|
HC METHANOL LVL
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Medicare |
$79.56
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: ASR Commercial |
$154.35
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: BCBS Trust/PPO |
$130.30
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.42
|
| Rate for Payer: Priority Health Narrow Network |
$111.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC METHANOL LVL
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100581
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.43 |
| Max. Negotiated Rate |
$159.12 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: ASR ASR |
$154.35
|
| Rate for Payer: ASR Commercial |
$154.35
|
| Rate for Payer: BCBS Trust/PPO |
$129.67
|
| Rate for Payer: BCN Commercial |
$123.37
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$149.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$159.12
|
| Rate for Payer: Healthscope Whirlpool |
$154.35
|
| Rate for Payer: Mclaren Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.03
|
|
|
HC METHEMOGLOBIN
|
Facility
|
OP
|
$47.02
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$69.18 |
| Rate for Payer: Aetna Commercial |
$42.32
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.25
|
| Rate for Payer: ASR ASR |
$45.61
|
| Rate for Payer: ASR Commercial |
$45.61
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: BCBS MAPPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$36.45
|
| Rate for Payer: BCN Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$44.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$47.02
|
| Rate for Payer: Healthscope Whirlpool |
$45.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$8.20
|
| Rate for Payer: Mclaren Commercial |
$42.32
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Mclaren Medicare |
$8.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.61
|
| Rate for Payer: Meridian Medicaid |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.97
|
| Rate for Payer: Nomi Health Commercial |
$38.56
|
| Rate for Payer: PACE Medicare |
$7.79
|
| Rate for Payer: PACE SWMI |
$8.20
|
| Rate for Payer: PHP Commercial |
$9.02
|
| Rate for Payer: PHP Medicaid |
$4.40
|
| Rate for Payer: PHP Medicare Advantage |
$8.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.18
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health Narrow Network |
$55.34
|
| Rate for Payer: Railroad Medicare Medicare |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.20
|
| Rate for Payer: UHC Exchange |
$12.71
|
| Rate for Payer: UHC Medicare Advantage |
$8.20
|
| Rate for Payer: UHCCP DNSP |
$8.20
|
| Rate for Payer: UHCCP Medicaid |
$4.40
|
| Rate for Payer: VA VA |
$8.20
|
|
|
HC METHEMOGLOBIN
|
Facility
|
IP
|
$47.02
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100239
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$47.02 |
| Rate for Payer: Aetna Commercial |
$42.32
|
| Rate for Payer: ASR ASR |
$45.61
|
| Rate for Payer: ASR Commercial |
$45.61
|
| Rate for Payer: BCBS Trust/PPO |
$38.32
|
| Rate for Payer: BCN Commercial |
$36.45
|
| Rate for Payer: Cash Price |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$44.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.62
|
| Rate for Payer: Healthscope Commercial |
$47.02
|
| Rate for Payer: Healthscope Whirlpool |
$45.61
|
| Rate for Payer: Mclaren Commercial |
$42.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.97
|
| Rate for Payer: Nomi Health Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.38
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
IP
|
$176.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.03 |
| Max. Negotiated Rate |
$176.97 |
| Rate for Payer: Aetna Commercial |
$159.27
|
| Rate for Payer: ASR ASR |
$171.66
|
| Rate for Payer: ASR Commercial |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$144.21
|
| Rate for Payer: BCN Commercial |
$137.20
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cofinity Commercial |
$166.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.58
|
| Rate for Payer: Healthscope Commercial |
$176.97
|
| Rate for Payer: Healthscope Whirlpool |
$171.66
|
| Rate for Payer: Mclaren Commercial |
$159.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.42
|
| Rate for Payer: Nomi Health Commercial |
$145.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.73
|
|
|
HC METHOTREXATE LEVEL
|
Facility
|
OP
|
$176.97
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100064
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$245.96 |
| Rate for Payer: Aetna Commercial |
$159.27
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.30
|
| Rate for Payer: ASR ASR |
$171.66
|
| Rate for Payer: ASR Commercial |
$171.66
|
| Rate for Payer: BCBS Complete |
$10.49
|
| Rate for Payer: BCBS MAPPO |
$18.64
|
| Rate for Payer: BCBS Trust/PPO |
$144.92
|
| Rate for Payer: BCN Commercial |
$137.20
|
| Rate for Payer: BCN Medicare Advantage |
$18.64
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cash Price |
