|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$84.11
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$75.70 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Aetna Medicare |
$48.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.73
|
| Rate for Payer: BCBS Complete |
$25.80
|
| Rate for Payer: BCBS MAPPO |
$46.98
|
| Rate for Payer: BCBS Trust/PPO |
$50.10
|
| Rate for Payer: BCN Commercial |
$50.10
|
| Rate for Payer: BCN Medicare Advantage |
$46.98
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cofinity Advantage |
$58.88
|
| Rate for Payer: Cofinity Commercial |
$72.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$75.70
|
| Rate for Payer: Mclaren Medicaid |
$24.57
|
| Rate for Payer: Mclaren Medicare |
$46.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.33
|
| Rate for Payer: Meridian Medicaid |
$49.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$70.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.08
|
| Rate for Payer: PACE Medicare |
$44.63
|
| Rate for Payer: PACE SWMI |
$46.98
|
| Rate for Payer: PHP Commercial |
$71.49
|
| Rate for Payer: PHP Medicare Advantage |
$46.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46.98
|
| Rate for Payer: Priority Health Medicare |
$46.98
|
| Rate for Payer: Priority Health SBD |
$52.99
|
| Rate for Payer: Priority Health Tiered Network |
$37.58
|
| Rate for Payer: Railroad Medicare Medicare |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.47
|
| Rate for Payer: UHC Core |
$70.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.98
|
| Rate for Payer: UHC Exchange |
$70.47
|
| Rate for Payer: UHC Medicaid |
$24.57
|
| Rate for Payer: UHCCP Medicaid |
$24.57
|
| Rate for Payer: VA VA |
$46.98
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$67.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.91
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Advantage |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: Priority Health SBD |
$42.56
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$67.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$39.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.16
|
| Rate for Payer: BCBS Complete |
$20.72
|
| Rate for Payer: BCBS MAPPO |
$37.73
|
| Rate for Payer: BCBS Trust/PPO |
$40.23
|
| Rate for Payer: BCN Commercial |
$40.23
|
| Rate for Payer: BCN Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Advantage |
$47.28
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.73
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Mclaren Medicaid |
$19.73
|
| Rate for Payer: Mclaren Medicare |
$37.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.62
|
| Rate for Payer: Meridian Medicaid |
$39.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Nomi Health Commercial |
$56.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PACE Medicare |
$35.84
|
| Rate for Payer: PACE SWMI |
$37.73
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: PHP Medicare Advantage |
$37.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37.73
|
| Rate for Payer: Priority Health Medicare |
$37.73
|
| Rate for Payer: Priority Health SBD |
$42.56
|
| Rate for Payer: Priority Health Tiered Network |
$30.18
|
| Rate for Payer: Railroad Medicare Medicare |
$37.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.60
|
| Rate for Payer: UHC Core |
$56.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.73
|
| Rate for Payer: UHC Exchange |
$56.60
|
| Rate for Payer: UHC Medicaid |
$19.73
|
| Rate for Payer: UHCCP Medicaid |
$19.73
|
| Rate for Payer: VA VA |
$37.73
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,641.95
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$447.50 |
| Max. Negotiated Rate |
$3,277.76 |
| Rate for Payer: Aetna Commercial |
$3,095.66
|
| Rate for Payer: Aetna Medicare |
$889.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,069.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,069.56
|
| Rate for Payer: BCBS Complete |
$469.92
|
| Rate for Payer: BCBS MAPPO |
$855.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,933.50
|
| Rate for Payer: BCN Commercial |
$1,933.50
|
| Rate for Payer: BCN Medicare Advantage |
$855.65
|
| Rate for Payer: Cash Price |
$2,913.56
|
| Rate for Payer: Cash Price |
$2,913.56
|
| Rate for Payer: Cofinity Advantage |
$2,549.36
|
| Rate for Payer: Cofinity Commercial |
$3,132.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$855.65
|
| Rate for Payer: Healthscope Commercial |
$3,277.76
|
| Rate for Payer: Mclaren Medicaid |
$447.50
|
| Rate for Payer: Mclaren Medicare |
$855.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$898.43
|
| Rate for Payer: Meridian Medicaid |
$898.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$984.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$941.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.66
|
| Rate for Payer: Nomi Health Commercial |
$2,566.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.46
|
| Rate for Payer: PACE Medicare |
$812.87
|
| Rate for Payer: PACE SWMI |
$855.65
|
| Rate for Payer: PHP Commercial |
$3,095.66
|
| Rate for Payer: PHP Medicare Advantage |
$855.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,767.09
|
| Rate for Payer: Priority Health Medicare |
$855.65
|
| Rate for Payer: Priority Health SBD |
$2,294.43
|
| Rate for Payer: Priority Health Tiered Network |
$2,213.67
|
| Rate for Payer: Railroad Medicare Medicare |
$855.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,367.27
|
| Rate for Payer: UHC Core |
$1,897.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$855.65
|
| Rate for Payer: UHC Exchange |
$1,431.29
|
| Rate for Payer: UHC Medicaid |
$447.50
|
| Rate for Payer: UHCCP Medicaid |
$447.50
|
| Rate for Payer: VA VA |
$855.65
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,641.95
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,294.43 |
| Max. Negotiated Rate |
$3,277.76 |
| Rate for Payer: Aetna Commercial |
$3,095.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.27
|
| Rate for Payer: Cash Price |
$2,913.56
|
| Rate for Payer: Cofinity Advantage |
$2,549.36
|
| Rate for Payer: Cofinity Commercial |
$3,132.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.56
|
| Rate for Payer: Healthscope Commercial |
$3,277.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.46
|
| Rate for Payer: PHP Commercial |
$3,095.66
|
| Rate for Payer: Priority Health SBD |
$2,294.43
