|
HC VITAMIN K LEVEL
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
30100459
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna Medicare |
$14.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.15
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: BCBS MAPPO |
$13.72
|
| Rate for Payer: BCN Medicare Advantage |
$13.72
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.72
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Mclaren Medicaid |
$7.35
|
| Rate for Payer: Mclaren Medicare |
$13.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.41
|
| Rate for Payer: Meridian Medicaid |
$7.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.04
|
| Rate for Payer: PACE Medicare |
$13.03
|
| Rate for Payer: PACE SWMI |
$13.72
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: PHP Medicare Advantage |
$13.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.56
|
| Rate for Payer: Priority Health Medicare |
$13.72
|
| Rate for Payer: Priority Health SBD |
$77.11
|
| Rate for Payer: Railroad Medicare Medicare |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.72
|
| Rate for Payer: UHC Medicare Advantage |
$13.72
|
| Rate for Payer: UHCCP Medicaid |
$7.72
|
| Rate for Payer: VA VA |
$13.72
|
|
|
HC VMA AND HVA 4 HOUR RANDOM URINE
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.27
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health SBD |
$56.55
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA AND HVA 4 HOUR RANDOM URINE
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.34
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health SBD |
$56.55
|
|
|
HC VMA AND HVA 4 HR RANDOM URINE CMPT
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health SBD |
$32.12
|
|
|
HC VMA AND HVA 4 HR RANDOM URINE CMPT
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$23.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: BCBS Complete |
$12.61
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$43.84
|
| Rate for Payer: Cofinity Commercial |
$35.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$43.33
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health SBD |
$32.12
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.41
|
| Rate for Payer: UHC Medicare Advantage |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$12.62
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC VMA RANDOM URINE
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC VMA RANDOM URINE
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$43.63 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.27
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA URINE
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$43.63 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.27
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health SBD |
$30.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA URINE
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$43.15 |
| Rate for Payer: Aetna Commercial |
$40.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.16
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Cofinity Commercial |
$41.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: PHP Commercial |
$40.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health SBD |
$30.20
|
|
|
HC VNUS ABLATION FIRST VEIN
|
Facility
|
OP
|
$5,127.14
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
36100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$4,358.07
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,332.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cofinity Commercial |
$4,409.34
|
| Rate for Payer: Cofinity Commercial |
$3,589.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,589.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,101.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$4,614.43
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.07
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$4,358.07
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.64
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$3,230.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
HC VNUS ABLATION FIRST VEIN
|
Facility
|
IP
|
$5,127.14
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
36100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,230.10 |
| Max. Negotiated Rate |
$4,614.43 |
| Rate for Payer: Aetna Commercial |
$4,358.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,332.64
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cofinity Commercial |
$3,589.00
|
| Rate for Payer: Cofinity Commercial |
$4,409.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,589.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,101.71
|
| Rate for Payer: Healthscope Commercial |
$4,614.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.07
|
| Rate for Payer: PHP Commercial |
$4,358.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.64
|
| Rate for Payer: Priority Health SBD |
$3,230.10
|
|
|
HC VNUS ABLATION SUBSEQ VEINS
|
Facility
|
IP
|
$2,505.14
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
36100436
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,578.24 |
| Max. Negotiated Rate |
$2,254.63 |
| Rate for Payer: Aetna Commercial |
$2,129.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.34
|
| Rate for Payer: Cash Price |
$2,004.11
|
| Rate for Payer: Cofinity Commercial |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$2,154.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,753.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.11
|
| Rate for Payer: Healthscope Commercial |
$2,254.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,129.37
|
| Rate for Payer: PHP Commercial |
$2,129.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,628.34
|
| Rate for Payer: Priority Health SBD |
$1,578.24
|
|
|
HC VNUS ABLATION SUBSEQ VEINS
|
Facility
|
OP
|
$2,505.14
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
36100436
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.06 |
| Max. Negotiated Rate |
$2,254.63 |
| Rate for Payer: Aetna Commercial |
$2,129.37
|
| Rate for Payer: Aetna Medicare |
$1,252.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.34
|
| Rate for Payer: BCBS Complete |
$1,002.06
|
