|
HC PRESSURE WIRE
|
Facility
|
IP
|
$2,201.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,386.79 |
| Max. Negotiated Rate |
$1,981.12 |
| Rate for Payer: Aetna Commercial |
$1,871.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.81
|
| Rate for Payer: Cash Price |
$1,761.00
|
| Rate for Payer: Cofinity Commercial |
$1,540.88
|
| Rate for Payer: Cofinity Commercial |
$1,893.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,540.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.00
|
| Rate for Payer: Healthscope Commercial |
$1,981.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.06
|
| Rate for Payer: PHP Commercial |
$1,871.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.81
|
| Rate for Payer: Priority Health SBD |
$1,386.79
|
|
|
HC PRESSURE WIRE
|
Facility
|
OP
|
$2,201.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$880.50 |
| Max. Negotiated Rate |
$1,981.12 |
| Rate for Payer: Aetna Commercial |
$1,871.06
|
| Rate for Payer: Aetna Medicare |
$1,100.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.81
|
| Rate for Payer: BCBS Complete |
$880.50
|
| Rate for Payer: Cash Price |
$1,761.00
|
| Rate for Payer: Cofinity Commercial |
$1,540.88
|
| Rate for Payer: Cofinity Commercial |
$1,893.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,540.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,761.00
|
| Rate for Payer: Healthscope Commercial |
$1,981.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,871.06
|
| Rate for Payer: PHP Commercial |
$1,871.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.81
|
| Rate for Payer: Priority Health SBD |
$1,386.79
|
|
|
HC PRESUMPTIVE DRUG TEST CHEM ANALYZER
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC PRESUMPTIVE DRUG TEST CHEM ANALYZER
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100727
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC PRESUMPTIVE DRUG TEST OPTICAL
|
Facility
|
IP
|
$51.50
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.45 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$43.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.20
|
| Rate for Payer: Healthscope Commercial |
$46.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.77
|
| Rate for Payer: PHP Commercial |
$43.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.48
|
| Rate for Payer: Priority Health SBD |
$32.45
|
|
|
HC PRESUMPTIVE DRUG TEST OPTICAL
|
Facility
|
OP
|
$51.50
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100728
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$46.35 |
| Rate for Payer: Aetna Commercial |
$43.77
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cash Price |
$41.20
|
| Rate for Payer: Cofinity Commercial |
$44.29
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$46.35
|
| Rate for Payer: Mclaren Medicaid |
$6.75
|
| Rate for Payer: Mclaren Medicare |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.77
|
| Rate for Payer: PACE Medicare |
$11.97
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$43.77
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.48
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health SBD |
$32.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UHCCP Medicaid |
$7.09
|
| Rate for Payer: VA VA |
$12.60
|
|
|
HC PRIMARY MEMBRANOUS NEPH DX CASCADE S
|
Facility
|
IP
|
$211.14
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.02 |
| Max. Negotiated Rate |
$190.03 |
| Rate for Payer: Aetna Commercial |
$179.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.24
|
| Rate for Payer: Cash Price |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$181.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.91
|
| Rate for Payer: Healthscope Commercial |
$190.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.47
|
| Rate for Payer: PHP Commercial |
$179.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.24
|
| Rate for Payer: Priority Health SBD |
$133.02
|
|
|
HC PRIMARY MEMBRANOUS NEPH DX CASCADE S
|
Facility
|
OP
|
$211.14
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100757
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$190.03 |
| Rate for Payer: Aetna Commercial |
$179.47
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.24
|
| 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 |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$168.91
|
| Rate for Payer: Cash Price |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$181.58
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$190.03
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| 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 |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.47
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$179.47
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.24
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$133.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.72
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC PRIMIDONE MYSOLINE LEVEL
|
Facility
|
IP
|
$27.05
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health SBD |
$17.04
|
|
|
HC PRIMIDONE MYSOLINE LEVEL
|
Facility
|
OP
|
$27.05
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$43.07 |
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| 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 |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| 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 |
$22.99
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$22.99
|
| 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 |
