|
HC HAPTOGLOGIN
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: Priority Health SBD |
$54.40
|
|
|
HC HAPTOGLOGIN
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
30100234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.72
|
| Rate for Payer: BCBS Complete |
$6.91
|
| Rate for Payer: BCBS MAPPO |
$12.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$13.42
|
| Rate for Payer: BCN Medicare Advantage |
$12.58
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$6.58
|
| Rate for Payer: Mclaren Medicare |
$12.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PACE Medicare |
$11.95
|
| Rate for Payer: PACE SWMI |
$12.58
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$12.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.58
|
| Rate for Payer: Priority Health Medicare |
$12.58
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: Priority Health Tiered Network |
$10.06
|
| Rate for Payer: Railroad Medicare Medicare |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.87
|
| Rate for Payer: UHC Core |
$18.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.58
|
| Rate for Payer: UHC Exchange |
$18.87
|
| Rate for Payer: UHC Medicaid |
$6.58
|
| Rate for Payer: UHCCP Medicaid |
$6.58
|
| Rate for Payer: VA VA |
$12.58
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC HAZELNUT FILBERT IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200043
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC HBC IGM AB, S
|
Facility
|
IP
|
$51.30
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200515
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$46.17 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.34
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cofinity Advantage |
$35.91
|
| Rate for Payer: Cofinity Commercial |
$44.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.04
|
| Rate for Payer: Healthscope Commercial |
$46.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.48
|
| Rate for Payer: PHP Commercial |
$43.60
|
| Rate for Payer: Priority Health SBD |
$32.32
|
|
|
HC HBC IGM AB, S
|
Facility
|
OP
|
$51.30
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
30200515
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$46.17 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna Medicare |
$12.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.71
|
| Rate for Payer: BCBS Complete |
$6.46
|
| Rate for Payer: BCBS MAPPO |
$11.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.55
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.77
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cash Price |
$41.04
|
| Rate for Payer: Cofinity Advantage |
$35.91
|
| Rate for Payer: Cofinity Commercial |
$44.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$46.17
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.36
|
| Rate for Payer: Meridian Medicaid |
$12.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.60
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.48
|
| Rate for Payer: PACE Medicare |
$11.18
|
| Rate for Payer: PACE SWMI |
$11.77
|
| Rate for Payer: PHP Commercial |
$43.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Medicare |
$11.77
|
| Rate for Payer: Priority Health SBD |
$32.32
|
| Rate for Payer: Priority Health Tiered Network |
$9.42
|
| Rate for Payer: Railroad Medicare Medicare |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.66
|
| Rate for Payer: UHC Core |
$17.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.77
|
| Rate for Payer: UHC Exchange |
$17.66
|
| Rate for Payer: UHC Medicaid |
$6.16
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: VA VA |
$11.77
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
OP
|
$667.31
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$600.58 |
| Rate for Payer: Aetna Commercial |
$567.21
|
| Rate for Payer: Aetna Medicare |
$142.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$171.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$171.39
|
| Rate for Payer: BCBS Complete |
$75.30
|
| Rate for Payer: BCBS MAPPO |
$137.11
|
| Rate for Payer: BCBS Trust/PPO |
$308.35
|
| Rate for Payer: BCN Commercial |
$308.35
|
| Rate for Payer: BCN Medicare Advantage |
$137.11
|
| Rate for Payer: Cash Price |
$533.85
|
| Rate for Payer: Cash Price |
$533.85
|
| Rate for Payer: Cofinity Advantage |
$467.12
|
| Rate for Payer: Cofinity Commercial |
$573.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.11
|
| Rate for Payer: Healthscope Commercial |
$600.58
|
| Rate for Payer: Mclaren Medicaid |
$71.71
|
| Rate for Payer: Mclaren Medicare |
$137.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.97
|
| Rate for Payer: Meridian Medicaid |
$143.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.21
|
| Rate for Payer: Nomi Health Commercial |
$411.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.48
|
| Rate for Payer: PACE Medicare |
$130.25
|
| Rate for Payer: PACE SWMI |
$137.11
|
| Rate for Payer: PHP Commercial |
$567.21
|
| Rate for Payer: PHP Medicare Advantage |
$137.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$443.41
|
| Rate for Payer: Priority Health Medicare |
$137.11
|
| Rate for Payer: Priority Health SBD |
$420.41
|
| Rate for Payer: Priority Health Tiered Network |
$354.73
|
| Rate for Payer: Railroad Medicare Medicare |
$137.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.75
|
| Rate for Payer: UHC Core |
$347.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$137.11
|
| Rate for Payer: UHC Exchange |
$262.25
|
