|
HC EP+PVI ABL
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,608.26 |
| Max. Negotiated Rate |
$67,348.90 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$24,882.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,907.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,907.33
|
| Rate for Payer: BCBS Complete |
$13,465.47
|
| Rate for Payer: BCBS MAPPO |
$23,925.86
|
| Rate for Payer: BCN Medicare Advantage |
$23,925.86
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,925.86
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Mclaren Medicaid |
$12,824.26
|
| Rate for Payer: Mclaren Medicare |
$23,925.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,122.15
|
| Rate for Payer: Meridian Medicaid |
$13,465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,514.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PACE Medicare |
$22,729.57
|
| Rate for Payer: PACE SWMI |
$23,925.86
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$23,925.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,824.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health Medicare |
$23,925.86
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
| Rate for Payer: Railroad Medicare Medicare |
$23,925.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,348.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,925.86
|
| Rate for Payer: UHC Medicare Advantage |
$23,925.86
|
| Rate for Payer: UHCCP Medicaid |
$13,470.26
|
| Rate for Payer: VA VA |
$23,925.86
|
|
|
HC EP+PVI ABL
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93656
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,608.26 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,786.30
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$6,231.40
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,231.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health SBD |
$5,608.26
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR AB-IGG & IGM
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200353
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| 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 |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| 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 |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR ANTIBODY
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
30200268
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| 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 |
$10.21
|
| Rate for Payer: BCBS MAPPO |
$18.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.14
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.14
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$9.72
|
| 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 |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PACE Medicare |
$17.23
|
| Rate for Payer: PACE SWMI |
$18.14
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health Medicare |
$18.14
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.14
|
| Rate for Payer: UHC Medicare Advantage |
$18.14
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$18.14
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN-BARR ANTIBODY NUCLEAR ANTIGEN
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
30200267
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$43.04 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$15.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| 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 |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.29
|
| Rate for Payer: BCN Medicare Advantage |
$15.29
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.29
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| 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 |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PACE Medicare |
$14.53
|
| Rate for Payer: PACE SWMI |
$15.29
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$15.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health Medicare |
$15.29
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.29
|
| Rate for Payer: UHC Medicare Advantage |
$15.29
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$15.29
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
OP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$36.93 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| 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 |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$13.12
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.12
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| 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 |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PACE Medicare |
$12.46
|
| Rate for Payer: PACE SWMI |
$13.12
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$13.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health Medicare |
$13.12
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.12
|
| Rate for Payer: UHC Medicare Advantage |
$13.12
|
| Rate for Payer: UHCCP Medicaid |
$7.39
|
| Rate for Payer: VA VA |
$13.12
|
|
|
HC EPSTEIN BARR EA AG
|
Facility
|
IP
|
$37.45
|
|
|
Service Code
|
CPT 86663
|
| Hospital Charge Code |
30200365
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.96
|
| Rate for Payer: Cofinity Commercial |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.83
|
| Rate for Payer: PHP Commercial |
$31.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.34
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.81 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| 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 |
$19.75
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$18.81
|
| 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 |
$19.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PACE Medicare |
$33.34
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: Railroad Medicare Medicare |
$35.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$35.09
|
|
|
HC EPSTEIN BARR VIRUS BY PCR FLUID
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600171
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
IP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.69 |
| Max. Negotiated Rate |
$109.56 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health SBD |
$76.69
|
|
|
HC EPSTEIN BARR VIRUS PCR BLOOD
|
Facility
|
OP
|
$121.73
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
30600172
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$120.59 |
| Rate for Payer: Aetna Commercial |
$103.47
|
| Rate for Payer: Aetna Medicare |
$44.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.12
|
| 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 |
$24.11
|
| Rate for Payer: BCBS MAPPO |
$42.84
|
| Rate for Payer: BCN Medicare Advantage |
$42.84
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cash Price |
$97.38
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Cofinity Commercial |
$104.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.84
|
| Rate for Payer: Healthscope Commercial |
$109.56
|
| Rate for Payer: Mclaren Medicaid |
$22.96
|
| 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 |
$24.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.47
|
| Rate for Payer: PACE Medicare |
$40.70
|
| Rate for Payer: PACE SWMI |
$42.84
|
| Rate for Payer: PHP Commercial |
$103.47
|
| Rate for Payer: PHP Medicare Advantage |
$42.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.12
|
| Rate for Payer: Priority Health Medicare |
$42.84
|
| Rate for Payer: Priority Health SBD |
$76.69
|
| Rate for Payer: Railroad Medicare Medicare |
$42.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.84
|
| Rate for Payer: UHC Medicare Advantage |
$42.84
|
| Rate for Payer: UHCCP Medicaid |
$24.12
|
| Rate for Payer: VA VA |
$42.84
