|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$786.42
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.44 |
| Max. Negotiated Rate |
$707.78 |
| Rate for Payer: Aetna Commercial |
$668.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.17
|
| Rate for Payer: Cash Price |
$629.14
|
| Rate for Payer: Cofinity Advantage |
$550.49
|
| Rate for Payer: Cofinity Commercial |
$676.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.14
|
| Rate for Payer: Healthscope Commercial |
$707.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$589.82
|
| Rate for Payer: PHP Commercial |
$668.46
|
| Rate for Payer: Priority Health SBD |
$495.44
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$786.42
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.06 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$668.46
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$313.81
|
| Rate for Payer: BCN Commercial |
$313.81
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$629.14
|
| Rate for Payer: Cash Price |
$629.14
|
| Rate for Payer: Cash Price |
$629.14
|
| Rate for Payer: Cofinity Advantage |
$550.49
|
| Rate for Payer: Cofinity Commercial |
$676.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$707.78
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.46
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$589.82
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$668.46
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$495.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.17
|
| Rate for Payer: UHC Core |
$409.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Exchange |
$309.06
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,150.09
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$742.00 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Commercial |
$1,827.58
|
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,397.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$742.00
|
| Rate for Payer: BCN Commercial |
$742.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Cash Price |
$1,720.07
|
| Rate for Payer: Cash Price |
$1,720.07
|
| Rate for Payer: Cash Price |
$1,720.07
|
| Rate for Payer: Cofinity Advantage |
$1,505.06
|
| Rate for Payer: Cofinity Commercial |
$1,849.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Healthscope Commercial |
$1,935.08
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,827.58
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,612.57
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Commercial |
$1,827.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health SBD |
$1,354.56
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,150.09
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,354.56 |
| Max. Negotiated Rate |
$1,935.08 |
| Rate for Payer: Aetna Commercial |
$1,827.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,397.56
|
| Rate for Payer: Cash Price |
$1,720.07
|
| Rate for Payer: Cofinity Advantage |
$1,505.06
|
| Rate for Payer: Cofinity Commercial |
$1,849.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.07
|
| Rate for Payer: Healthscope Commercial |
$1,935.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,827.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,612.57
|
| Rate for Payer: PHP Commercial |
$1,827.58
|
| Rate for Payer: Priority Health SBD |
$1,354.56
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Advantage |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health SBD |
$104.87
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$9.87
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Advantage |
$116.52
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Mclaren Medicaid |
$9.40
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$18.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$26.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.84
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.98
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$104.87
|
| Rate for Payer: Priority Health Tiered Network |
$14.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.97
|
| Rate for Payer: UHC Core |
$26.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.98
|
| Rate for Payer: UHC Exchange |
$26.97
|
| Rate for Payer: UHC Medicaid |
$9.40
|
| Rate for Payer: UHCCP Medicaid |
$9.40
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN, 1 MILLICURIE
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
34300040
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$135.77 |
| Max. Negotiated Rate |
$806.92 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna Medicare |
$269.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.50
|
| Rate for Payer: BCBS Complete |
$142.57
|
| Rate for Payer: BCBS MAPPO |
$259.60
|
| Rate for Payer: BCBS Trust/PPO |
$363.73
|
| Rate for Payer: BCN Commercial |
$363.73