| Rate for Payer: UHC Medicaid |
$71.71
|
| Rate for Payer: UHCCP Medicaid |
$71.71
|
| Rate for Payer: VA VA |
$137.11
|
|
|
HC HBO PER 30 MINUTES
|
Facility
|
IP
|
$667.31
|
|
|
Service Code
|
HCPCS G0277
|
| Hospital Charge Code |
41300001
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$420.41 |
| Max. Negotiated Rate |
$600.58 |
| Rate for Payer: Aetna Commercial |
$567.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.75
|
| Rate for Payer: Cash Price |
$533.85
|
| Rate for Payer: Cofinity Advantage |
$467.12
|
| Rate for Payer: Cofinity Commercial |
$573.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.85
|
| Rate for Payer: Healthscope Commercial |
$600.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$500.48
|
| Rate for Payer: PHP Commercial |
$567.21
|
| Rate for Payer: Priority Health SBD |
$420.41
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
IP
|
$852.13
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$536.84 |
| Max. Negotiated Rate |
$766.92 |
| Rate for Payer: Aetna Commercial |
$724.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.88
|
| Rate for Payer: Cash Price |
$681.70
|
| Rate for Payer: Cofinity Advantage |
$596.49
|
| Rate for Payer: Cofinity Commercial |
$732.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.70
|
| Rate for Payer: Healthscope Commercial |
$766.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.10
|
| Rate for Payer: PHP Commercial |
$724.31
|
| Rate for Payer: Priority Health SBD |
$536.84
|
|
|
HC HBO TCPO2 ARTERIAL STUDY COMPLETE
|
Facility
|
OP
|
$852.13
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$112.52 |
| Max. Negotiated Rate |
$766.92 |
| Rate for Payer: Aetna Commercial |
$724.31
|
| Rate for Payer: Aetna Medicare |
$223.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.94
|
| Rate for Payer: BCBS Complete |
$118.16
|
| Rate for Payer: BCBS MAPPO |
$215.15
|
| Rate for Payer: BCBS Trust/PPO |
$482.64
|
| Rate for Payer: BCN Commercial |
$482.64
|
| Rate for Payer: BCN Medicare Advantage |
$215.15
|
| Rate for Payer: Cash Price |
$681.70
|
| Rate for Payer: Cash Price |
$681.70
|
| Rate for Payer: Cofinity Advantage |
$596.49
|
| Rate for Payer: Cofinity Commercial |
$732.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$681.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.15
|
| Rate for Payer: Healthscope Commercial |
$766.92
|
| Rate for Payer: Mclaren Medicaid |
$112.52
|
| Rate for Payer: Mclaren Medicare |
$215.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.91
|
| Rate for Payer: Meridian Medicaid |
$225.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$236.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.31
|
| Rate for Payer: Nomi Health Commercial |
$645.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.10
|
| Rate for Payer: PACE Medicare |
$204.39
|
| Rate for Payer: PACE SWMI |
$215.15
|
| Rate for Payer: PHP Commercial |
$724.31
|
| Rate for Payer: PHP Medicare Advantage |
$215.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.77
|
| Rate for Payer: Priority Health Medicare |
$215.15
|
| Rate for Payer: Priority Health SBD |
$536.84
|
| Rate for Payer: Priority Health Tiered Network |
$556.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.88
|
| Rate for Payer: UHC Core |
$443.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.15
|
| Rate for Payer: UHC Exchange |
$334.89
|
| Rate for Payer: UHC Medicaid |
$112.52
|
| Rate for Payer: UHCCP Medicaid |
$112.52
|
| Rate for Payer: VA VA |
$215.15
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
OP
|
$546.48
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$491.83 |
| Rate for Payer: Aetna Commercial |
$464.51
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$310.91
|
| Rate for Payer: BCN Commercial |
$310.91
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Cash Price |
$437.18
|
| Rate for Payer: Cash Price |
$437.18
|
| Rate for Payer: Cofinity Advantage |
$382.54
|
| Rate for Payer: Cofinity Commercial |
$469.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Healthscope Commercial |
$491.83
|
| Rate for Payer: Mclaren Medicaid |
$69.33
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.51
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.86
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Commercial |
$464.51
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health SBD |
$344.28
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.21
|
| Rate for Payer: UHC Core |
$284.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Exchange |
$214.77
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
HC HBO TCPO2 ARTERIAL STUDY UNILATERAL OR LIMITED
|
Facility
|
IP
|
$546.48
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
92100033
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$491.83 |
| Rate for Payer: Aetna Commercial |
$464.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.21
|
| Rate for Payer: Cash Price |
$437.18
|
| Rate for Payer: Cofinity Advantage |
$382.54
|
| Rate for Payer: Cofinity Commercial |
$469.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.18
|
| Rate for Payer: Healthscope Commercial |
$491.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$464.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.86
|
| Rate for Payer: PHP Commercial |
$464.51
|
| Rate for Payer: Priority Health SBD |
$344.28
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
IP
|
$6,615.80
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,167.95 |
| Max. Negotiated Rate |
$5,954.22 |