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
IP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$705.78 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.19
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$784.20
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health SBD |
$705.78
|
|
|
HC EP UPPER EXTREMITY SOMATOSENSO
|
Facility
|
OP
|
$1,120.29
|
|
|
Service Code
|
CPT 95925
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$1,008.26 |
| Rate for Payer: Aetna Commercial |
$952.25
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cash Price |
$896.23
|
| Rate for Payer: Cofinity Commercial |
$963.45
|
| Rate for Payer: Cofinity Commercial |
$784.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$784.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$896.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$1,008.26
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$952.25
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$728.19
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$705.78
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$829.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$829.01
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
IP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$1,579.36 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,629.50
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$1,754.84
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,754.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health SBD |
$1,579.36
|
|
|
HC EP UPPER/LOWER EXT. SOMATOSENSORY
|
Facility
|
OP
|
$2,506.92
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
92200025
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$277.37 |
| Max. Negotiated Rate |
$2,256.23 |
| Rate for Payer: Aetna Commercial |
$2,130.88
|
| Rate for Payer: Aetna Medicare |
$538.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,629.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.85
|
| Rate for Payer: BCBS Complete |
$291.24
|
| Rate for Payer: BCBS MAPPO |
$517.48
|
| Rate for Payer: BCN Medicare Advantage |
$517.48
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cash Price |
$2,005.54
|
| Rate for Payer: Cofinity Commercial |
$2,155.95
|
| Rate for Payer: Cofinity Commercial |
$1,754.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,754.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,005.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$2,256.23
|
| Rate for Payer: Mclaren Medicaid |
$277.37
|
| Rate for Payer: Mclaren Medicare |
$517.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.35
|
| Rate for Payer: Meridian Medicaid |
$291.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,130.88
|
| Rate for Payer: PACE Medicare |
$491.61
|
| Rate for Payer: PACE SWMI |
$517.48
|
| Rate for Payer: PHP Commercial |
$2,130.88
|
| Rate for Payer: PHP Medicare Advantage |
$517.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,629.50
|
| Rate for Payer: Priority Health Medicare |
$517.48
|
| Rate for Payer: Priority Health SBD |
$1,579.36
|
| Rate for Payer: Railroad Medicare Medicare |
$517.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.65
|
| Rate for Payer: UHC Core |
$1,855.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.48
|
| Rate for Payer: UHC Exchange |
$1,855.12
|
| Rate for Payer: UHC Medicare Advantage |
$517.48
|
| Rate for Payer: UHCCP Medicaid |
$291.34
|
| Rate for Payer: VA VA |
$517.48
|
|
|
HC EP VISUAL
|
Facility
|
IP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$495.13 |
| Max. Negotiated Rate |
$707.33 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.85
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$550.14
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health SBD |
$495.13
|
|
|
HC EP VISUAL
|
Facility
|
OP
|
$785.92
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Commercial |
$668.03
|
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cash Price |
$628.74
|
| Rate for Payer: Cofinity Commercial |
$675.89
|
| Rate for Payer: Cofinity Commercial |
$550.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$550.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$628.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$707.33
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.03
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Commercial |
$668.03
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.85
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Priority Health SBD |
$495.13
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Core |
$581.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$581.58
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$170.98
|
| Rate for Payer: VA VA |
$303.70
|
|
|
HC ERBE IRRIGATION
|
Facility
|
IP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.97 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.29
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health SBD |
$198.97
|
|
|
HC ERBE IRRIGATION
|
Facility
|
OP
|
$315.83
|
|
| Hospital Charge Code |
27000070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.33 |
| Max. Negotiated Rate |
$284.25 |
| Rate for Payer: Aetna Commercial |
$268.46
|
| Rate for Payer: Aetna Medicare |
$157.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.29
|
| Rate for Payer: BCBS Complete |
$126.33
|
| Rate for Payer: Cash Price |
$252.66
|
| Rate for Payer: Cofinity Commercial |
$221.08
|
| Rate for Payer: Cofinity Commercial |
$271.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$221.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.66
|
| Rate for Payer: Healthscope Commercial |
$284.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.46
|
| Rate for Payer: PHP Commercial |
$268.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.29
|
| Rate for Payer: Priority Health SBD |
$198.97
|
|
|
HC ER BURN CARE
|
Facility
|
IP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.56 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.65
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health SBD |
$254.56
|
|
|
HC ER BURN CARE
|
Facility
|
OP
|
$404.07
|
|
| Hospital Charge Code |
45000038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.63 |
| Max. Negotiated Rate |
$363.66 |
| Rate for Payer: Aetna Commercial |
$343.46
|
| Rate for Payer: Aetna Medicare |
$202.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.65
|
| Rate for Payer: BCBS Complete |
$161.63
|
| Rate for Payer: Cash Price |
$323.26
|
| Rate for Payer: Cofinity Commercial |
$282.85
|
| Rate for Payer: Cofinity Commercial |
$347.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.26
|
| Rate for Payer: Healthscope Commercial |
$363.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.46
|
| Rate for Payer: PHP Commercial |
$343.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.65
|
| Rate for Payer: Priority Health SBD |
$254.56
|
|
|
HC ERCP
|
Facility
|
OP
|
$3,396.96
|
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,358.78 |
| Max. Negotiated Rate |
$3,057.26 |
| Rate for Payer: Aetna Commercial |
$2,887.42
|
| Rate for Payer: Aetna Medicare |
$1,698.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,208.02
|
| Rate for Payer: BCBS Complete |
$1,358.78
|
| Rate for Payer: Cash Price |
$2,717.57
|
| Rate for Payer: Cofinity Commercial |
$2,377.87
|
| Rate for Payer: Cofinity Commercial |
$2,921.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,377.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,717.57
|
| Rate for Payer: Healthscope Commercial |
$3,057.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,887.42
|
| Rate for Payer: PHP Commercial |
$2,887.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,208.02
|
| Rate for Payer: Priority Health SBD |
$2,140.08
|
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