|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
IP
|
$163.42
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.95 |
| Max. Negotiated Rate |
$147.08 |
| Rate for Payer: Aetna Commercial |
$138.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.22
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cofinity Advantage |
$114.39
|
| Rate for Payer: Cofinity Commercial |
$140.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.74
|
| Rate for Payer: Healthscope Commercial |
$147.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.56
|
| Rate for Payer: PHP Commercial |
$138.91
|
| Rate for Payer: Priority Health SBD |
$102.95
|
|
|
HC MENIGOCOCCAL, QUADRIVALENT (MCV4 OR MENACWY) IM
|
Facility
|
OP
|
$163.42
|
|
|
Service Code
|
CPT 90734
|
| Hospital Charge Code |
63600085
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$410.61 |
| Rate for Payer: Aetna Commercial |
$138.91
|
| Rate for Payer: Aetna Medicare |
$81.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.22
|
| Rate for Payer: BCBS Complete |
$65.37
|
| Rate for Payer: BCBS Trust/PPO |
$410.61
|
| Rate for Payer: BCN Commercial |
$410.61
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cash Price |
$130.74
|
| Rate for Payer: Cofinity Advantage |
$114.39
|
| Rate for Payer: Cofinity Commercial |
$140.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.74
|
| Rate for Payer: Healthscope Commercial |
$147.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.56
|
| Rate for Payer: PHP Commercial |
$138.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$189.95
|
| Rate for Payer: Priority Health SBD |
$102.95
|
| Rate for Payer: Priority Health Tiered Network |
$151.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.64
|
| Rate for Payer: UHC Core |
$349.64
|
| Rate for Payer: UHC Exchange |
$349.64
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
OP
|
$746.09
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$217.98 |
| Max. Negotiated Rate |
$671.48 |
| Rate for Payer: Aetna Commercial |
$634.18
|
| Rate for Payer: Aetna Medicare |
$433.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.98
|
| Rate for Payer: BCBS Complete |
$228.90
|
| Rate for Payer: BCBS MAPPO |
$416.78
|
| Rate for Payer: BCBS Trust/PPO |
$444.38
|
| Rate for Payer: BCN Commercial |
$444.38
|
| Rate for Payer: BCN Medicare Advantage |
$416.78
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cofinity Advantage |
$522.26
|
| Rate for Payer: Cofinity Commercial |
$641.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.78
|
| Rate for Payer: Healthscope Commercial |
$671.48
|
| Rate for Payer: Mclaren Medicaid |
$217.98
|
| Rate for Payer: Mclaren Medicare |
$416.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.62
|
| Rate for Payer: Meridian Medicaid |
$437.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.18
|
| Rate for Payer: Nomi Health Commercial |
$625.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.57
|
| Rate for Payer: PACE Medicare |
$395.94
|
| Rate for Payer: PACE SWMI |
$416.78
|
| Rate for Payer: PHP Commercial |
$634.18
|
| Rate for Payer: PHP Medicare Advantage |
$416.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$416.78
|
| Rate for Payer: Priority Health Medicare |
$416.78
|
| Rate for Payer: Priority Health SBD |
$470.04
|
| Rate for Payer: Priority Health Tiered Network |
$333.42
|
| Rate for Payer: Railroad Medicare Medicare |
$416.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$625.17
|
| Rate for Payer: UHC Core |
$625.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.78
|
| Rate for Payer: UHC Exchange |
$625.17
|
| Rate for Payer: UHC Medicaid |
$217.98
|
| Rate for Payer: UHCCP Medicaid |
$217.98
|
| Rate for Payer: VA VA |
$416.78
|
|
|
HC MENINGITIS/ENCEPHALITIS PANEL
|
Facility
|
IP
|
$746.09
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
30600287
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$470.04 |
| Max. Negotiated Rate |
$671.48 |
| Rate for Payer: Aetna Commercial |
$634.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.96
|
| Rate for Payer: Cash Price |
$596.87
|
| Rate for Payer: Cofinity Advantage |
$522.26
|
| Rate for Payer: Cofinity Commercial |
$641.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.87
|
| Rate for Payer: Healthscope Commercial |
$671.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.57
|
| Rate for Payer: PHP Commercial |
$634.18
|
| Rate for Payer: Priority Health SBD |
$470.04
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$9.55
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$8.60 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Advantage |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: Priority Health SBD |
$6.02
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$9.55