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$419.91
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$165.02 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna Medicare |
$209.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: BCBS Complete |
$167.96
|
| Rate for Payer: BCBS Trust/PPO |
$210.23
|
| Rate for Payer: BCN Commercial |
$210.23
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cofinity Advantage |
$293.94
|
| Rate for Payer: Cofinity Commercial |
$361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.93
|
| Rate for Payer: Healthscope Commercial |
$377.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health SBD |
$264.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.94
|
| Rate for Payer: UHC Core |
$218.77
|
| Rate for Payer: UHC Exchange |
$165.02
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$419.91
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$264.54 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.94
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cofinity Advantage |
$293.94
|
| Rate for Payer: Cofinity Commercial |
$361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.93
|
| Rate for Payer: Healthscope Commercial |
$377.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health SBD |
$264.54
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$322.46
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$274.09
|
| Rate for Payer: Aetna Medicare |
$161.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.60
|
| Rate for Payer: BCBS Complete |
$128.98
|
| Rate for Payer: BCBS Trust/PPO |
$210.23
|
| Rate for Payer: BCN Commercial |
$210.23
|
| Rate for Payer: Cash Price |
$257.97
|
| Rate for Payer: Cash Price |
$257.97
|
| Rate for Payer: Cofinity Advantage |
$225.72
|
| Rate for Payer: Cofinity Commercial |
$277.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.97
|
| Rate for Payer: Healthscope Commercial |
$290.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.84
|
| Rate for Payer: PHP Commercial |
$274.09
|
| Rate for Payer: Priority Health SBD |
$203.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.60
|
| Rate for Payer: UHC Core |
$168.00
|
| Rate for Payer: UHC Exchange |
$126.73
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$322.46
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$203.15 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$274.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.60
|
| Rate for Payer: Cash Price |
$257.97
|
| Rate for Payer: Cofinity Advantage |
$225.72
|
| Rate for Payer: Cofinity Commercial |
$277.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.97
|
| Rate for Payer: Healthscope Commercial |
$290.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.84
|
| Rate for Payer: PHP Commercial |
$274.09
|
| Rate for Payer: Priority Health SBD |
$203.15
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$112.58
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UHC Medicaid |
$1,608.00
|
| Rate for Payer: UHCCP Medicaid |
$810.00
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Advantage |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$5,170.88
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$3,257.65 |
| Max. Negotiated Rate |
$4,653.79 |
| Rate for Payer: Aetna Commercial |
$4,395.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,361.07
|
| Rate for Payer: Cash Price |
$4,136.70
|
| Rate for Payer: Cofinity Advantage |
$3,619.62
|
| Rate for Payer: Cofinity Commercial |
$4,446.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,136.70
|
| Rate for Payer: Healthscope Commercial |
$4,653.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,395.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,878.16
|
| Rate for Payer: PHP Commercial |
$4,395.25
|
| Rate for Payer: Priority Health SBD |
$3,257.65
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,926.69
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,213.81 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Advantage |
$1,348.68
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: Priority Health SBD |
$1,213.81
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,926.69
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,760.71 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna Medicare |
$566.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$680.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$680.56
|
| Rate for Payer: BCBS Complete |
$299.01
|
| Rate for Payer: BCBS MAPPO |
$544.45
|
| Rate for Payer: BCBS Trust/PPO |
$569.98
|
| Rate for Payer: BCN Commercial |
$569.98
|
| Rate for Payer: BCN Medicare Advantage |
$544.45
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Advantage |
$1,348.68
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.45
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Mclaren Medicaid |
$284.75
|
| Rate for Payer: Mclaren Medicare |
$544.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.67
|
| Rate for Payer: Meridian Medicaid |
$571.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$626.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$598.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,633.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PACE Medicare |
$517.23
|
| Rate for Payer: PACE SWMI |
$544.45
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: PHP Medicare Advantage |
$544.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,760.71
|
| Rate for Payer: Priority Health Medicare |
$544.45
|
| Rate for Payer: Priority Health SBD |
$1,213.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.57
|
| Rate for Payer: Railroad Medicare Medicare |
$544.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.35
|
| Rate for Payer: UHC Core |
$1,003.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$544.45
|
| Rate for Payer: UHC Exchange |
$757.19
|
| Rate for Payer: UHC Medicaid |
$284.75
|
| Rate for Payer: UHCCP Medicaid |
$284.75
|
| Rate for Payer: VA VA |
$544.45
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,213.81 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Advantage |
$1,348.68
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: Priority Health SBD |
$1,213.81
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$2,526.00 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna Medicare |
$812.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$976.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$976.38