|
| Rate for Payer: BCN Medicare Advantage |
$259.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Advantage |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.60
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Mclaren Medicaid |
$135.77
|
| Rate for Payer: Mclaren Medicare |
$259.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.58
|
| Rate for Payer: Meridian Medicaid |
$272.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$285.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.25
|
| Rate for Payer: Nomi Health Commercial |
$778.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE Medicare |
$246.62
|
| Rate for Payer: PACE SWMI |
$259.60
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: PHP Medicare Advantage |
$259.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$806.92
|
| Rate for Payer: Priority Health Medicare |
$259.60
|
| Rate for Payer: Priority Health SBD |
$204.75
|
| Rate for Payer: Priority Health Tiered Network |
$645.54
|
| Rate for Payer: Railroad Medicare Medicare |
$259.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.88
|
| Rate for Payer: UHC Core |
$427.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$259.60
|
| Rate for Payer: UHC Exchange |
$427.88
|
| Rate for Payer: UHC Medicaid |
$135.77
|
| Rate for Payer: UHCCP Medicaid |
$135.77
|
| Rate for Payer: VA VA |
$259.60
|
|
|
HC LUTETIUM LU 177 VIPIVOTIDE TETRAXETAN, 1 MILLICURIE
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS A9607
|
| Hospital Charge Code |
34300040
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$276.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.25
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Advantage |
$227.50
|
| Rate for Payer: Cofinity Commercial |
$279.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.00
|
| Rate for Payer: Healthscope Commercial |
$292.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PHP Commercial |
$276.25
|
| Rate for Payer: Priority Health SBD |
$204.75
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$317.32
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$285.59 |
| Rate for Payer: Aetna Commercial |
$269.72
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.90
|
| Rate for Payer: BCBS Complete |
$28.51
|
| Rate for Payer: BCBS MAPPO |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$71.12
|
| Rate for Payer: BCCCP Commercial |
$67.27
|
| Rate for Payer: BCN Commercial |
$71.12
|
| Rate for Payer: BCN Medicare Advantage |
$51.92
|
| Rate for Payer: Cash Price |
$253.86
|
| Rate for Payer: Cash Price |
$253.86
|
| Rate for Payer: Cofinity Advantage |
$222.12
|
| Rate for Payer: Cofinity Commercial |
$272.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.92
|
| Rate for Payer: Healthscope Commercial |
$285.59
|
| Rate for Payer: Mclaren Medicaid |
$27.15
|
| Rate for Payer: Mclaren Medicare |
$51.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.52
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.72
|
| Rate for Payer: Nomi Health Commercial |
$155.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.99
|
| Rate for Payer: PACE Medicare |
$49.32
|
| Rate for Payer: PACE SWMI |
$51.92
|
| Rate for Payer: PHP Commercial |
$269.72
|
| Rate for Payer: PHP Medicare Advantage |
$51.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$167.92
|
| Rate for Payer: Priority Health Medicare |
$51.92
|
| Rate for Payer: Priority Health SBD |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$134.34
|
| Rate for Payer: Railroad Medicare Medicare |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.15
|
| Rate for Payer: UHC Core |
$80.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.92
|
| Rate for Payer: UHC Exchange |
$80.15
|
| Rate for Payer: UHC Medicaid |
$27.15
|
| Rate for Payer: UHCCP Medicaid |
$27.15
|
| Rate for Payer: VA VA |
$51.92
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$317.32
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$199.91 |
| Max. Negotiated Rate |
$285.59 |
| Rate for Payer: Aetna Commercial |
$269.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.26
|
| Rate for Payer: Cash Price |
$253.86
|
| Rate for Payer: Cofinity Advantage |
$222.12
|
| Rate for Payer: Cofinity Commercial |
$272.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.86
|
| Rate for Payer: Healthscope Commercial |
$285.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.99
|
| Rate for Payer: PHP Commercial |
$269.72
|
| Rate for Payer: Priority Health SBD |
$199.91
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,288.11
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,152.63 |
| Max. Negotiated Rate |
$2,959.30 |
| Rate for Payer: Aetna Commercial |
$2,794.89
|
| Rate for Payer: Aetna Medicare |
$1,644.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.27
|
| Rate for Payer: BCBS Complete |
