|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna Medicare |
$505.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.27
|
| Rate for Payer: BCBS Complete |
$404.48
|
| Rate for Payer: BCBS Trust/PPO |
$372.45
|
| Rate for Payer: BCN Commercial |
$372.45
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Advantage |
$707.83
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: Priority Health SBD |
$637.05
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.05 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.27
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Advantage |
$707.83
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: Priority Health SBD |
$637.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.81
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$16.05
|
| Rate for Payer: BCN Commercial |
$16.05
|
| Rate for Payer: BCN Medicare Advantage |
$15.05
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Mclaren Medicaid |
$7.87
|
| Rate for Payer: Mclaren Medicare |
$15.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.80
|
| Rate for Payer: Meridian Medicaid |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PACE Medicare |
$14.30
|
| Rate for Payer: PACE SWMI |
$15.05
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$15.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.05
|
| Rate for Payer: Priority Health Medicare |
$15.05
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health Tiered Network |
$12.04
|
| Rate for Payer: Railroad Medicare Medicare |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.58
|
| Rate for Payer: UHC Core |
$22.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.05
|
| Rate for Payer: UHC Exchange |
$22.58
|
| Rate for Payer: UHC Medicaid |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$7.87
|
| Rate for Payer: VA VA |
$15.05
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| 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 Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| 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: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$58.99
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.61
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Advantage |
$192.35
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: Priority Health SBD |
$173.12
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: Aetna Medicare |
$159.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.88
|
| Rate for Payer: BCBS Complete |
$84.30
|
| Rate for Payer: BCBS MAPPO |
$153.50
|
| Rate for Payer: BCBS Trust/PPO |
$163.67
|
| Rate for Payer: BCN Commercial |
$163.67
|
| Rate for Payer: BCN Medicare Advantage |
$153.50
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Advantage |
$192.35
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.50
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Mclaren Medicaid |
$80.28
|
| Rate for Payer: Mclaren Medicare |
$153.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.18
|
| Rate for Payer: Meridian Medicaid |
$161.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$230.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PACE Medicare |
$145.82
|
| Rate for Payer: PACE SWMI |
$153.50
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: PHP Medicare Advantage |
$153.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$153.50
|
| Rate for Payer: Priority Health Medicare |
$153.50
|
| Rate for Payer: Priority Health SBD |
$173.12
|
| Rate for Payer: Priority Health Tiered Network |
$122.80
|
| Rate for Payer: Railroad Medicare Medicare |
$153.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.25
|
| Rate for Payer: UHC Core |
$230.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$153.50
|
| Rate for Payer: UHC Exchange |
$230.25
|
| Rate for Payer: UHC Medicaid |
$80.28
|
| Rate for Payer: UHCCP Medicaid |
$80.28
|
| Rate for Payer: VA VA |
$153.50
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$1,891.39
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$500.58
|
| Rate for Payer: BCN Commercial |
$500.58
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Advantage |
$1,557.61
|
| Rate for Payer: Cofinity Commercial |
$1,913.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$2,002.64
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$1,891.39
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$1,401.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,401.85 |
| Max. Negotiated Rate |
$2,002.64 |
| Rate for Payer: Aetna Commercial |
$1,891.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,446.35
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Advantage |
$1,557.61
|
| Rate for Payer: Cofinity Commercial |
$1,913.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Healthscope Commercial |
$2,002.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: PHP Commercial |
$1,891.39
|
| Rate for Payer: Priority Health SBD |
$1,401.85
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,832.22 |
| Max. Negotiated Rate |
$26,665.62 |
| Rate for Payer: Aetna Commercial |
$3,821.25
|
| Rate for Payer: Aetna Medicare |
$8,575.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,922.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,307.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,307.04
|
| Rate for Payer: BCBS Complete |
$4,528.50
|
| Rate for Payer: BCBS MAPPO |
$8,245.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,986.94
|
| Rate for Payer: BCN Commercial |
$4,986.94
|
| Rate for Payer: BCN Medicare Advantage |
$8,245.63
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Advantage |
$3,146.91
|
| Rate for Payer: Cofinity Commercial |
$3,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,245.63
|
| Rate for Payer: Healthscope Commercial |
$4,046.03
|
| Rate for Payer: Mclaren Medicaid |
$4,312.46
|
| Rate for Payer: Mclaren Medicare |
$8,245.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,657.91
|
| Rate for Payer: Meridian Medicaid |
$8,657.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,482.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,070.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Nomi Health Commercial |
$24,736.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: PACE Medicare |
$7,833.35
|
| Rate for Payer: PACE SWMI |
$8,245.63
|
| Rate for Payer: PHP Commercial |
$3,821.25
|
| Rate for Payer: PHP Medicare Advantage |
$8,245.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,312.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,665.62
|
| Rate for Payer: Priority Health Medicare |
$8,245.63
|
| Rate for Payer: Priority Health SBD |
$2,832.22
|
| Rate for Payer: Priority Health Tiered Network |
$21,332.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,245.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,245.63
|
| Rate for Payer: UHC Medicaid |
$4,312.46
|
| Rate for Payer: UHCCP Medicaid |
$4,312.46
|
| Rate for Payer: VA VA |
$8,245.63
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,832.22 |
