|
HC CAST SUP SHT ARM PED FBRGLAS
|
Facility
|
IP
|
$20.40
|
|
| Hospital Charge Code |
27200330
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC CAST SUP SHT ARM SPLINT FBRG
|
Facility
|
IP
|
$25.50
|
|
| Hospital Charge Code |
27200334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC CAST SUP SHT ARM SPLINT FBRG
|
Facility
|
OP
|
$25.50
|
|
| Hospital Charge Code |
27200334
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC CAST SUP SHT ARM SPLNT PED F
|
Facility
|
OP
|
$27.54
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.02 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: BCBS Complete |
$11.02
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health SBD |
$17.35
|
|
|
HC CAST SUP SHT ARM SPLNT PED F
|
Facility
|
IP
|
$27.54
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health SBD |
$17.35
|
|
|
HC CAST SUP SHT GAUNTLET FIBERGLASS
|
Facility
|
OP
|
$56.10
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: BCBS Complete |
$22.44
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health SBD |
$35.34
|
|
|
HC CAST SUP SHT GAUNTLET FIBERGLASS
|
Facility
|
IP
|
$56.10
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.46
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$39.27
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health SBD |
$35.34
|
|
|
HC CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
IP
|
$30.60
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.28 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC CAST SUP SHT LEG SPLNT FBRGL
|
Facility
|
OP
|
$30.60
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.89
|
| Rate for Payer: BCBS Complete |
$12.24
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health SBD |
$19.28
|
|
|
HC CAST SUP SHT LEG SPLNT PED F
|
Facility
|
IP
|
$25.50
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC CAST SUP SHT LEG SPLNT PED F
|
Facility
|
OP
|
$25.50
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$488.11
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$439.30 |
| Rate for Payer: Aetna Commercial |
$414.89
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$119.49
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$390.49
|
| Rate for Payer: Cash Price |
$390.49
|
| Rate for Payer: Cofinity Commercial |
$341.68
|
| Rate for Payer: Cofinity Commercial |
$419.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$439.30
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.89
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$414.89
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.68
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$307.51
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$96.60
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$488.11
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$307.51 |
| Max. Negotiated Rate |
$439.30 |
| Rate for Payer: Aetna Commercial |
$414.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.27
|
| Rate for Payer: Cash Price |
$390.49
|
| Rate for Payer: Cofinity Commercial |
$419.77
|
| Rate for Payer: Cofinity Commercial |
$341.68
|
| Rate for Payer: Healthscope Commercial |
$439.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.89
|
| Rate for Payer: PHP Commercial |
$414.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.68
|
| Rate for Payer: Priority Health SBD |
$307.51
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$351.62
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$316.46 |
| Rate for Payer: Aetna Commercial |
$298.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$246.13
|
| Rate for Payer: Cofinity Commercial |
$302.39
|
| Rate for Payer: Healthscope Commercial |
$316.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.88
|
| Rate for Payer: PHP Commercial |
$298.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.13
|
| Rate for Payer: Priority Health SBD |
$221.52
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$351.62
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$316.46 |
| Rate for Payer: Aetna Commercial |
$298.88
|
| Rate for Payer: Aetna Medicare |
$248.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$298.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$298.70
|
| Rate for Payer: BCBS Complete |
$137.26
|
| Rate for Payer: BCBS MAPPO |
$238.96
|
| Rate for Payer: BCBS Trust/PPO |
$39.70
|
| Rate for Payer: BCN Medicare Advantage |
$238.96
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cash Price |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$302.39
|
| Rate for Payer: Cofinity Commercial |
$246.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.96
|
| Rate for Payer: Healthscope Commercial |
$316.46
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Mclaren Medicare |
$238.96
|
| Rate for Payer: Meridian Medicaid |
$137.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.88
|
| Rate for Payer: PACE Medicare |
$227.01
|
| Rate for Payer: PACE SWMI |
$238.96
|
| Rate for Payer: PHP Commercial |
$298.88
|
| Rate for Payer: PHP Medicare Advantage |
$238.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.13
|
| Rate for Payer: Priority Health Medicare |
$238.96
|
| Rate for Payer: Priority Health SBD |
$221.52
|
| Rate for Payer: Railroad Medicare Medicare |
$238.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.96
|
| Rate for Payer: UHC Exchange |
$67.45
|
| Rate for Payer: UHC Medicare Advantage |
$246.13
|
| Rate for Payer: VA VA |
$238.96
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$190.11
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$119.77 |
| Max. Negotiated Rate |
$171.10 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health SBD |
$119.77
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$190.11