$1,315.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.63
|
| Rate for Payer: BCN Commercial |
$1,152.63
|
| Rate for Payer: Cash Price |
$2,630.49
|
| Rate for Payer: Cash Price |
$2,630.49
|
| Rate for Payer: Cofinity Advantage |
$2,301.68
|
| Rate for Payer: Cofinity Commercial |
$2,827.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.49
|
| Rate for Payer: Healthscope Commercial |
$2,959.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,630.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,466.08
|
| Rate for Payer: PHP Commercial |
$2,794.89
|
| Rate for Payer: Priority Health SBD |
$2,071.51
|
|
|
HC LVAD INSERTION
|
Facility
|
IP
|
$3,288.11
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,071.51 |
| Max. Negotiated Rate |
$2,959.30 |
| Rate for Payer: Aetna Commercial |
$2,794.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,137.27
|
| Rate for Payer: Cash Price |
$2,630.49
|
| Rate for Payer: Cofinity Advantage |
$2,301.68
|
| Rate for Payer: Cofinity Commercial |
$2,827.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,630.49
|
| Rate for Payer: Healthscope Commercial |
$2,959.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,794.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,466.08
|
| Rate for Payer: PHP Commercial |
$2,794.89
|
| Rate for Payer: Priority Health SBD |
$2,071.51
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
OP
|
$2,889.46
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$2,600.51 |
| Rate for Payer: Aetna Commercial |
$2,456.04
|
| Rate for Payer: Aetna Medicare |
$690.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$829.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$829.74
|
| Rate for Payer: BCBS Complete |
$364.55
|
| Rate for Payer: BCBS MAPPO |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.13
|
| Rate for Payer: BCN Commercial |
$1,878.13
|
| Rate for Payer: BCN Medicare Advantage |
$663.79
|
| Rate for Payer: Cash Price |
$2,311.57
|
| Rate for Payer: Cash Price |
$2,311.57
|
| Rate for Payer: Cofinity Advantage |
$2,022.62
|
| Rate for Payer: Cofinity Commercial |
$2,484.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,311.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.79
|
| Rate for Payer: Healthscope Commercial |
$2,600.51
|
| Rate for Payer: Mclaren Medicaid |
$347.16
|
| Rate for Payer: Mclaren Medicare |
$663.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.98
|
| Rate for Payer: Meridian Medicaid |
$696.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,456.04
|
| Rate for Payer: Nomi Health Commercial |
$1,991.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,167.09
|
| Rate for Payer: PACE Medicare |
$630.60
|
| Rate for Payer: PACE SWMI |
$663.79
|
| Rate for Payer: PHP Commercial |
$2,456.04
|
| Rate for Payer: PHP Medicare Advantage |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,146.63
|
| Rate for Payer: Priority Health Medicare |
$663.79
|
| Rate for Payer: Priority Health SBD |
$1,820.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,717.30
|
| Rate for Payer: Railroad Medicare Medicare |
$663.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,878.15
|
| Rate for Payer: UHC Core |
$1,505.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.79
|
| Rate for Payer: UHC Exchange |
$1,135.56
|
| Rate for Payer: UHC Medicaid |
$347.16
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: VA VA |
$663.79
|
|
|
HC LVDS PLT PER LEUKO RED IRRAD
|
Facility
|
IP
|
$2,889.46
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000088
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,820.36 |
| Max. Negotiated Rate |
$2,600.51 |
| Rate for Payer: Aetna Commercial |
$2,456.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,878.15
|
| Rate for Payer: Cash Price |
$2,311.57
|
| Rate for Payer: Cofinity Advantage |
$2,022.62
|
| Rate for Payer: Cofinity Commercial |
$2,484.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,311.57
|
| Rate for Payer: Healthscope Commercial |
$2,600.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,456.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,167.09
|
| Rate for Payer: PHP Commercial |
$2,456.04
|
| Rate for Payer: Priority Health SBD |
$1,820.36
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
OP
|
$2,244.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$2,019.64 |
| Rate for Payer: Aetna Commercial |
$1,907.44
|
| Rate for Payer: Aetna Medicare |
$518.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.67
|
| Rate for Payer: BCBS Complete |
$274.02
|
| Rate for Payer: BCBS MAPPO |
$498.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.99
|
| Rate for Payer: BCN Commercial |
$1,353.99
|
| Rate for Payer: BCN Medicare Advantage |
$498.94
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cofinity Advantage |
$1,570.84
|
| Rate for Payer: Cofinity Commercial |