| Max. Negotiated Rate |
$4,046.03 |
| Rate for Payer: Aetna Commercial |
$3,821.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,922.13
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Advantage |
$3,146.91
|
| Rate for Payer: Cofinity Commercial |
$3,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Healthscope Commercial |
$4,046.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: PHP Commercial |
$3,821.25
|
| Rate for Payer: Priority Health SBD |
$2,832.22
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,189.32 |
| Max. Negotiated Rate |
$9,593.86 |
| Rate for Payer: Aetna Commercial |
$9,060.86
|
| Rate for Payer: Aetna Medicare |
$5,329.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,928.90
|
| Rate for Payer: BCBS Complete |
$4,263.94
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Advantage |
$7,461.89
|
| Rate for Payer: Cofinity Commercial |
$9,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Healthscope Commercial |
$9,593.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,527.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: PHP Commercial |
$9,060.86
|
| Rate for Payer: Priority Health SBD |
$6,715.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,928.90
|
| Rate for Payer: UHC Core |
$5,553.78
|
| Rate for Payer: UHC Exchange |
$4,189.32
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,715.70 |
| Max. Negotiated Rate |
$9,593.86 |
| Rate for Payer: Aetna Commercial |
$9,060.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,928.90
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Advantage |
$7,461.89
|
| Rate for Payer: Cofinity Commercial |
$9,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Healthscope Commercial |
$9,593.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: PHP Commercial |
$9,060.86
|
| Rate for Payer: Priority Health SBD |
$6,715.70
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Advantage |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health SBD |
$42.79
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna Medicare |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.73
|
| Rate for Payer: BCBS Complete |
$17.01
|
| Rate for Payer: BCBS MAPPO |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$33.04
|
| Rate for Payer: BCN Commercial |
$33.04
|
| Rate for Payer: BCN Medicare Advantage |
$30.98
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Advantage |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Mclaren Medicaid |
$16.20
|
| Rate for Payer: Mclaren Medicare |
$30.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.53
|
| Rate for Payer: Meridian Medicaid |
$32.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$46.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PACE Medicare |
$29.43
|
| Rate for Payer: PACE SWMI |
$30.98
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: PHP Medicare Advantage |
$30.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30.98
|
| Rate for Payer: Priority Health Medicare |
$30.98
|
| Rate for Payer: Priority Health SBD |
$42.79
|
| Rate for Payer: Priority Health Tiered Network |
$24.78
|
| Rate for Payer: Railroad Medicare Medicare |
$30.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.47
|
| Rate for Payer: UHC Core |
$46.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.98
|
| Rate for Payer: UHC Exchange |
$46.47
|
| Rate for Payer: UHC Medicaid |
$16.20
|
| Rate for Payer: UHCCP Medicaid |
$16.20
|
| Rate for Payer: VA VA |
$30.98
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$352.32
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Advantage |
$246.62
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Nomi Health Commercial |
$27.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.24
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.37
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$221.96
|
| Rate for Payer: Priority Health Tiered Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.37
|
| Rate for Payer: UHC Exchange |
$27.56
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$352.32
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$221.96 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.01
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Advantage |
$246.62
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.24
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: Priority Health SBD |
$221.96
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$107.18
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.67
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Advantage |
$75.03
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: Priority Health SBD |
$67.52
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$107.18
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Advantage |
$75.03
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Nomi Health Commercial |
$27.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.37
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$67.52
|
| Rate for Payer: Priority Health Tiered Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.37
|
| Rate for Payer: UHC Exchange |
$27.56
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.40
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Advantage |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: Priority Health SBD |
$262.08
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Advantage |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$27.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.37
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$262.08
|
| Rate for Payer: Priority Health Tiered Network |
$14.70
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$27.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.37
|
| Rate for Payer: UHC Exchange |
$27.56
|
| Rate for Payer: UHC Medicaid |
$9.61
|
| Rate for Payer: UHCCP Medicaid |
$9.61
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.75
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| 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 |
$63.18
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| 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 |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$67.12
|
| 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 |
$49.75
|
| 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 SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.75 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.75
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.33
|
| 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 |
$63.18
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Advantage |
$55.28
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| 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 |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$67.12
|
| 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 |
$49.75
|
| 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 SESAME SEED IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