|
| Rate for Payer: BCBS Complete |
$428.98
|
| Rate for Payer: BCBS MAPPO |
$781.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,123.15
|
| Rate for Payer: BCN Commercial |
$1,123.15
|
| Rate for Payer: BCN Medicare Advantage |
$781.10
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Advantage |
$1,348.68
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.10
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Mclaren Medicaid |
$408.52
|
| Rate for Payer: Mclaren Medicare |
$781.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.15
|
| Rate for Payer: Meridian Medicaid |
$820.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$898.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$859.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$2,343.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PACE Medicare |
$742.04
|
| Rate for Payer: PACE SWMI |
$781.10
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: PHP Medicare Advantage |
$781.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,526.00
|
| Rate for Payer: Priority Health Medicare |
$781.10
|
| Rate for Payer: Priority Health SBD |
$1,213.81
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.80
|
| Rate for Payer: Railroad Medicare Medicare |
$781.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.35
|
| Rate for Payer: UHC Core |
$1,003.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$781.10
|
| Rate for Payer: UHC Exchange |
$757.19
|
| Rate for Payer: UHC Medicaid |
$408.52
|
| Rate for Payer: UHCCP Medicaid |
$408.52
|
| Rate for Payer: VA VA |
$781.10
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$4.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.35
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS MAPPO |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.28
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.28
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$2.24
|
| Rate for Payer: Mclaren Medicare |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.49
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$6.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$4.07
|
| Rate for Payer: PACE SWMI |
$4.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health SBD |
$18.72
|
| Rate for Payer: Priority Health Tiered Network |
$3.42
|
| Rate for Payer: Railroad Medicare Medicare |
$4.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.42
|
| Rate for Payer: UHC Core |
$6.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.28
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.28
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: Priority Health SBD |
$18.72
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$5.34
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$10.36
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Mclaren Medicaid |
$5.08
|
| Rate for Payer: Mclaren Medicare |
$9.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$14.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PACE Medicare |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health SBD |
$41.95
|
| Rate for Payer: Priority Health Tiered Network |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.72
|
| Rate for Payer: UHC Exchange |
$14.58
|
| Rate for Payer: UHC Medicaid |
$5.08
|
| Rate for Payer: UHCCP Medicaid |
$5.08
|
| Rate for Payer: VA VA |
$9.72
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.95 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.28
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Advantage |
$46.61
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health SBD |
$41.95
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$108.25
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Advantage |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$109.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$114.61
|
| Rate for Payer: Mclaren Medicaid |
$13.03
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$37.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$108.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$80.23
|
| Rate for Payer: Priority Health Tiered Network |
$19.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.37
|
| Rate for Payer: UHC Core |
$37.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.91
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$13.03
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.23 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$108.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.78
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Advantage |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$109.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Healthscope Commercial |
$114.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PHP Commercial |
$108.25
|
| Rate for Payer: Priority Health SBD |
$80.23
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health SBD |
$69.09
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.21
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$14.57
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.57
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Advantage |
$76.76
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Mclaren Medicaid |
$7.62
|
| Rate for Payer: Mclaren Medicare |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.30
|
| Rate for Payer: Meridian Medicaid |
$15.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$21.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Medicare |
$13.84
|
| Rate for Payer: PACE SWMI |
$14.57
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$14.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.57
|
| Rate for Payer: Priority Health Medicare |
$14.57
|
| Rate for Payer: Priority Health SBD |
$69.09
|
| Rate for Payer: Priority Health Tiered Network |
$11.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Core |
$21.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.57
|
| Rate for Payer: UHC Exchange |
$21.86
|
| Rate for Payer: UHC Medicaid |
$7.62
|
| Rate for Payer: UHCCP Medicaid |
$7.62
|
| Rate for Payer: VA VA |
$14.57
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.09 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.04
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Advantage |
$33.43
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.82
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health SBD |
$30.09
|
|
