|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$542.58
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$341.83 |
| Max. Negotiated Rate |
$488.32 |
| Rate for Payer: Aetna Commercial |
$461.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.68
|
| Rate for Payer: Cash Price |
$434.06
|
| Rate for Payer: Cofinity Advantage |
$379.81
|
| Rate for Payer: Cofinity Commercial |
$466.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.06
|
| Rate for Payer: Healthscope Commercial |
$488.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.94
|
| Rate for Payer: PHP Commercial |
$461.19
|
| Rate for Payer: Priority Health SBD |
$341.83
|
|
|
HC BURN CARE SMALL
|
Facility
|
OP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Commercial |
$316.62
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$148.89
|
| Rate for Payer: BCN Commercial |
$148.89
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Advantage |
$260.75
|
| Rate for Payer: Cofinity Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$335.25
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$316.62
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$234.68
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.12
|
| Rate for Payer: UHC Core |
$194.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$146.39
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$372.50
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.68 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Aetna Commercial |
$316.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.12
|
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Cofinity Advantage |
$260.75
|
| Rate for Payer: Cofinity Commercial |
$320.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.00
|
| Rate for Payer: Healthscope Commercial |
$335.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.38
|
| Rate for Payer: PHP Commercial |
$316.62
|
| Rate for Payer: Priority Health SBD |
$234.68
|
|
|
HC BURN R&B
|
Facility
|
IP
|
$7,587.64
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$4,780.21 |
| Max. Negotiated Rate |
$6,828.88 |
| Rate for Payer: Aetna Commercial |
$6,449.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,931.97
|
| Rate for Payer: Cash Price |
$6,070.11
|
| Rate for Payer: Cofinity Advantage |
$5,311.35
|
| Rate for Payer: Cofinity Commercial |
$6,525.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,070.11
|
| Rate for Payer: Healthscope Commercial |
$6,828.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,449.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,690.73
|
| Rate for Payer: PHP Commercial |
$6,449.49
|
| Rate for Payer: Priority Health SBD |
$4,780.21
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.86 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.43
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Advantage |
$159.84
|
| Rate for Payer: Cofinity Commercial |
$196.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Healthscope Commercial |
$205.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: PHP Commercial |
$194.10
|
| Rate for Payer: Priority Health SBD |
$143.86
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$228.35
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.74 |
| Max. Negotiated Rate |
$292.17 |
| Rate for Payer: Aetna Commercial |
$194.10
|
| Rate for Payer: Aetna Medicare |
$114.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.43
|
| Rate for Payer: BCBS Complete |
$91.34
|
| Rate for Payer: BCBS Trust/PPO |
$292.17
|
| Rate for Payer: BCN Commercial |
$292.17
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cash Price |
$182.68
|
| Rate for Payer: Cofinity Advantage |
$159.84
|
| Rate for Payer: Cofinity Commercial |
$196.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.68
|
| Rate for Payer: Healthscope Commercial |
$205.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.26
|
| Rate for Payer: PHP Commercial |
$194.10
|
| Rate for Payer: Priority Health SBD |
$143.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.43
|
| Rate for Payer: UHC Core |
$118.97
|
| Rate for Payer: UHC Exchange |
$89.74
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$77.47
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$69.72 |
| Rate for Payer: Aetna Commercial |
$65.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$54.23
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.10
|
| Rate for Payer: PHP Commercial |
$65.85
|
| Rate for Payer: Priority Health SBD |
$48.81
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna Medicare |
$17.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.59
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: BCBS MAPPO |
$17.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCN Commercial |
$18.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.27
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Advantage |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$65.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.27
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Mclaren Medicaid |
$9.03
|
| Rate for Payer: Mclaren Medicare |
$17.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.13
|
| Rate for Payer: Meridian Medicaid |
$18.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Nomi Health Commercial |
$25.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE Medicare |
$16.41
|
| Rate for Payer: PACE SWMI |
$17.27
|
| Rate for Payer: PHP Commercial |
$64.60
|
| Rate for Payer: PHP Medicare Advantage |
$17.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.27
|
| Rate for Payer: Priority Health Medicare |
$17.27
|
| Rate for Payer: Priority Health SBD |
$47.88
|
| Rate for Payer: Priority Health Tiered Network |
$13.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.91
|
| Rate for Payer: UHC Core |
$25.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.27
|
| Rate for Payer: UHC Exchange |
$25.91
|
| Rate for Payer: UHC Medicaid |
$9.03
|
| Rate for Payer: UHCCP Medicaid |
$9.03
|
| Rate for Payer: VA VA |
$17.27
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$64.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Advantage |
$53.20
|
| Rate for Payer: Cofinity Commercial |
$65.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.80