| Rate for Payer: Cash Price |
$2,004.11
|
| Rate for Payer: Cofinity Commercial |
$1,753.60
|
| Rate for Payer: Cofinity Commercial |
$2,154.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,753.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.11
|
| Rate for Payer: Healthscope Commercial |
$2,254.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,129.37
|
| Rate for Payer: PHP Commercial |
$2,129.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,628.34
|
| Rate for Payer: Priority Health SBD |
$1,578.24
|
|
|
HC VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Facility
|
OP
|
$262.22
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
76100193
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$222.89
|
| Rate for Payer: Aetna Medicare |
$131.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.44
|
| Rate for Payer: BCBS Complete |
$104.89
|
| Rate for Payer: Cash Price |
$209.78
|
| Rate for Payer: Cofinity Commercial |
$183.55
|
| Rate for Payer: Cofinity Commercial |
$225.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.78
|
| Rate for Payer: Healthscope Commercial |
$236.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.89
|
| Rate for Payer: PHP Commercial |
$222.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.44
|
| Rate for Payer: Priority Health SBD |
$165.20
|
| Rate for Payer: UHC Core |
$194.04
|
| Rate for Payer: UHC Exchange |
$194.04
|
|
|
HC VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Facility
|
IP
|
$262.22
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
76100193
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$222.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.44
|
| Rate for Payer: Cash Price |
$209.78
|
| Rate for Payer: Cofinity Commercial |
$183.55
|
| Rate for Payer: Cofinity Commercial |
$225.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.78
|
| Rate for Payer: Healthscope Commercial |
$236.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.89
|
| Rate for Payer: PHP Commercial |
$222.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.44
|
| Rate for Payer: Priority Health SBD |
$165.20
|
|
|
HC VOLUME MEASUREMENT
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
30700006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health SBD |
$12.39
|
|
|
HC VOLUME MEASUREMENT
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
30700006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$2.05
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$13.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Mclaren Medicaid |
$1.95
|
| Rate for Payer: Mclaren Medicare |
$3.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$2.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: PACE Medicare |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health Medicare |
$3.64
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$2.05
|
| Rate for Payer: VA VA |
$3.64
|
|
|
HC VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30000059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.90
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Cofinity Commercial |
$177.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$185.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.10
|
| Rate for Payer: PHP Commercial |
$175.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health SBD |
$129.78
|
|
|
HC VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30000059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$177.16
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$185.40
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.10
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$175.10
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$129.78
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$17.37
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC VON WILLEBRAND MULTIMETRIC ANALYSIS
|
Facility
|
OP
|
$95.88
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
30500028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$86.29 |
| Rate for Payer: Aetna Commercial |
$81.50
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.50
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$81.50
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.32
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health SBD |
$60.40
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.92
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC VON WILLEBRAND MULTIMETRIC ANALYSIS
|
Facility
|
IP
|
$95.88
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
30500028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$86.29 |
| Rate for Payer: Aetna Commercial |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.32
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$82.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.70
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.50
|
| Rate for Payer: PHP Commercial |
$81.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.32
|
| Rate for Payer: Priority Health SBD |
$60.40
|
|
|
HC VON WILLEBRAND PANEL
|
Facility
|
OP
|
$129.01
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$109.66
|
| Rate for Payer: Aetna Medicare |
$32.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: BCBS Complete |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Commercial |
$110.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$116.11
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.66
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$109.66
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$17.37
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC VON WILLEBRAND PANEL
|
Facility
|
IP
|
$129.01
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.28 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$109.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.86
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cofinity Commercial |
$110.95
|
| Rate for Payer: Cofinity Commercial |
$90.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.21
|
| Rate for Payer: Healthscope Commercial |
$116.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.66
|
| Rate for Payer: PHP Commercial |
$109.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health SBD |
$81.28
|
|
