|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Advantage |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$45.47
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
IP
|
$71.10
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.22
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cofinity Advantage |
$49.77
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.88
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.33
|
| Rate for Payer: PHP Commercial |
$60.44
|
| Rate for Payer: Priority Health SBD |
$44.79
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
OP
|
$71.10
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: Aetna Medicare |
$386.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.77
|
| Rate for Payer: BCBS Complete |
$204.20
|
| Rate for Payer: BCBS MAPPO |
$371.82
|
| Rate for Payer: BCN Medicare Advantage |
$371.82
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cofinity Advantage |
$49.77
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.82
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Mclaren Medicaid |
$194.46
|
| Rate for Payer: Mclaren Medicare |
$371.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.41
|
| Rate for Payer: Meridian Medicaid |
$390.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$427.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.44
|
| Rate for Payer: Nomi Health Commercial |
$1,115.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.33
|
| Rate for Payer: PACE Medicare |
$353.23
|
| Rate for Payer: PACE SWMI |
$371.82
|
| Rate for Payer: PHP Commercial |
$60.44
|
| Rate for Payer: PHP Medicare Advantage |
$371.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,202.41
|
| Rate for Payer: Priority Health Medicare |
$371.82
|
| Rate for Payer: Priority Health SBD |
$44.79
|
| Rate for Payer: Priority Health Tiered Network |
$961.93
|
| Rate for Payer: Railroad Medicare Medicare |
$371.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.22
|
| Rate for Payer: UHC Core |
$37.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$371.82
|
| Rate for Payer: UHC Exchange |
$27.94
|
| Rate for Payer: UHC Medicaid |
$194.46
|
| Rate for Payer: UHCCP Medicaid |
$194.46
|
| Rate for Payer: VA VA |
$371.82
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.14
|
| Rate for Payer: BCBS Complete |
$14.86
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Advantage |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health SBD |
$23.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.14
|
| Rate for Payer: UHC Core |
$19.35
|
| Rate for Payer: UHC Exchange |
$14.60
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.90 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.50
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Advantage |
$1,071.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: Priority Health SBD |
$963.90
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$601.29 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.50
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Advantage |
$1,071.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,224.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: Priority Health SBD |
$963.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.50
|
| Rate for Payer: UHC Core |
$797.13
|
| Rate for Payer: UHC Exchange |
$601.29
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.50 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Aetna Commercial |
$2,167.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.50
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Advantage |
$1,785.00
|
| Rate for Payer: Cofinity Commercial |
$2,193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Commercial |
$2,295.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.50
|
| Rate for Payer: PHP Commercial |
$2,167.50
|
| Rate for Payer: Priority Health SBD |
$1,606.50
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.15 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Aetna Commercial |
$2,167.50
|
| Rate for Payer: Aetna Medicare |
$1,275.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.50
|
| Rate for Payer: BCBS Complete |
$1,020.00
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Advantage |
$1,785.00
|
| Rate for Payer: Cofinity Commercial |
$2,193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Commercial |
$2,295.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,040.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.50
|
| Rate for Payer: PHP Commercial |
$2,167.50
|
| Rate for Payer: Priority Health SBD |
$1,606.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,657.50
|
| Rate for Payer: UHC Core |
$1,328.55
|
| Rate for Payer: UHC Exchange |
$1,002.15
|
|
|
HC NEUROSYPHILIS SCR, IGG, CSF
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200517
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.49 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Advantage |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health SBD |
$22.49
|
|
|
HC NEUROSYPHILIS SCR, IGG, CSF
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200517
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$39.72 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.55
|
| Rate for Payer: BCBS Complete |
$7.27
|
| Rate for Payer: BCBS MAPPO |
$13.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.12
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: BCN Medicare Advantage |
$13.24
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Advantage |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.24
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Mclaren Medicaid |
$6.92
|
| Rate for Payer: Mclaren Medicare |
$13.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$39.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: PACE Medicare |
$12.58
|
| Rate for Payer: PACE SWMI |
$13.24
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.24
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: Priority Health Tiered Network |
$10.59
|
| Rate for Payer: Railroad Medicare Medicare |
$13.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.86
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.24
|
| Rate for Payer: UHC Exchange |
$19.86
|
| Rate for Payer: UHC Medicaid |
$6.92
|
| Rate for Payer: UHCCP Medicaid |
$6.92
|
| Rate for Payer: VA VA |
$13.24
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$161.53
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna Commercial |
$137.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Advantage |
$113.07
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$145.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.15
|
| Rate for Payer: PHP Commercial |
$137.30
|
| Rate for Payer: Priority Health SBD |
$101.76
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$161.53
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.76 |
