|
HC PHENOBARB LVL
|
Facility
|
OP
|
$100.57
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$85.48
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cofinity Commercial |
$86.49
|
| Rate for Payer: Cofinity Commercial |
$70.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.48
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$85.48
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.37
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health SBD |
$63.36
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: UHCCP Medicaid |
$8.61
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC PH GASTRIC
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Cofinity Commercial |
$17.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Mclaren Medicaid |
$3.60
|
| Rate for Payer: Mclaren Medicare |
$6.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: Meridian Medicaid |
$3.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health Medicare |
$6.71
|
| Rate for Payer: Priority Health SBD |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.71
|
| Rate for Payer: UHC Medicare Advantage |
$6.71
|
| Rate for Payer: UHCCP Medicaid |
$3.78
|
| Rate for Payer: VA VA |
$6.71
|
|
|
HC PH GASTRIC
|
Facility
|
IP
|
$24.68
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.04
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$17.28
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health SBD |
$15.55
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$48.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health SBD |
$47.55
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Cofinity Commercial |
$52.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Mclaren Medicaid |
$8.85
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$47.55
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.52
|
| Rate for Payer: UHC Medicare Advantage |
$16.52
|
| Rate for Payer: UHCCP Medicaid |
$9.30
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Mclaren Medicaid |
$8.85
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$53.34
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.52
|
| Rate for Payer: UHC Medicare Advantage |
$16.52
|
| Rate for Payer: UHCCP Medicaid |
$9.30
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.34 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.03
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$59.26
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health SBD |
$53.34
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$34.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$9.05
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.84
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$38.60
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health SBD |
$34.74
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$34.08
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.07
|
| Rate for Payer: UHC Medicare Advantage |
$16.07
|
| Rate for Payer: UHCCP Medicaid |
$9.05
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$48.69 |
| Rate for Payer: Aetna Commercial |
$45.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.16
|
| Rate for Payer: Cash Price |
$43.28
|
| Rate for Payer: Cofinity Commercial |
$37.87
|
| Rate for Payer: Cofinity Commercial |
$46.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.28
|
| Rate for Payer: Healthscope Commercial |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.98
|
| Rate for Payer: PHP Commercial |
$45.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.16
|
| Rate for Payer: Priority Health SBD |
$34.08
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
OP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$239.81
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$242.63
|
| Rate for Payer: Cofinity Commercial |
$197.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$239.81
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$177.74
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
IP
|
$282.13
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$177.74 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$239.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.38
|
| Rate for Payer: Cash Price |
$225.70
|
| Rate for Payer: Cofinity Commercial |
$197.49
|
| Rate for Payer: Cofinity Commercial |
$242.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$197.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.70
|
| Rate for Payer: Healthscope Commercial |
$253.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.81
|
| Rate for Payer: PHP Commercial |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.38
|
| Rate for Payer: Priority Health SBD |
$177.74
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.38 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.58
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$147.08
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health SBD |
$132.38
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Cofinity Commercial |
$147.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$132.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Cofinity Commercial |
$147.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$132.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$132.38 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.58
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$147.08
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health SBD |
$132.38
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.92
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.74
|
| Rate for Payer: BCN Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicare |
$4.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.98
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.74
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$4.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.74
|
| Rate for Payer: UHC Medicare Advantage |
$4.74
|
| Rate for Payer: UHCCP Medicaid |
$2.67
|
| Rate for Payer: VA VA |
$4.74
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.41
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health SBD |
$33.35
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.22
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Cofinity Commercial |
$37.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Mclaren Medicaid |
$3.10
|
| Rate for Payer: Mclaren Medicare |
$5.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: PACE Medicare |
$5.49
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health SBD |
$33.35
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
| Rate for Payer: UHCCP Medicaid |
$3.25
|
| Rate for Payer: VA VA |
$5.78
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$135.00
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: UHC Core |
$69.29
|
| Rate for Payer: UHC Exchange |
$69.29
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
