |
$124.34
|
| Rate for Payer: VA VA |
$237.74
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$374.54
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$235.96 |
| Max. Negotiated Rate |
$337.09 |
| Rate for Payer: Aetna Commercial |
$318.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.45
|
| Rate for Payer: Cash Price |
$299.63
|
| Rate for Payer: Cofinity Advantage |
$262.18
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.63
|
| Rate for Payer: Healthscope Commercial |
$337.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.90
|
| Rate for Payer: PHP Commercial |
$318.36
|
| Rate for Payer: Priority Health SBD |
$235.96
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,138.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.40 |
| Max. Negotiated Rate |
$1,924.59 |
| Rate for Payer: Aetna Commercial |
$1,817.67
|
| Rate for Payer: Aetna Medicare |
$1,069.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.98
|
| Rate for Payer: BCBS Complete |
$855.37
|
| Rate for Payer: Cash Price |
$1,710.74
|
| Rate for Payer: Cofinity Advantage |
$1,496.90
|
| Rate for Payer: Cofinity Commercial |
$1,839.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,710.74
|
| Rate for Payer: Healthscope Commercial |
$1,924.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,710.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,817.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,603.82
|
| Rate for Payer: PHP Commercial |
$1,817.67
|
| Rate for Payer: Priority Health SBD |
$1,347.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,389.98
|
| Rate for Payer: UHC Core |
$1,114.12
|
| Rate for Payer: UHC Exchange |
$840.40
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,138.43
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,347.21 |
| Max. Negotiated Rate |
$1,924.59 |
| Rate for Payer: Aetna Commercial |
$1,817.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.98
|
| Rate for Payer: Cash Price |
$1,710.74
|
| Rate for Payer: Cofinity Advantage |
$1,496.90
|
| Rate for Payer: Cofinity Commercial |
$1,839.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,710.74
|
| Rate for Payer: Healthscope Commercial |
$1,924.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,817.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,603.82
|
| Rate for Payer: PHP Commercial |
$1,817.67
|
| Rate for Payer: Priority Health SBD |
$1,347.21
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,956.14
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,492.37 |
| Max. Negotiated Rate |
$3,560.53 |
| Rate for Payer: Aetna Commercial |
$3,362.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,571.49
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Advantage |
$2,769.30
|
| Rate for Payer: Cofinity Commercial |
$3,402.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,560.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: PHP Commercial |
$3,362.72
|
| Rate for Payer: Priority Health SBD |
$2,492.37
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,956.14
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$578.87 |
| Max. Negotiated Rate |
$3,560.53 |
| Rate for Payer: Aetna Commercial |
$3,362.72
|
| Rate for Payer: Aetna Medicare |
$1,978.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,571.49
|
| Rate for Payer: BCBS Complete |
$1,582.46
|
| Rate for Payer: BCBS Trust/PPO |
$578.87
|
| Rate for Payer: BCN Commercial |
$578.87
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cash Price |
$3,164.91
|
| Rate for Payer: Cofinity Advantage |
$2,769.30
|
| Rate for Payer: Cofinity Commercial |
$3,402.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,164.91
|
| Rate for Payer: Healthscope Commercial |
$3,560.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,164.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,362.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,967.11
|
| Rate for Payer: PHP Commercial |
$3,362.72
|
| Rate for Payer: Priority Health SBD |
$2,492.37
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$857.37
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$540.14 |
| Max. Negotiated Rate |
$771.63 |
| Rate for Payer: Aetna Commercial |
$728.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.29
|
| Rate for Payer: Cash Price |
$685.90
|
| Rate for Payer: Cofinity Advantage |
$600.16
|
| Rate for Payer: Cofinity Commercial |
$737.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.90
|
| Rate for Payer: Healthscope Commercial |
$771.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.03
|
| Rate for Payer: PHP Commercial |
$728.76
|
| Rate for Payer: Priority Health SBD |
$540.14
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$857.37
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$275.36 |
| Max. Negotiated Rate |
$771.63 |
| Rate for Payer: Aetna Commercial |
$728.76
|
| Rate for Payer: Aetna Medicare |
$428.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.29
|
| Rate for Payer: BCBS Complete |
$342.95
|
| Rate for Payer: BCBS Trust/PPO |
$275.36
|
| Rate for Payer: BCN Commercial |
$275.36
|
| Rate for Payer: Cash Price |
$685.90
|
| Rate for Payer: Cash Price |
$685.90
|
| Rate for Payer: Cofinity Advantage |
$600.16
|
| Rate for Payer: Cofinity Commercial |
$737.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$685.90
|
| Rate for Payer: Healthscope Commercial |
$771.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$685.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$728.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.03
|
| Rate for Payer: PHP Commercial |
$728.76
|
| Rate for Payer: Priority Health SBD |
$540.14
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,729.96
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,072.87 |
| Max. Negotiated Rate |
$2,456.96 |
| Rate for Payer: Aetna Commercial |
