|
HC T CELL TOTAL
|
Facility
|
OP
|
$59.60
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$64.12 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$41.72
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$53.64
|
| Rate for Payer: Mclaren Medicaid |
$20.64
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Medicaid |
$21.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.66
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$50.66
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.72
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$37.55
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.28
|
| Rate for Payer: UHC Core |
$64.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.73
|
| Rate for Payer: UHC Exchange |
$37.73
|
| Rate for Payer: UHC Medicare Advantage |
$38.86
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,205.33 |
| Max. Negotiated Rate |
$3,150.48 |
| Rate for Payer: Aetna Commercial |
$2,975.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.34
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$2,450.37
|
| Rate for Payer: Cofinity Commercial |
$3,010.46
|
| Rate for Payer: Healthscope Commercial |
$3,150.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: PHP Commercial |
$2,975.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: Priority Health SBD |
$2,205.33
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$508.88 |
| Max. Negotiated Rate |
$3,150.48 |
| Rate for Payer: Aetna Commercial |
$2,975.45
|
| Rate for Payer: Aetna Medicare |
$967.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,162.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,162.89
|
| Rate for Payer: BCBS Complete |
$534.37
|
| Rate for Payer: BCBS MAPPO |
$930.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,974.10
|
| Rate for Payer: BCN Medicare Advantage |
$930.31
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$3,010.46
|
| Rate for Payer: Cofinity Commercial |
$2,450.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.31
|
| Rate for Payer: Healthscope Commercial |
$3,150.48
|
| Rate for Payer: Mclaren Medicaid |
$508.88
|
| Rate for Payer: Mclaren Medicare |
$930.31
|
| Rate for Payer: Meridian Medicaid |
$534.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$976.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,069.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: PACE Medicare |
$883.79
|
| Rate for Payer: PACE SWMI |
$930.31
|
| Rate for Payer: PHP Commercial |
$2,975.45
|
| Rate for Payer: PHP Medicare Advantage |
$930.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: Priority Health Medicare |
$930.31
|
| Rate for Payer: Priority Health SBD |
$2,205.33
|
| Rate for Payer: Railroad Medicare Medicare |
$930.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.31
|
| Rate for Payer: UHC Exchange |
$548.14
|
| Rate for Payer: UHC Medicare Advantage |
$958.22
|
| Rate for Payer: VA VA |
$930.31
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: BCBS Complete |
$161.44
|
| Rate for Payer: BCBS Trust/PPO |
$219.53
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health SBD |
$254.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.24
|
| Rate for Payer: UHC Exchange |
$55.67
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.27 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.35
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$282.53
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health SBD |
$254.27
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.26 |
| Max. Negotiated Rate |
$278.95 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.46
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$216.96
|
| Rate for Payer: Cofinity Commercial |
$266.55
|
| Rate for Payer: Healthscope Commercial |
$278.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: PHP Commercial |
$263.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: Priority Health SBD |
$195.26
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.67 |
| Max. Negotiated Rate |
$278.95 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.46
|
| Rate for Payer: BCBS Complete |
$123.98
|
| Rate for Payer: BCBS Trust/PPO |
$219.53
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$216.96
|
| Rate for Payer: Cofinity Commercial |
$266.55
|
| Rate for Payer: Healthscope Commercial |
$278.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: PHP Commercial |
$263.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: Priority Health SBD |
$195.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.24
|
| Rate for Payer: UHC Exchange |
$55.67
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$84.63 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$94.03
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Meridian Medicaid |
$1,000.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health SBD |
$84.63
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$4,970.09
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,131.16 |
| Max. Negotiated Rate |
$4,473.08 |
| Rate for Payer: Aetna Commercial |
$4,224.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,230.56
|
| Rate for Payer: Cash Price |
$3,976.07
|
| Rate for Payer: Cofinity Commercial |
$3,479.06
|
| Rate for Payer: Cofinity Commercial |
$4,274.28
|
| Rate for Payer: Healthscope Commercial |
$4,473.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,224.58
|
| Rate for Payer: PHP Commercial |
$4,224.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,479.06
|
| Rate for Payer: Priority Health SBD |
$3,131.16
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna Medicare |
$510.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.60
|
| Rate for Payer: BCBS Complete |
$281.96
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$604.82
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,296.31
|
| Rate for Payer: Cofinity Commercial |
$1,592.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Mclaren Medicaid |
$268.51
|
| Rate for Payer: Mclaren Medicare |
$490.88
|
| Rate for Payer: Meridian Medicaid |
$281.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PACE Medicare |
$466.34
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,504.47
|
| Rate for Payer: Priority Health Medicare |
$490.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,203.58
|
| Rate for Payer: Priority Health SBD |
$1,166.68
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$505.61
|
| Rate for Payer: VA VA |
$490.88
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,166.68 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.72
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,296.31
|
| Rate for Payer: Cofinity Commercial |
$1,592.61
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health SBD |
$1,166.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,851.87
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,166.68 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.72
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,296.31
|
| Rate for Payer: Cofinity Commercial |
$1,592.61
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health SBD |
$1,166.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,851.87
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$1,997.47 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna Medicare |
$740.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.55
|
| Rate for Payer: BCBS Complete |
$409.23
|
| Rate for Payer: BCBS MAPPO |
$712.44
|
| Rate for Payer: BCBS Trust/PPO |
$773.42
|
| Rate for Payer: BCN Medicare Advantage |
$712.44
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,296.31
|
| Rate for Payer: Cofinity Commercial |
$1,592.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.44
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Mclaren Medicaid |
$389.70
|
| Rate for Payer: Mclaren Medicare |
$712.44
|
| Rate for Payer: Meridian Medicaid |
$409.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$748.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PACE Medicare |
$676.82
|
| Rate for Payer: PACE SWMI |
$712.44
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: PHP Medicare Advantage |
$712.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$389.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health Medicare |
$712.44
|
| Rate for Payer: Priority Health SBD |
$1,166.68
|
| Rate for Payer: Railroad Medicare Medicare |
$712.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,997.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.44
|
| Rate for Payer: UHC Exchange |
$1,361.54
|
| Rate for Payer: UHC Medicare Advantage |
$733.81
|
| Rate for Payer: VA VA |
$712.44
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.14
|
| Rate for Payer: UHC Core |
$7.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.28
|
| Rate for Payer: UHC Exchange |
$4.28
|
| Rate for Payer: UHC Medicare Advantage |
$4.41
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health SBD |
$17.99
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Mclaren Medicaid |
$5.32
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Medicaid |
$5.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health SBD |
$40.32
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.66
|
| Rate for Payer: UHC Core |
$14.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$10.01
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health SBD |
$40.32
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$77.11
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$77.11 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.56
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Cofinity Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$77.11
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Mclaren Medicaid |
$7.97
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Medicaid |
$8.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$66.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Core |
$24.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health SBD |
$66.40
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.92 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health SBD |
$28.92
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.37
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Cofinity Commercial |
$32.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Mclaren Medicaid |
$7.97
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Medicaid |
$8.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$28.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.48
|
| Rate for Payer: UHC Core |
$24.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.57
|
| Rate for Payer: UHC Exchange |
$14.57
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.52
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