$141.58
|
| Rate for Payer: Cofinity Commercial |
$166.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.64
|
| Rate for Payer: Healthscope Commercial |
$176.97
|
| Rate for Payer: Healthscope Whirlpool |
$171.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.64
|
| Rate for Payer: Mclaren Commercial |
$159.27
|
| Rate for Payer: Mclaren Medicaid |
$9.99
|
| Rate for Payer: Mclaren Medicare |
$18.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.57
|
| Rate for Payer: Meridian Medicaid |
$10.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.42
|
| Rate for Payer: Nomi Health Commercial |
$145.12
|
| Rate for Payer: PACE Medicare |
$17.71
|
| Rate for Payer: PACE SWMI |
$18.64
|
| Rate for Payer: PHP Commercial |
$20.50
|
| Rate for Payer: PHP Medicaid |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$18.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.96
|
| Rate for Payer: Priority Health Medicare |
$18.64
|
| Rate for Payer: Priority Health Narrow Network |
$196.77
|
| Rate for Payer: Railroad Medicare Medicare |
$18.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.64
|
| Rate for Payer: UHC Exchange |
$28.89
|
| Rate for Payer: UHC Medicare Advantage |
$18.64
|
| Rate for Payer: UHCCP DNSP |
$18.64
|
| Rate for Payer: UHCCP Medicaid |
$9.99
|
| Rate for Payer: VA VA |
$18.64
|
|
|
HC METHYLMALONIC ACID
|
Facility
|
OP
|
$62.33
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
30100373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$142.75 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: Aetna Medicare |
$21.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.51
|
| Rate for Payer: ASR ASR |
$60.46
|
| Rate for Payer: ASR Commercial |
$60.46
|
| Rate for Payer: BCBS Complete |
$11.94
|
| Rate for Payer: BCBS MAPPO |
$21.21
|
| Rate for Payer: BCBS Trust/PPO |
$51.04
|
| Rate for Payer: BCN Commercial |
$48.32
|
| Rate for Payer: BCN Medicare Advantage |
$21.21
|
| Rate for Payer: Cash Price |
$49.86
|
| Rate for Payer: Cash Price |
$49.86
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.21
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Whirlpool |
$60.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.21
|
| Rate for Payer: Mclaren Commercial |
$56.10
|
| Rate for Payer: Mclaren Medicaid |
$11.37
|
| Rate for Payer: Mclaren Medicare |
$21.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.27
|
| Rate for Payer: Meridian Medicaid |
$11.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.98
|
| Rate for Payer: Nomi Health Commercial |
$51.11
|
| Rate for Payer: PACE Medicare |
$20.15
|
| Rate for Payer: PACE SWMI |
$21.21
|
| Rate for Payer: PHP Commercial |
$23.33
|
| Rate for Payer: PHP Medicaid |
$11.37
|
| Rate for Payer: PHP Medicare Advantage |
$21.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.75
|
| Rate for Payer: Priority Health Medicare |
$21.21
|
| Rate for Payer: Priority Health Narrow Network |
$114.20
|
| Rate for Payer: Railroad Medicare Medicare |
$21.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.21
|
| Rate for Payer: UHC Exchange |
$32.88
|
| Rate for Payer: UHC Medicare Advantage |
$21.21
|
| Rate for Payer: UHCCP DNSP |
$21.21
|
| Rate for Payer: UHCCP Medicaid |
$11.37
|
| Rate for Payer: VA VA |
$21.21
|
|
|
HC METHYLMALONIC ACID
|
Facility
|
IP
|
$62.33
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
30100373
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.51 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Aetna Commercial |
$56.10
|
| Rate for Payer: ASR ASR |
$60.46
|
| Rate for Payer: ASR Commercial |
$60.46
|
| Rate for Payer: BCBS Trust/PPO |
$50.79
|
| Rate for Payer: BCN Commercial |
$48.32
|
| Rate for Payer: Cash Price |
$49.86
|
| Rate for Payer: Cofinity Commercial |
$58.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.86
|
| Rate for Payer: Healthscope Commercial |
$62.33
|
| Rate for Payer: Healthscope Whirlpool |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$56.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.98
|
| Rate for Payer: Nomi Health Commercial |
$51.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.85
|
|
|
HC MFM CORDOCENTESIS
|
Facility
|
IP
|
$437.63
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
36100262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.46 |
| Max. Negotiated Rate |
$437.63 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Trust/PPO |
$356.62
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
|
|
HC MFM CORDOCENTESIS
|
Facility
|
OP
|
$437.63
|
|
|
Service Code
|
CPT 59012
|
| Hospital Charge Code |
36100262
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$461.96 |
| Rate for Payer: Aetna Commercial |
$393.87
|
| Rate for Payer: Aetna Medicare |
$298.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: ASR ASR |
$424.50
|
| Rate for Payer: ASR Commercial |
$424.50
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$358.38
|
| Rate for Payer: BCN Commercial |
$339.29