$2,320.47
|
| Rate for Payer: Aetna Medicare |
$1,364.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,774.47
|
| Rate for Payer: BCBS Complete |
$1,091.98
|
| Rate for Payer: Cash Price |
$2,183.97
|
| Rate for Payer: Cofinity Advantage |
$1,910.97
|
| Rate for Payer: Cofinity Commercial |
$2,347.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,183.97
|
| Rate for Payer: Healthscope Commercial |
$2,456.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,183.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,320.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,047.47
|
| Rate for Payer: PHP Commercial |
$2,320.47
|
| Rate for Payer: Priority Health SBD |
$1,719.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,774.47
|
| Rate for Payer: UHC Core |
$1,422.31
|
| Rate for Payer: UHC Exchange |
$1,072.87
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,729.96
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,719.87 |
| Max. Negotiated Rate |
$2,456.96 |
| Rate for Payer: Aetna Commercial |
$2,320.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,774.47
|
| Rate for Payer: Cash Price |
$2,183.97
|
| Rate for Payer: Cofinity Advantage |
$1,910.97
|
| Rate for Payer: Cofinity Commercial |
$2,347.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,183.97
|
| Rate for Payer: Healthscope Commercial |
$2,456.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,320.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,047.47
|
| Rate for Payer: PHP Commercial |
$2,320.47
|
| Rate for Payer: Priority Health SBD |
$1,719.87
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$78.45
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: Priority Health SBD |
$49.42
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$78.45
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$70.61 |
| Rate for Payer: Aetna Commercial |
$66.68
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$10.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Cofinity Advantage |
$54.91
|
| Rate for Payer: Cofinity Commercial |
$67.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$70.61
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.68
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.84
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$66.68
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health SBD |
$49.42
|
| Rate for Payer: Priority Health Tiered Network |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.72
|
| Rate for Payer: UHC Exchange |
$14.58
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$296.51
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$266.86 |
| Rate for Payer: Aetna Commercial |
$252.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.73
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Advantage |
$207.56
|
| Rate for Payer: Cofinity Commercial |
$255.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$266.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PHP Commercial |
$252.03
|
| Rate for Payer: Priority Health SBD |
$186.80
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$296.51
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$266.86 |
| Rate for Payer: Aetna Commercial |
$252.03
|
| Rate for Payer: Aetna Medicare |
$75.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.24
|
| Rate for Payer: BCBS Complete |
$39.65
|
| Rate for Payer: BCBS MAPPO |
$72.19
|
| Rate for Payer: BCBS Trust/PPO |
$76.97
|
| Rate for Payer: BCN Commercial |
$76.97
|
| Rate for Payer: BCN Medicare Advantage |
$72.19
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cash Price |
$237.21
|
| Rate for Payer: Cofinity Advantage |
$207.56
|
| Rate for Payer: Cofinity Commercial |
$255.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.19
|
| Rate for Payer: Healthscope Commercial |
$266.86
|
| Rate for Payer: Mclaren Medicaid |
$37.76
|
| Rate for Payer: Mclaren Medicare |
$72.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.80
|
| Rate for Payer: Meridian Medicaid |
$75.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.03
|
| Rate for Payer: Nomi Health Commercial |
$216.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.38
|
| Rate for Payer: PACE Medicare |
$68.58
|
| Rate for Payer: PACE SWMI |
$72.19
|
| Rate for Payer: PHP Commercial |
$252.03
|
| Rate for Payer: PHP Medicare Advantage |
$72.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$72.19
|
| Rate for Payer: Priority Health Medicare |
$72.19
|
| Rate for Payer: Priority Health SBD |
$186.80
|
| Rate for Payer: Priority Health Tiered Network |
$57.75
|
| Rate for Payer: Railroad Medicare Medicare |
$72.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.29
|
| Rate for Payer: UHC Core |
$108.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.19
|
| Rate for Payer: UHC Exchange |
$108.29
|
| Rate for Payer: UHC Medicaid |
$37.76
|
| Rate for Payer: UHCCP Medicaid |
$37.76
|
| Rate for Payer: VA VA |
$72.19
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$342.54
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.62 |
| Max. Negotiated Rate |
$308.29 |
| Rate for Payer: Aetna Commercial |
$291.16
|
| Rate for Payer: Aetna Medicare |
$171.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.65
|
| Rate for Payer: BCBS Complete |
$137.02
|
| Rate for Payer: Cash Price |
$274.03
|
| Rate for Payer: Cofinity Advantage |
$239.78
|
| Rate for Payer: Cofinity Commercial |
$294.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.03
|
| Rate for Payer: Healthscope Commercial |
$308.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.90
|
| Rate for Payer: PHP Commercial |
$291.16
|
| Rate for Payer: Priority Health SBD |
$215.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.65
|
| Rate for Payer: UHC Core |
$178.46
|
| Rate for Payer: UHC Exchange |
$134.62
|
|