| Max. Negotiated Rate |
$1,155.01 |
| Rate for Payer: Aetna Commercial |
$137.30
|
| Rate for Payer: Aetna Medicare |
$371.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.45
|
| Rate for Payer: BCBS Complete |
$196.15
|
| Rate for Payer: BCBS MAPPO |
$357.16
|
| Rate for Payer: BCBS Trust/PPO |
$132.88
|
| Rate for Payer: BCN Commercial |
$132.88
|
| Rate for Payer: BCN Medicare Advantage |
$357.16
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Advantage |
$113.07
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.16
|
| Rate for Payer: Healthscope Commercial |
$145.38
|
| Rate for Payer: Mclaren Medicaid |
$186.79
|
| Rate for Payer: Mclaren Medicare |
$357.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.02
|
| Rate for Payer: Meridian Medicaid |
$375.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$410.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.30
|
| Rate for Payer: Nomi Health Commercial |
$1,071.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.15
|
| Rate for Payer: PACE Medicare |
$339.30
|
| Rate for Payer: PACE SWMI |
$357.16
|
| Rate for Payer: PHP Commercial |
$137.30
|
| Rate for Payer: PHP Medicare Advantage |
$357.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$186.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,155.01
|
| Rate for Payer: Priority Health Medicare |
$357.16
|
| Rate for Payer: Priority Health SBD |
$101.76
|
| Rate for Payer: Priority Health Tiered Network |
$924.01
|
| Rate for Payer: Railroad Medicare Medicare |
$357.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.58
|
| Rate for Payer: UHC Core |
$539.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$357.16
|
| Rate for Payer: UHC Exchange |
$539.58
|
| Rate for Payer: UHC Medicaid |
$186.79
|
| Rate for Payer: UHCCP Medicaid |
$186.79
|
| Rate for Payer: VA VA |
$357.16
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.92 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$28.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: BCBS Complete |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$38.62
|
| Rate for Payer: BCN Commercial |
$38.62
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health SBD |
$36.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.00
|
| Rate for Payer: UHC Core |
$33.00
|
| Rate for Payer: UHC Exchange |
$33.00
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.24
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Advantage |
$40.11
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health SBD |
$36.10
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.42 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna Medicare |
$84.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS Trust/PPO |
$120.58
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$120.58
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Advantage |
$118.31
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health SBD |
$106.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.86
|
| Rate for Payer: UHC Core |
$88.06
|
| Rate for Payer: UHC Exchange |
$66.42
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.48 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.86
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Advantage |
$118.31
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health SBD |
$106.48
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.31
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Advantage |
$143.57
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health SBD |
$129.21
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna Medicare |
$102.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.31
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS Trust/PPO |
$159.36
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$159.36
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Advantage |
$143.57
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health SBD |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.31
|
| Rate for Payer: UHC Core |
$106.86
|
| Rate for Payer: UHC Exchange |
$80.60
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.55 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Advantage |
$206.17
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health SBD |
$185.55
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$147.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.44
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$213.18
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$213.18
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Advantage |
$206.17
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health SBD |
$185.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$153.45
|
| Rate for Payer: UHC Exchange |
$115.75
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.97 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Advantage |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health SBD |
$308.97
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.78
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS Trust/PPO |
$258.37
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$258.37
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Advantage |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$392.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health SBD |
$308.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.78
|
| Rate for Payer: UHC Core |
$255.51
|
| Rate for Payer: UHC Exchange |
$192.74
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID CEPHEID
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600357
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna Medicare |
$72.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Mclaren Medicaid |
$36.70
|
| Rate for Payer: Mclaren Medicare |
$70.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: Meridian Medicaid |
$73.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$105.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Medicare |
$66.67
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$70.18
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health SBD |
$85.21
|
| Rate for Payer: Priority Health Tiered Network |
$56.14
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.27
|
| Rate for Payer: UHC Core |
$105.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.18
|
| Rate for Payer: UHC Exchange |
$105.27
|
| Rate for Payer: UHC Medicaid |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$36.70
|
| Rate for Payer: VA VA |
$70.18
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID CEPHEID
|
Facility
|
IP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600357
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.92
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Advantage |
$94.68
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: Priority Health SBD |
$85.21
|
|