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cofinity Commercial |
$411.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Healthscope Commercial |
$437.63
|
| Rate for Payer: Healthscope Whirlpool |
$424.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$298.04
|
| Rate for Payer: Mclaren Commercial |
$393.87
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.99
|
| Rate for Payer: Nomi Health Commercial |
$358.86
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Commercial |
$327.84
|
| Rate for Payer: PHP Medicaid |
$159.75
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.45
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$306.78
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$461.96
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP DNSP |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
HC MG EVALUATION WITH MUSK REFLEX, S
|
Facility
|
IP
|
$83.47
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$83.47 |
| Rate for Payer: Aetna Commercial |
$75.12
|
| Rate for Payer: ASR ASR |
$80.97
|
| Rate for Payer: ASR Commercial |
$80.97
|
| Rate for Payer: BCBS Trust/PPO |
$68.02
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$78.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.78
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Healthscope Whirlpool |
$80.97
|
| Rate for Payer: Mclaren Commercial |
$75.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.95
|
| Rate for Payer: Nomi Health Commercial |
$68.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.45
|
|
|
HC MG EVALUATION WITH MUSK REFLEX, S
|
Facility
|
OP
|
$83.47
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000160
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$75.12
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: ASR ASR |
$80.97
|
| Rate for Payer: ASR Commercial |
$80.97
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$68.35
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$66.78
|
| Rate for Payer: Cash Price |
$66.78
|
| Rate for Payer: Cofinity Commercial |
$78.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$83.47
|
| Rate for Payer: Healthscope Whirlpool |
$80.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.27
|
| Rate for Payer: Mclaren Commercial |
$75.12
|
| Rate for Payer: Mclaren Medicaid |
$9.26
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$9.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.95
|
| Rate for Payer: Nomi Health Commercial |
$68.45
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$19.00
|
| Rate for Payer: PHP Medicaid |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health Narrow Network |
$250.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.27
|
| Rate for Payer: UHC Exchange |
$26.77
|
| Rate for Payer: UHC Medicare Advantage |
$17.27
|
| Rate for Payer: UHCCP DNSP |
$17.27
|
| Rate for Payer: UHCCP Medicaid |
$9.26
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC MG EVALUATION W REFLEX
|
Facility
|
IP
|
$81.15
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$81.15 |
| Rate for Payer: Aetna Commercial |
$73.04
|
| Rate for Payer: ASR ASR |
$78.72
|
| Rate for Payer: ASR Commercial |
$78.72
|
| Rate for Payer: BCBS Trust/PPO |
$66.13
|
| Rate for Payer: BCN Commercial |
$62.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Healthscope Commercial |
$81.15
|
| Rate for Payer: Healthscope Whirlpool |
$78.72
|
| Rate for Payer: Mclaren Commercial |
$73.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
|
|
HC MG EVALUATION W REFLEX
|
Facility
|
OP
|
$81.15
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$73.04
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$78.72
|
| Rate for Payer: ASR Commercial |
$78.72
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$66.45
|
| Rate for Payer: BCN Commercial |
$62.92
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cash Price |
$64.92
|
| Rate for Payer: Cofinity Commercial |
$76.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$81.15
|
| Rate for Payer: Healthscope Whirlpool |
$78.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$73.04
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.98
|
| Rate for Payer: Nomi Health Commercial |
$66.54
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.40
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC MGLUR1 AB CBA, S
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200464
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: ASR Commercial |
$247.35
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$208.82
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MGLUR1 AB CBA, S
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200464
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: ASR ASR |
$247.35
|
| Rate for Payer: ASR Commercial |
$247.35
|
| Rate for Payer: BCBS Trust/PPO |
$207.80
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$239.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.00
|
| Rate for Payer: Healthscope Commercial |
$255.00
|
| Rate for Payer: Healthscope Whirlpool |