$1,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,795.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.94
|
| Rate for Payer: Healthscope Commercial |
$2,019.64
|
| Rate for Payer: Mclaren Medicaid |
$260.95
|
| Rate for Payer: Mclaren Medicare |
$498.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.89
|
| Rate for Payer: Meridian Medicaid |
$523.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.44
|
| Rate for Payer: Nomi Health Commercial |
$1,496.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,683.04
|
| Rate for Payer: PACE Medicare |
$473.99
|
| Rate for Payer: PACE SWMI |
$498.94
|
| Rate for Payer: PHP Commercial |
$1,907.44
|
| Rate for Payer: PHP Medicare Advantage |
$498.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,613.55
|
| Rate for Payer: Priority Health Medicare |
$498.94
|
| Rate for Payer: Priority Health SBD |
$1,413.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,290.84
|
| Rate for Payer: Railroad Medicare Medicare |
$498.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.63
|
| Rate for Payer: UHC Core |
$1,169.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.94
|
| Rate for Payer: UHC Exchange |
$881.91
|
| Rate for Payer: UHC Medicaid |
$260.95
|
| Rate for Payer: UHCCP Medicaid |
$260.95
|
| Rate for Payer: VA VA |
$498.94
|
|
|
HC LVDS PLT PHER LEUKO RED
|
Facility
|
IP
|
$2,244.05
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000087
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,413.75 |
| Max. Negotiated Rate |
$2,019.64 |
| Rate for Payer: Aetna Commercial |
$1,907.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,458.63
|
| Rate for Payer: Cash Price |
$1,795.24
|
| Rate for Payer: Cofinity Advantage |
$1,570.84
|
| Rate for Payer: Cofinity Commercial |
$1,929.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,795.24
|
| Rate for Payer: Healthscope Commercial |
$2,019.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,683.04
|
| Rate for Payer: PHP Commercial |
$1,907.44
|
| Rate for Payer: Priority Health SBD |
$1,413.75
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
OP
|
$9,737.48
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,894.99 |
| Max. Negotiated Rate |
$13,485.44 |
| Rate for Payer: Aetna Commercial |
$8,276.86
|
| Rate for Payer: Aetna Medicare |
$4,868.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.36
|
| Rate for Payer: BCBS Complete |
$3,894.99
|
| Rate for Payer: BCBS Trust/PPO |
$13,485.44
|
| Rate for Payer: BCN Commercial |
$13,485.44
|
| Rate for Payer: Cash Price |
$7,789.98
|
| Rate for Payer: Cash Price |
$7,789.98
|
| Rate for Payer: Cofinity Advantage |
$6,816.24
|
| Rate for Payer: Cofinity Commercial |
$8,374.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.98
|
| Rate for Payer: Healthscope Commercial |
$8,763.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,789.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,276.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.11
|
| Rate for Payer: PHP Commercial |
$8,276.86
|
| Rate for Payer: Priority Health SBD |
$6,134.61
|
|
|
HC LV LEAD PLACEMENT
|
Facility
|
IP
|
$9,737.48
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
36100070
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,134.61 |
| Max. Negotiated Rate |
$8,763.73 |
| Rate for Payer: Aetna Commercial |
$8,276.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,329.36
|
| Rate for Payer: Cash Price |
$7,789.98
|
| Rate for Payer: Cofinity Advantage |
$6,816.24
|
| Rate for Payer: Cofinity Commercial |
$8,374.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,789.98
|
| Rate for Payer: Healthscope Commercial |
$8,763.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,276.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,303.11
|
| Rate for Payer: PHP Commercial |
$8,276.86
|
| Rate for Payer: Priority Health SBD |
$6,134.61
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
OP
|
$3,660.20
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,460.54 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,111.17
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,379.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,460.54
|
| Rate for Payer: BCN Commercial |
$1,460.54
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cofinity Advantage |
$2,562.14
|
| Rate for Payer: Cofinity Commercial |
$3,147.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,928.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,294.18
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,111.17
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,745.15
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,111.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,305.93
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
HC LV LEAD REPOSITIONING
|
Facility
|
IP
|
$3,660.20