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200218
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna Commercial |
$8.12
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: Cofinity Advantage |
$6.68
|
| Rate for Payer: Cofinity Commercial |
$8.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.12
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.16
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$8.12
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$6.02
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health SBD |
$9.09
|
|
|
HC MENINGOENCEPHALITIS PANEL CSF
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
30200356
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Medicare |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.06
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS MAPPO |
$16.85
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Commercial |
$17.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.85
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.85
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Mclaren Medicaid |
$8.81
|
| Rate for Payer: Mclaren Medicare |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.69
|
| Rate for Payer: Meridian Medicaid |
$17.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$25.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: PACE Medicare |
$16.01
|
| Rate for Payer: PACE SWMI |
$16.85
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Medicare Advantage |
$16.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.85
|
| Rate for Payer: Priority Health Medicare |
$16.85
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health Tiered Network |
$13.48
|
| Rate for Payer: Railroad Medicare Medicare |
$16.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.28
|
| Rate for Payer: UHC Core |
$25.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.85
|
| Rate for Payer: UHC Exchange |
$25.28
|
| Rate for Payer: UHC Medicaid |
$8.81
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: VA VA |
$16.85
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$13.72
|
| Rate for Payer: BCN Commercial |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC MENINGOENCEPHALITIS PANEL SERUM
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200217
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Advantage |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.14
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health SBD |
$9.36
|
|
|
HC MERCURY
|
Facility
|
OP
|
$50.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna Medicare |
$16.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.32
|
| Rate for Payer: BCBS Complete |
$8.93
|
| Rate for Payer: BCBS MAPPO |
$16.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Mclaren Medicaid |
$8.50
|
| Rate for Payer: Mclaren Medicare |
$16.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.07
|
| Rate for Payer: Meridian Medicaid |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Nomi Health Commercial |
$24.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PACE Medicare |
$15.45
|
| Rate for Payer: PACE SWMI |
$16.26
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: PHP Medicare Advantage |
$16.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.26
|
| Rate for Payer: Priority Health Medicare |
$16.26
|
| Rate for Payer: Priority Health SBD |
$32.09
|
| Rate for Payer: Priority Health Tiered Network |
$13.01
|
| Rate for Payer: Railroad Medicare Medicare |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.39
|
| Rate for Payer: UHC Core |
$24.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.26
|
| Rate for Payer: UHC Exchange |
$24.39
|
| Rate for Payer: UHC Medicaid |
$8.50
|
| Rate for Payer: UHCCP Medicaid |
$8.50
|
| Rate for Payer: VA VA |
$16.26
|
|
|
HC MERCURY
|
Facility
|
IP
|
$50.94
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100291
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.09 |
| Max. Negotiated Rate |
$45.85 |
| Rate for Payer: Aetna Commercial |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.11
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cofinity Advantage |
$35.66
|
| Rate for Payer: Cofinity Commercial |
$43.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.20
|
| Rate for Payer: PHP Commercial |
$43.30
|
| Rate for Payer: Priority Health SBD |
$32.09
|
|
|
HC MESH
|
Facility
|
OP
|
$4,739.23
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,862.52 |
| Max. Negotiated Rate |
$4,265.31 |
| Rate for Payer: Aetna Commercial |
$4,028.35
|
| Rate for Payer: Aetna Medicare |
$2,369.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,080.50
|
| Rate for Payer: BCBS Complete |
$1,895.69
|
| Rate for Payer: Cash Price |