| Rate for Payer: Aetna Commercial |
$5,623.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,300.27
|
| Rate for Payer: Cash Price |
$5,292.64
|
| Rate for Payer: Cofinity Advantage |
$4,631.06
|
| Rate for Payer: Cofinity Commercial |
$5,689.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,292.64
|
| Rate for Payer: Healthscope Commercial |
$5,954.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,623.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,961.85
|
| Rate for Payer: PHP Commercial |
$5,623.43
|
| Rate for Payer: Priority Health SBD |
$4,167.95
|
|
|
HC HCCORO/CABG ANGIOS ONLY
|
Facility
|
OP
|
$6,615.80
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
48100014
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.43 |
| Max. Negotiated Rate |
$10,446.41 |
| Rate for Payer: Aetna Commercial |
$5,623.43
|
| Rate for Payer: Aetna Medicare |
$3,359.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,300.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,037.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,037.84
|
| Rate for Payer: BCBS Complete |
$1,774.06
|
| Rate for Payer: BCBS MAPPO |
$3,230.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,067.54
|
| Rate for Payer: BCN Commercial |
$3,067.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,230.27
|
| Rate for Payer: Cash Price |
$5,292.64
|
| Rate for Payer: Cash Price |
$5,292.64
|
| Rate for Payer: Cofinity Advantage |
$4,631.06
|
| Rate for Payer: Cofinity Commercial |
$5,689.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,292.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,230.27
|
| Rate for Payer: Healthscope Commercial |
$5,954.22
|
| Rate for Payer: Mclaren Medicaid |
$1,689.43
|
| Rate for Payer: Mclaren Medicare |
$3,230.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,391.78
|
| Rate for Payer: Meridian Medicaid |
$3,391.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,714.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,553.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,623.43
|
| Rate for Payer: Nomi Health Commercial |
$9,690.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,961.85
|
| Rate for Payer: PACE Medicare |
$3,068.76
|
| Rate for Payer: PACE SWMI |
$3,230.27
|
| Rate for Payer: PHP Commercial |
$5,623.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,230.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,689.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,446.41
|
| Rate for Payer: Priority Health Medicare |
$3,230.27
|
| Rate for Payer: Priority Health SBD |
$4,167.95
|
| Rate for Payer: Priority Health Tiered Network |
$8,357.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,230.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,230.27
|
| Rate for Payer: UHC Medicaid |
$1,689.43
|
| Rate for Payer: UHCCP Medicaid |
$1,689.43
|
| Rate for Payer: VA VA |
$3,230.27
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
IP
|
$64.73
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.07
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Advantage |
$45.31
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: Priority Health SBD |
$40.78
|
|
|
HC HCG SERUM QUANTITATIVE
|
Facility
|
OP
|
$64.73
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
30100465
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$55.02
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.05
|
| Rate for Payer: BCN Commercial |
$16.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cash Price |
$51.78
|
| Rate for Payer: Cofinity Advantage |
$45.31
|
| Rate for Payer: Cofinity Commercial |
$55.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.55
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$55.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.05
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$40.78
|
| Rate for Payer: Priority Health Tiered Network |
$12.04
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC Core |
$22.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.05
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
OP
|
$411.56
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$386.18 |
| Rate for Payer: Aetna Commercial |
$349.83
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$321.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$321.81
|
| Rate for Payer: BCBS Complete |
$141.39
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCBS Trust/PPO |
$274.50
|
| Rate for Payer: BCN Commercial |
$274.50
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cofinity Advantage |
$288.09
|
| Rate for Payer: Cofinity Commercial |
$353.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Healthscope Commercial |
$370.40
|
| Rate for Payer: Mclaren Medicaid |
$134.65
|
| Rate for Payer: Mclaren Medicare |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Meridian Medicaid |
$270.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.83
|
| Rate for Payer: Nomi Health Commercial |
$386.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.67
|
| Rate for Payer: PACE Medicare |
$244.58
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$349.83
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.45
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: Priority Health SBD |
$259.28
|
| Rate for Payer: Priority Health Tiered Network |
$205.96
|
| Rate for Payer: Railroad Medicare Medicare |
$257.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.18
|
| Rate for Payer: UHC Core |
$386.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.45