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
36100071
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,305.93 |
| Max. Negotiated Rate |
$3,294.18 |
| Rate for Payer: Aetna Commercial |
$3,111.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,379.13
|
| Rate for Payer: Cash Price |
$2,928.16
|
| Rate for Payer: Cofinity Advantage |
$2,562.14
|
| Rate for Payer: Cofinity Commercial |
$3,147.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,928.16
|
| Rate for Payer: Healthscope Commercial |
$3,294.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,111.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,745.15
|
| Rate for Payer: PHP Commercial |
$3,111.17
|
| Rate for Payer: Priority Health SBD |
$2,305.93
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
OP
|
$35.02
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: Aetna Commercial |
$29.77
|
| Rate for Payer: Aetna Medicare |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.36
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS MAPPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Commercial |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$15.49
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Advantage |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$30.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.49
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Mclaren Medicaid |
$8.10
|
| Rate for Payer: Mclaren Medicare |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.26
|
| Rate for Payer: Meridian Medicaid |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.77
|
| Rate for Payer: Nomi Health Commercial |
$23.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.49
|
| Rate for Payer: PHP Commercial |
$29.77
|
| Rate for Payer: PHP Medicare Advantage |
$15.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.49
|
| Rate for Payer: Priority Health Medicare |
$15.49
|
| Rate for Payer: Priority Health SBD |
$22.06
|
| Rate for Payer: Priority Health Tiered Network |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.24
|
| Rate for Payer: UHC Core |
$23.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.49
|
| Rate for Payer: UHC Exchange |
$23.24
|
| Rate for Payer: UHC Medicaid |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$8.10
|
| Rate for Payer: VA VA |
$15.49
|
|
|
HC LYME AB CONFIRMATION CMPT
|
Facility
|
IP
|
$35.02
|
|
|
Service Code
|
CPT 86617
|
| Hospital Charge Code |
30200232
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$31.52 |
| Rate for Payer: Aetna Commercial |
$29.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.76
|
| Rate for Payer: Cash Price |
$28.02
|
| Rate for Payer: Cofinity Advantage |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$30.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$31.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.27
|
| Rate for Payer: PHP Commercial |
$29.77
|
| Rate for Payer: Priority Health SBD |
$22.06
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Advantage |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.03
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: Priority Health SBD |
$38.67
|
|
|
HC LYME CSF COMPONENT 1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
30100669
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Advantage |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Mclaren Medicaid |
$4.07
|
| Rate for Payer: Mclaren Medicare |
$7.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.17
|
| Rate for Payer: Meridian Medicaid |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$11.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.03
|
| Rate for Payer: PACE Medicare |
$7.39
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.78
|
| Rate for Payer: Priority Health Medicare |
$7.78
|
| Rate for Payer: Priority Health SBD |
$38.67
|
| Rate for Payer: Priority Health Tiered Network |
$6.22
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$11.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.78
|
| Rate for Payer: UHC Exchange |
$11.67
|
| Rate for Payer: UHC Medicaid |
$4.07
|
| Rate for Payer: UHCCP Medicaid |
$4.07
|
| Rate for Payer: VA VA |
$7.78
|
|
|
HC LYME CSF COMPONENT 2
|
Facility
|
IP
|
$165.42
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
30200410
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$148.88 |
| Rate for Payer: Aetna Commercial |
$140.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.52
|
| Rate for Payer: Cash Price |
$132.34
|
| Rate for Payer: Cofinity Advantage |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$142.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.34
|
| Rate for Payer: Healthscope Commercial |
$148.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.06
|
| Rate for Payer: PHP Commercial |
$140.61
|
| Rate for Payer: Priority Health SBD |
$104.21
|
|