$17.58
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| 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 PRIMIDONE PHENOBARB CMPT
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
30100489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health SBD |
$24.25
|
|
|
HC PRIMIDONE PHENOBARB CMPT
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 80188
|
| Hospital Charge Code |
30100489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$46.70 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.74
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$16.59
|
| Rate for Payer: BCN Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.59
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Mclaren Medicare |
$16.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.42
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: PACE Medicare |
$15.76
|
| Rate for Payer: PACE SWMI |
$16.59
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health Medicare |
$16.59
|
| Rate for Payer: Priority Health SBD |
$24.25
|
| Rate for Payer: Railroad Medicare Medicare |
$16.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.59
|
| Rate for Payer: UHC Medicare Advantage |
$16.59
|
| Rate for Payer: UHCCP Medicaid |
$9.34
|
| Rate for Payer: VA VA |
$16.59
|
|
|
HC PRINCIPAL CARE MGMT 1ST 30 MIN STAFF/CAL MO
|
Facility
|
OP
|
$252.96
|
|
|
Service Code
|
CPT 99426
|
| Hospital Charge Code |
51000112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$253.93 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna Medicare |
$93.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.76
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$90.21
|
| Rate for Payer: BCN Medicare Advantage |
$90.21
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.21
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Mclaren Medicare |
$90.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.72
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PACE Medicare |
$85.70
|
| Rate for Payer: PACE SWMI |
$90.21
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: PHP Medicare Advantage |
$90.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health Medicare |
$90.21
|
| Rate for Payer: Priority Health SBD |
$159.36
|
| Rate for Payer: Railroad Medicare Medicare |
$90.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.21
|
| Rate for Payer: UHC Medicare Advantage |
$90.21
|
| Rate for Payer: UHCCP Medicaid |
$50.79
|
| Rate for Payer: VA VA |
$90.21
|
|
|
HC PRINCIPAL CARE MGMT 1ST 30 MIN STAFF/CAL MO
|
Facility
|
IP
|
$252.96
|
|
|
Service Code
|
CPT 99426
|
| Hospital Charge Code |
51000112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.36 |
| Max. Negotiated Rate |
$227.66 |
| Rate for Payer: Aetna Commercial |
$215.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.42
|
| Rate for Payer: Cash Price |
$202.37
|
| Rate for Payer: Cofinity Commercial |
$177.07
|
| Rate for Payer: Cofinity Commercial |
$217.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.37
|
| Rate for Payer: Healthscope Commercial |
$227.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.02
|
| Rate for Payer: PHP Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.42
|
| Rate for Payer: Priority Health SBD |
$159.36
|
|
|
HC PRINCIPAL CARE MGMT EA ADDL 30 MIN STAFF/CAL MO
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
CPT 99427
|
| Hospital Charge Code |
51000113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
HC PRINCIPAL CARE MGMT EA ADDL 30 MIN STAFF/CAL MO
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
CPT 99427
|
| Hospital Charge Code |
51000113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.52 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
HC PRO BNP
|
Facility
|
OP
|
$154.22
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
30100304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$138.80 |
| Rate for Payer: Aetna Commercial |
$131.09
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.08
|
| Rate for Payer: BCBS Complete |
$22.10
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Commercial |
$107.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Healthscope Commercial |
$138.80
|
| Rate for Payer: Mclaren Medicaid |
$21.04
|
| Rate for Payer: Mclaren Medicare |
$39.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: Meridian Medicaid |
$22.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.09
|
| Rate for Payer: PACE Medicare |
$37.30
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Commercial |
$131.09
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.24
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health SBD |
$97.16
|
| Rate for Payer: Railroad Medicare Medicare |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$39.26
|
| Rate for Payer: UHCCP Medicaid |
$22.10
|
| Rate for Payer: VA VA |
$39.26
|
|
|
HC PRO BNP
|
Facility
|
IP
|
$154.22
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
30100304
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.16 |
| Max. Negotiated Rate |
$138.80 |
| Rate for Payer: Aetna Commercial |
$131.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.24
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$107.95
|
| Rate for Payer: Cofinity Commercial |
$132.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.38
|
| Rate for Payer: Healthscope Commercial |
$138.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.09
|
| Rate for Payer: PHP Commercial |
$131.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.24