$3,791.38
|
| Rate for Payer: Cofinity Advantage |
$3,317.46
|
| Rate for Payer: Cofinity Commercial |
$4,075.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,791.38
|
| Rate for Payer: Healthscope Commercial |
$4,265.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,791.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,028.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,554.42
|
| Rate for Payer: PHP Commercial |
$4,028.35
|
| Rate for Payer: Priority Health SBD |
$2,985.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,080.50
|
| Rate for Payer: UHC Core |
$2,469.14
|
| Rate for Payer: UHC Exchange |
$1,862.52
|
|
|
HC MESH
|
Facility
|
IP
|
$4,739.23
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27800022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,985.71 |
| Max. Negotiated Rate |
$4,265.31 |
| Rate for Payer: Aetna Commercial |
$4,028.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,080.50
|
| Rate for Payer: Cash Price |
$3,791.38
|
| Rate for Payer: Cofinity Advantage |
$3,317.46
|
| Rate for Payer: Cofinity Commercial |
$4,075.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,791.38
|
| Rate for Payer: Healthscope Commercial |
$4,265.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,028.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,554.42
|
| Rate for Payer: PHP Commercial |
$4,028.35
|
| Rate for Payer: Priority Health SBD |
$2,985.71
|
|
|
HC METANEB SUPPLY
|
Facility
|
IP
|
$264.46
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$166.61 |
| Max. Negotiated Rate |
$238.01 |
| Rate for Payer: Aetna Commercial |
$224.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.90
|
| Rate for Payer: Cash Price |
$211.57
|
| Rate for Payer: Cofinity Advantage |
$185.12
|
| Rate for Payer: Cofinity Commercial |
$227.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.57
|
| Rate for Payer: Healthscope Commercial |
$238.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.34
|
| Rate for Payer: PHP Commercial |
$224.79
|
| Rate for Payer: Priority Health SBD |
$166.61
|
|
|
HC METANEB SUPPLY
|
Facility
|
OP
|
$264.46
|
|
| Hospital Charge Code |
27000466
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.93 |
| Max. Negotiated Rate |
$238.01 |
| Rate for Payer: Aetna Commercial |
$224.79
|
| Rate for Payer: Aetna Medicare |
$132.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.90
|
| Rate for Payer: BCBS Complete |
$105.78
|
| Rate for Payer: Cash Price |
$211.57
|
| Rate for Payer: Cofinity Advantage |
$185.12
|
| Rate for Payer: Cofinity Commercial |
$227.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.57
|
| Rate for Payer: Healthscope Commercial |
$238.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.34
|
| Rate for Payer: PHP Commercial |
$224.79
|
| Rate for Payer: Priority Health SBD |
$166.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.90
|
| Rate for Payer: UHC Core |
$137.78
|
| Rate for Payer: UHC Exchange |
$103.93
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: Priority Health SBD |
$29.42
|
|
|
HC METANEPHRINES FRACTIONATION URINE
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100297
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$42.03 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCN Commercial |
$18.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cash Price |
$37.36
|
| Rate for Payer: Cofinity Advantage |
$32.69
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$42.03
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.70
|
| Rate for Payer: Nomi Health Commercial |
$25.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.02
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$39.70
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.94
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health SBD |
$29.42
|
| Rate for Payer: Priority Health Tiered Network |
$13.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.41
|
| Rate for Payer: UHC Core |
$25.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health SBD |
$39.98
|
|
|
HC METANEPHRINES PLASMA
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30200013
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCN Commercial |
$18.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$25.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.94
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: Priority Health Tiered Network |
$13.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.41
|
| Rate for Payer: UHC Core |
$25.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES URINE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.18
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCN Commercial |
$18.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Mclaren Medicare |