|
| Rate for Payer: UHC Exchange |
$386.18
|
| Rate for Payer: UHC Medicaid |
$134.65
|
| Rate for Payer: UHCCP Medicaid |
$134.65
|
| Rate for Payer: VA VA |
$257.45
|
|
|
HC HCV GENOTYPE RESOLUTION
|
Facility
|
IP
|
$411.56
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
30600262
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$259.28 |
| Max. Negotiated Rate |
$370.40 |
| Rate for Payer: Aetna Commercial |
$349.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.51
|
| Rate for Payer: Cash Price |
$329.25
|
| Rate for Payer: Cofinity Advantage |
$288.09
|
| Rate for Payer: Cofinity Commercial |
$353.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.25
|
| Rate for Payer: Healthscope Commercial |
$370.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.67
|
| Rate for Payer: PHP Commercial |
$349.83
|
| Rate for Payer: Priority Health SBD |
$259.28
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: Priority Health Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.29
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Advantage |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.87
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$24.57 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.24
|
| Rate for Payer: BCBS Complete |
$4.50
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Meridian Medicaid |
$8.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$24.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$7.78
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.19
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$6.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.29
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.19
|
| Rate for Payer: UHC Exchange |
$12.29
|
| Rate for Payer: UHC Medicaid |
$4.28
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: VA VA |
$8.19
|
|
|
HC HDL CHOLESTEROL LMPP
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
30100690
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
IP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,278.55 |
| Max. Negotiated Rate |
$1,826.51 |
| Rate for Payer: Aetna Commercial |
$1,725.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.14
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Advantage |
$1,420.62
|
| Rate for Payer: Cofinity Commercial |
$1,745.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Healthscope Commercial |
$1,826.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: PHP Commercial |
$1,725.03
|
| Rate for Payer: Priority Health SBD |
$1,278.55
|
|
|
HC HDR 1 CHANNEL
|
Facility
|
OP
|
$2,029.45
|
|
|
Service Code
|
CPT 77770
|
| Hospital Charge Code |
33300055
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$2,244.23 |
| Rate for Payer: Aetna Commercial |
$1,725.03
|
| Rate for Payer: Aetna Medicare |
$721.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$867.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$867.46
|
| Rate for Payer: BCBS Complete |
$381.13
|
| Rate for Payer: BCBS MAPPO |
$693.97
|
| Rate for Payer: BCBS Trust/PPO |
$507.13
|
| Rate for Payer: BCN Commercial |
$507.13
|
| Rate for Payer: BCN Medicare Advantage |
$693.97
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cash Price |
$1,623.56
|
| Rate for Payer: Cofinity Advantage |
$1,420.62
|
| Rate for Payer: Cofinity Commercial |
$1,745.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.97
|
| Rate for Payer: Healthscope Commercial |
$1,826.51
|
| Rate for Payer: Mclaren Medicaid |
$362.95
|
| Rate for Payer: Mclaren Medicare |
$693.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$728.67
|
| Rate for Payer: Meridian Medicaid |
$728.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$798.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$763.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.03
|
| Rate for Payer: Nomi Health Commercial |
$2,081.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,522.09
|
| Rate for Payer: PACE Medicare |
$659.27
|
| Rate for Payer: PACE SWMI |
$693.97
|
| Rate for Payer: PHP Commercial |
$1,725.03
|
| Rate for Payer: PHP Medicare Advantage |
$693.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,244.23
|
| Rate for Payer: Priority Health Medicare |
$693.97
|
| Rate for Payer: Priority Health SBD |
$1,278.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,795.38
|
| Rate for Payer: Railroad Medicare Medicare |
$693.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,319.14
|
| Rate for Payer: UHC Core |
$1,057.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$693.97
|
| Rate for Payer: UHC Exchange |
$797.57
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
| Rate for Payer: VA VA |
$693.97
|
|
|
HC HDR 2-12 CHANNELS
|
Facility
|
IP
|
$2,254.25
|
|
|
Service Code
|
CPT 77771
|
| Hospital Charge Code |
33300056
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,420.18 |
| Max. Negotiated Rate |
$2,028.83 |
| Rate for Payer: Aetna Commercial |
$1,916.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.26
|
| Rate for Payer: Cash Price |
$1,803.40
|
| Rate for Payer: Cofinity Advantage |
$1,577.97
|
| Rate for Payer: Cofinity Commercial |
$1,938.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,803.40
|
| Rate for Payer: Healthscope Commercial |
$2,028.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,916.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,690.69
|
| Rate for Payer: PHP Commercial |
$1,916.11
|
| Rate for Payer: Priority Health SBD |
$1,420.18
|
|