|
| Rate for Payer: Priority Health SBD |
$97.16
|
|
|
HC PROCAINAMIDE AND NAPA LEVEL
|
Facility
|
IP
|
$68.34
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
30100042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health SBD |
$43.05
|
|
|
HC PROCAINAMIDE AND NAPA LEVEL
|
Facility
|
OP
|
$68.34
|
|
|
Service Code
|
CPT 80192
|
| Hospital Charge Code |
30100042
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$61.51 |
| Rate for Payer: Aetna Commercial |
$58.09
|
| Rate for Payer: Aetna Medicare |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.94
|
| Rate for Payer: BCBS Complete |
$9.43
|
| Rate for Payer: BCBS MAPPO |
$16.75
|
| Rate for Payer: BCN Medicare Advantage |
$16.75
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cash Price |
$54.67
|
| Rate for Payer: Cofinity Commercial |
$58.77
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.75
|
| Rate for Payer: Healthscope Commercial |
$61.51
|
| Rate for Payer: Mclaren Medicaid |
$8.98
|
| Rate for Payer: Mclaren Medicare |
$16.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.59
|
| Rate for Payer: Meridian Medicaid |
$9.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.09
|
| Rate for Payer: PACE Medicare |
$15.91
|
| Rate for Payer: PACE SWMI |
$16.75
|
| Rate for Payer: PHP Commercial |
$58.09
|
| Rate for Payer: PHP Medicare Advantage |
$16.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: Priority Health Medicare |
$16.75
|
| Rate for Payer: Priority Health SBD |
$43.05
|
| Rate for Payer: Railroad Medicare Medicare |
$16.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.75
|
| Rate for Payer: UHC Medicare Advantage |
$16.75
|
| Rate for Payer: UHCCP Medicaid |
$9.43
|
| Rate for Payer: VA VA |
$16.75
|
|
|
HC PROCAINAMIDE CHALLENGE
|
Facility
|
OP
|
$7,423.93
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100123
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$81.79 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: Aetna Medicare |
$158.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,825.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.74
|
| Rate for Payer: BCBS Complete |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$152.59
|
| Rate for Payer: BCN Medicare Advantage |
$152.59
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Cofinity Commercial |
$5,196.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.59
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Mclaren Medicaid |
$81.79
|
| Rate for Payer: Mclaren Medicare |
$152.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.22
|
| Rate for Payer: Meridian Medicaid |
$85.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: PACE Medicare |
$144.96
|
| Rate for Payer: PACE SWMI |
$152.59
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: PHP Medicare Advantage |
$152.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health Medicare |
$152.59
|
| Rate for Payer: Priority Health SBD |
$4,677.08
|
| Rate for Payer: Railroad Medicare Medicare |
$152.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.59
|
| Rate for Payer: UHC Medicare Advantage |
$152.59
|
| Rate for Payer: UHCCP Medicaid |
$85.91
|
| Rate for Payer: VA VA |
$152.59
|
|
|
HC PROCAINAMIDE CHALLENGE
|
Facility
|
IP
|
$7,423.93
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
48100123
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,677.08 |
| Max. Negotiated Rate |
$6,681.54 |
| Rate for Payer: Aetna Commercial |
$6,310.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,825.55
|
| Rate for Payer: Cash Price |
$5,939.14
|
| Rate for Payer: Cofinity Commercial |
$5,196.75
|
| Rate for Payer: Cofinity Commercial |
$6,384.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,939.14
|
| Rate for Payer: Healthscope Commercial |
$6,681.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,310.34
|
| Rate for Payer: PHP Commercial |
$6,310.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,825.55
|
| Rate for Payer: Priority Health SBD |
$4,677.08
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
30100480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$28.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.02
|
| Rate for Payer: BCBS Complete |
$15.32
|
| Rate for Payer: BCBS MAPPO |
$27.22
|
| Rate for Payer: BCN Medicare Advantage |
$27.22
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$14.59
|
| Rate for Payer: Mclaren Medicare |
$27.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.58
|
| Rate for Payer: Meridian Medicaid |
$15.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PACE Medicare |
$25.86
|
| Rate for Payer: PACE SWMI |
$27.22
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$27.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health Medicare |
$27.22
|
| Rate for Payer: Priority Health SBD |
$65.55
|
| Rate for Payer: Railroad Medicare Medicare |
$27.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.22
|
| Rate for Payer: UHC Medicare Advantage |
$27.22
|
| Rate for Payer: UHCCP Medicaid |
$15.32
|
| Rate for Payer: VA VA |
$27.22
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
30100480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.55 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.63
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$72.83
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health SBD |
$65.55
|
|
|
HC PROCESS FEE
|
Facility
|
OP
|
$36.72
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.87
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