$247.35
|
| Rate for Payer: Mclaren Commercial |
$229.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.75
|
| Rate for Payer: Nomi Health Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.40
|
|
|
HC MGLUR1 AB IFA, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200465
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$227.29 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MGLUR1 AB IFA, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200465
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC MGLUR1 AB IFA TITER, S
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$227.29 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$63.90
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.05
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$13.26
|
| Rate for Payer: PHP Medicaid |
$6.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.29
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$181.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC MGLUR1 AB IFA TITER, S
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200466
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$78.03 |
| Rate for Payer: Aetna Commercial |
$70.23
|
| Rate for Payer: ASR ASR |
$75.69
|
| Rate for Payer: ASR Commercial |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$63.59
|
| Rate for Payer: BCN Commercial |
$60.50
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$73.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$78.03
|
| Rate for Payer: Healthscope Whirlpool |
$75.69
|
| Rate for Payer: Mclaren Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.67
|
|
|
HC M. GRAVIS EVAL, ADULT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: ASR Commercial |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$58.50
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$71.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.64
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
|
|
HC M. GRAVIS EVAL, ADULT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100603
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: ASR Commercial |
$69.64
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$58.79
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$71.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.40
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT
|
Facility
|
OP
|
$71.79
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$210.82 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: Aetna Medicare |
$18.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.00
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: ASR Commercial |
$69.64
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS MAPPO |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$58.79
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.40
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$71.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.40
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Mclaren Medicaid |
$9.86
|
| Rate for Payer: Mclaren Medicare |
$18.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.32
|
| Rate for Payer: Meridian Medicaid |
$10.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: PACE Medicare |
$17.48
|
| Rate for Payer: PACE SWMI |
$18.40
|
| Rate for Payer: PHP Commercial |
$20.24
|
| Rate for Payer: PHP Medicaid |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.82
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow Network |
$168.66
|
| Rate for Payer: Railroad Medicare Medicare |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.40
|
| Rate for Payer: UHC Exchange |
$28.52
|
| Rate for Payer: UHC Medicare Advantage |
$18.40
|
| Rate for Payer: UHCCP DNSP |
$18.40
|
| Rate for Payer: UHCCP Medicaid |
$9.86
|
| Rate for Payer: VA VA |
$18.40
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
30100604
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: ASR Commercial |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$58.50
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$71.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.64
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
|
|
HC M. GRAVIS EVAL, ADULT CMPT2
|
Facility
|
IP
|
$71.79
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100605
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$71.79 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: ASR ASR |
$69.64
|
| Rate for Payer: ASR Commercial |
$69.64
|
| Rate for Payer: BCBS Trust/PPO |
$58.50
|
| Rate for Payer: BCN Commercial |
$55.66
|
| Rate for Payer: Cash Price |
$57.43
|
| Rate for Payer: Cofinity Commercial |
$67.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.43
|
| Rate for Payer: Healthscope Commercial |
$71.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.64
|
| Rate for Payer: Mclaren Commercial |
$64.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.02
|
| Rate for Payer: Nomi Health Commercial |
$58.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.18
|
|