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$175.25 |
| Rate for Payer: Aetna Commercial |
$161.59
|
| Rate for Payer: Aetna Medicare |
$145.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.25
|
| Rate for Payer: BCBS Complete |
$80.53
|
| Rate for Payer: BCBS MAPPO |
$140.20
|
| Rate for Payer: BCBS Trust/PPO |
$25.68
|
| Rate for Payer: BCN Medicare Advantage |
$140.20
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cash Price |
$152.09
|
| Rate for Payer: Cofinity Commercial |
$163.49
|
| Rate for Payer: Cofinity Commercial |
$133.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.20
|
| Rate for Payer: Healthscope Commercial |
$171.10
|
| Rate for Payer: Mclaren Medicaid |
$76.69
|
| Rate for Payer: Mclaren Medicare |
$140.20
|
| Rate for Payer: Meridian Medicaid |
$80.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.59
|
| Rate for Payer: PACE Medicare |
$133.19
|
| Rate for Payer: PACE SWMI |
$140.20
|
| Rate for Payer: PHP Commercial |
$161.59
|
| Rate for Payer: PHP Medicare Advantage |
$140.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.08
|
| Rate for Payer: Priority Health Medicare |
$140.20
|
| Rate for Payer: Priority Health SBD |
$119.77
|
| Rate for Payer: Railroad Medicare Medicare |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.20
|
| Rate for Payer: UHC Exchange |
$43.88
|
| Rate for Payer: UHC Medicare Advantage |
$144.41
|
| Rate for Payer: VA VA |
$140.20
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$59.16
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Aetna Commercial |
$50.29
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$14.50
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$19.78
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$53.24
|
| Rate for Payer: Mclaren Medicaid |
$13.81
|
| Rate for Payer: Mclaren Medicare |
$25.25
|
| Rate for Payer: Meridian Medicaid |
$14.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.29
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$50.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health SBD |
$37.27
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.30
|
| Rate for Payer: UHC Core |
$42.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.25
|
| Rate for Payer: UHC Exchange |
$25.25
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$59.16
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$53.24 |
| Rate for Payer: Aetna Commercial |
$50.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.45
|
| Rate for Payer: Cash Price |
$47.33
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$53.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.29
|
| Rate for Payer: PHP Commercial |
$50.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: Priority Health SBD |
$37.27
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$56.71
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.73 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.86
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cofinity Commercial |
$39.70
|
| Rate for Payer: Cofinity Commercial |
$48.77
|
| Rate for Payer: Healthscope Commercial |
$51.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.20
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health SBD |
$35.73
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$56.71
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$48.20
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.12
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cash Price |
$45.37
|
| Rate for Payer: Cofinity Commercial |
$39.70
|
| Rate for Payer: Cofinity Commercial |
$48.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$51.04
|
| Rate for Payer: Mclaren Medicaid |
$14.93
|
| Rate for Payer: Mclaren Medicare |
$27.30
|
| Rate for Payer: Meridian Medicaid |
$15.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.20
|
| Rate for Payer: PACE Medicare |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$48.20
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.70
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health SBD |
$35.73
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.76
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.30
|
| Rate for Payer: UHC Exchange |
$27.30
|
| Rate for Payer: UHC Medicare Advantage |
$28.12
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health SBD |
$44.98
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
IP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,524.02 |
| Max. Negotiated Rate |
$5,034.31 |
| Rate for Payer: Aetna Commercial |
$4,754.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,635.89
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$3,915.58
|
| Rate for Payer: Cofinity Commercial |
$4,810.56
|
| Rate for Payer: Healthscope Commercial |
$5,034.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: PHP Commercial |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: Priority Health SBD |
$3,524.02
|
|
|
HC CATH ATHRECT ROTATIONAL LVL 5
|
Facility
|
OP
|
$5,593.68
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,034.31 |
| Rate for Payer: Aetna Commercial |
$4,754.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,635.89
|
| Rate for Payer: BCBS Complete |
$2,237.47
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cash Price |
$4,474.94
|
| Rate for Payer: Cofinity Commercial |
$4,810.56
|
| Rate for Payer: Cofinity Commercial |
$3,915.58
|
| Rate for Payer: Healthscope Commercial |
$5,034.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,754.63
|
| Rate for Payer: PHP Commercial |
$4,754.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,915.58
|
| Rate for Payer: Priority Health SBD |
$3,524.02
|
|