$16.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.79
|
| Rate for Payer: Meridian Medicaid |
$17.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$25.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Medicare |
$16.09
|
| Rate for Payer: PACE SWMI |
$16.94
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicare Advantage |
$16.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.94
|
| Rate for Payer: Priority Health Medicare |
$16.94
|
| Rate for Payer: Priority Health SBD |
$34.10
|
| Rate for Payer: Priority Health Tiered Network |
$13.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.41
|
| Rate for Payer: UHC Core |
$25.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.94
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$8.86
|
| Rate for Payer: UHCCP Medicaid |
$8.86
|
| Rate for Payer: VA VA |
$16.94
|
|
|
HC METANEPHRINES URINE
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
30100295
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Advantage |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: Priority Health SBD |
$34.10
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
IP
|
$1,834.95
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,156.02 |
| Max. Negotiated Rate |
$1,651.45 |
| Rate for Payer: Aetna Commercial |
$1,559.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.72
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cofinity Advantage |
$1,284.46
|
| Rate for Payer: Cofinity Commercial |
$1,578.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,467.96
|
| Rate for Payer: Healthscope Commercial |
$1,651.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.21
|
| Rate for Payer: PHP Commercial |
$1,559.71
|
| Rate for Payer: Priority Health SBD |
$1,156.02
|
|
|
HC METASTRON SR 89 THERAPEUTIC PER MCI
|
Facility
|
OP
|
$1,834.95
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
34400003
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,156.02 |
| Max. Negotiated Rate |
$13,077.42 |
| Rate for Payer: Aetna Commercial |
$1,559.71
|
| Rate for Payer: Aetna Medicare |
$4,312.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,182.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,182.93
|
| Rate for Payer: BCBS Complete |
$2,277.17
|
| Rate for Payer: BCBS MAPPO |
$4,146.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,894.44
|
| Rate for Payer: BCN Commercial |
$5,894.44
|
| Rate for Payer: BCN Medicare Advantage |
$4,146.34
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cash Price |
$1,467.96
|
| Rate for Payer: Cofinity Advantage |
$1,284.46
|
| Rate for Payer: Cofinity Commercial |
$1,578.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,467.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,146.34
|
| Rate for Payer: Healthscope Commercial |
$1,651.45
|
| Rate for Payer: Mclaren Medicaid |
$2,168.54
|
| Rate for Payer: Mclaren Medicare |
$4,146.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,353.66
|
| Rate for Payer: Meridian Medicaid |
$4,353.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,768.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,560.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,559.71
|
| Rate for Payer: Nomi Health Commercial |
$12,439.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,376.21
|
| Rate for Payer: PACE Medicare |
$3,939.02
|
| Rate for Payer: PACE SWMI |
$4,146.34
|
| Rate for Payer: PHP Commercial |
$1,559.71
|
| Rate for Payer: PHP Medicare Advantage |
$4,146.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,168.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,077.42
|
| Rate for Payer: Priority Health Medicare |
$4,146.34
|
| Rate for Payer: Priority Health SBD |
$1,156.02
|
| Rate for Payer: Priority Health Tiered Network |
$10,461.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4,146.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,841.46
|
| Rate for Payer: UHC Core |
$6,841.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,146.34
|
| Rate for Payer: UHC Exchange |
$6,841.46
|
| Rate for Payer: UHC Medicaid |
$2,168.54
|
| Rate for Payer: UHCCP Medicaid |
$2,168.54
|
| Rate for Payer: VA VA |
$4,146.34
|
|
|
HC METHADONE CONFIRM MECON
|
Facility
|
IP
|
$119.65
|
|
|
Service Code
|
CPT 80358
|
| Hospital Charge Code |
30100574
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.38 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.77
|
| Rate for Payer: Cash Price |
$95.72
|
| Rate for Payer: Cofinity Advantage |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.72
|
| Rate for Payer: Healthscope Commercial |
$107.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.74
|
| Rate for Payer: PHP Commercial |
$101.70
|
| Rate for Payer: Priority Health SBD |
$75.38
|
|
