|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,395.59 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.64
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$2,661.76
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health SBD |
$2,395.59
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,802.52
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$93.65 |
| Max. Negotiated Rate |
$3,422.27 |
| Rate for Payer: Aetna Commercial |
$3,232.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,471.64
|
| Rate for Payer: BCBS Complete |
$1,521.01
|
| Rate for Payer: BCBS Trust/PPO |
$392.15
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cash Price |
$3,042.02
|
| Rate for Payer: Cofinity Commercial |
$3,270.17
|
| Rate for Payer: Cofinity Commercial |
$2,661.76
|
| Rate for Payer: Healthscope Commercial |
$3,422.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,232.14
|
| Rate for Payer: PHP Commercial |
$3,232.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.76
|
| Rate for Payer: Priority Health SBD |
$2,395.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.02
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$93.65
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.98 |
| Max. Negotiated Rate |
$244.25 |
| Rate for Payer: Aetna Commercial |
$230.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.40
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Cofinity Commercial |
$233.40
|
| Rate for Payer: Healthscope Commercial |
$244.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: PHP Commercial |
$230.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: Priority Health SBD |
$170.98
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$271.39
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$244.25 |
| Rate for Payer: Aetna Commercial |
$230.68
|
| Rate for Payer: Aetna Medicare |
$170.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.36
|
| Rate for Payer: BCBS Complete |
$93.91
|
| Rate for Payer: BCBS MAPPO |
$163.49
|
| Rate for Payer: BCBS Trust/PPO |
$114.74
|
| Rate for Payer: BCN Medicare Advantage |
$163.49
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cash Price |
$217.11
|
| Rate for Payer: Cofinity Commercial |
$233.40
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$244.25
|
| Rate for Payer: Mclaren Medicaid |
$89.43
|
| Rate for Payer: Mclaren Medicare |
$163.49
|
| Rate for Payer: Meridian Medicaid |
$93.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$171.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.68
|
| Rate for Payer: PACE Medicare |
$155.32
|
| Rate for Payer: PACE SWMI |
$163.49
|
| Rate for Payer: PHP Commercial |
$230.68
|
| Rate for Payer: PHP Medicare Advantage |
$163.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.97
|
| Rate for Payer: Priority Health Medicare |
$163.49
|
| Rate for Payer: Priority Health SBD |
$170.98
|
| Rate for Payer: Railroad Medicare Medicare |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.49
|
| Rate for Payer: UHC Exchange |
$92.99
|
| Rate for Payer: UHC Medicare Advantage |
$168.39
|
| Rate for Payer: VA VA |
$163.49
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health SBD |
$31.50
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health SBD |
$15.75
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health SBD |
$42.84
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.75
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: BCBS MAPPO |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Mclaren Medicaid |
$6.02
|
| Rate for Payer: Mclaren Medicare |
$11.00
|
| Rate for Payer: Meridian Medicaid |
$6.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Medicare |
$10.45
|
| Rate for Payer: PACE SWMI |
$11.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health Medicare |
$11.00
|
| Rate for Payer: Priority Health SBD |
$42.84
|
| Rate for Payer: Railroad Medicare Medicare |
$11.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$14.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.00
|
| Rate for Payer: UHC Exchange |
$11.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.33
|
| Rate for Payer: VA VA |
$11.00
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$24.68
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.04
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$17.28
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.98
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: Priority Health SBD |
$15.55
|
|
|
HC PH BODY FLUID
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.48
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$17.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Mclaren Medicaid |
$1.96
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Medicaid |
$2.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.98
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.28
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.30
|
| Rate for Payer: UHC Core |
$6.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Exchange |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC PHENOBARB LVL
|
Facility
|
OP
|
$98.60
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$88.74 |
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$11.99
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$84.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Mclaren Medicaid |
$8.37
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$8.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.81
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$83.81
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.02
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health SBD |
$62.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.36
|
| Rate for Payer: UHC Core |
$19.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC PHENOBARB LVL
|
Facility
|
IP
|
$98.60
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$88.74 |
| Rate for Payer: Aetna Commercial |
$83.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.09
|
| Rate for Payer: Cash Price |
$78.88
|
| Rate for Payer: Cofinity Commercial |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.81
|
| Rate for Payer: PHP Commercial |
$83.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.02
|
| Rate for Payer: Priority Health SBD |
$62.12
|
|
|
HC PH GASTRIC
|
Facility
|
IP
|
$24.20
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.25 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.73
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health SBD |
$15.25
|
|
|
HC PH GASTRIC
|
Facility
|
OP
|
$24.20
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$5.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicare |
$6.71
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.57
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.94
|
| Rate for Payer: Priority Health Medicare |
$6.71
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.05
|
| Rate for Payer: UHC Core |
$9.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.71
|
| Rate for Payer: UHC Exchange |
$6.71
|
| Rate for Payer: UHC Medicare Advantage |
$6.91
|
| Rate for Payer: VA VA |
$6.71
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$59.85
|
| Rate for Payer: UHC Core |
$17.64
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health SBD |
$59.85
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$46.62
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.82
|
| Rate for Payer: UHC Core |
$28.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.52
|
| Rate for Payer: UHC Exchange |
$16.52
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health SBD |
$46.62
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.29 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health SBD |
$52.29
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$58.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$9.04
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Medicaid |
$9.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$52.29
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.82
|
| Rate for Payer: UHC Core |
$28.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.52
|
| Rate for Payer: UHC Exchange |
$16.52
|
| Rate for Payer: UHC Medicare Advantage |
$17.02
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
OP
|
$54.06
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.28
|
| Rate for Payer: UHC Core |
$27.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Exchange |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
IP
|
$54.06
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$48.65 |
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.95
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.84
|
| Rate for Payer: Priority Health SBD |
$34.06
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.23
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Commercial |
$37.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Mclaren Medicaid |
$8.79
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$9.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.08
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.28
|
| Rate for Payer: UHC Core |
$27.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Exchange |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: VA VA |
$16.07
|
|