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PHP Commercial |
$64.60
|
| Rate for Payer: Priority Health SBD |
$47.88
|
|
|
HC C1Q BINDING
|
Facility
|
OP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: Aetna Medicare |
$25.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.46
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.99
|
| Rate for Payer: BCN Commercial |
$25.99
|
| Rate for Payer: BCN Medicare Advantage |
$24.37
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Advantage |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Mclaren Medicare |
$24.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.59
|
| Rate for Payer: Meridian Medicaid |
$25.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Nomi Health Commercial |
$36.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PACE Medicare |
$23.15
|
| Rate for Payer: PACE SWMI |
$24.37
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$24.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.37
|
| Rate for Payer: Priority Health Medicare |
$24.37
|
| Rate for Payer: Priority Health SBD |
$72.75
|
| Rate for Payer: Priority Health Tiered Network |
$19.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.56
|
| Rate for Payer: UHC Core |
$36.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.37
|
| Rate for Payer: UHC Exchange |
$36.56
|
| Rate for Payer: UHC Medicaid |
$12.75
|
| Rate for Payer: UHCCP Medicaid |
$12.75
|
| Rate for Payer: VA VA |
$24.37
|
|
|
HC C1Q BINDING
|
Facility
|
IP
|
$115.48
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200193
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$103.93 |
| Rate for Payer: Aetna Commercial |
$98.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.06
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cofinity Advantage |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.38
|
| Rate for Payer: Healthscope Commercial |
$103.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.61
|
| Rate for Payer: PHP Commercial |
$98.16
|
| Rate for Payer: Priority Health SBD |
$72.75
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$44.13
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC C1Q COMPL COMPONENT, S
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200409
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: Priority Health SBD |
$44.13
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
IP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.47
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Advantage |
$54.35
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: PHP Commercial |
$66.00
|
| Rate for Payer: Priority Health SBD |
$48.92
|
|
|
HC C2 COMPLEMENT, FUNCTIONAL, S
|
Facility
|
OP
|
$77.65
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200483
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$66.00
|
| Rate for Payer: Aetna Medicare |
$12.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.00
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS MAPPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: BCN Medicare Advantage |
$12.00
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cash Price |
$62.12
|
| Rate for Payer: Cofinity Advantage |
$54.35
|
| Rate for Payer: Cofinity Commercial |
$66.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.00
|
| Rate for Payer: Healthscope Commercial |
$69.89
|
| Rate for Payer: Mclaren Medicaid |
$6.28
|
| Rate for Payer: Mclaren Medicare |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Medicaid |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.00
|
| Rate for Payer: Nomi Health Commercial |
$18.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.24
|
| Rate for Payer: PACE Medicare |
$11.40
|
| Rate for Payer: PACE SWMI |
$12.00
|
| Rate for Payer: PHP Commercial |
$66.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Medicare |
$12.00
|
| Rate for Payer: Priority Health SBD |
$48.92
|
| Rate for Payer: Priority Health Tiered Network |
$9.60
|
| Rate for Payer: Railroad Medicare Medicare |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$18.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.00
|
| Rate for Payer: UHC Exchange |
$18.00
|
| Rate for Payer: UHC Medicaid |
$6.28
|
| Rate for Payer: UHCCP Medicaid |
$6.28
|
| Rate for Payer: VA VA |
$12.00
|
|
|
HC CA 125
|
Facility
|
OP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$133.99 |
| Rate for Payer: Aetna Commercial |
$126.55
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.19
|
| Rate for Payer: BCN Commercial |
$22.19
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Advantage |
$104.22
|
| Rate for Payer: Cofinity Commercial |
$128.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$133.99
|
| Rate for Payer: Mclaren Medicaid |
$10.88
|
| Rate for Payer: Mclaren Medicare |
$20.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$21.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Nomi Health Commercial |
$31.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PACE Medicare |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$126.55
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.81
|
| Rate for Payer: Priority Health Medicare |
$20.81
|
| Rate for Payer: Priority Health SBD |
$93.79
|
| Rate for Payer: Priority Health Tiered Network |
$16.65
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.22
|
| Rate for Payer: UHC Core |
$31.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.81
|
| Rate for Payer: UHC Exchange |
$31.22
|
| Rate for Payer: UHC Medicaid |
$10.88
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$20.81
|
|
|
HC CA 125
|
Facility
|
IP
|
$148.88
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
30200185
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$93.79 |
| Max. Negotiated Rate |
$133.99 |
| Rate for Payer: Aetna Commercial |
$126.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.77
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cofinity Advantage |
$104.22
|
| Rate for Payer: Cofinity Commercial |
$128.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.10
|
| Rate for Payer: Healthscope Commercial |
$133.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.66
|
| Rate for Payer: PHP Commercial |
$126.55
|
| Rate for Payer: Priority Health SBD |
$93.79
|
|
|
HC CADMIUM LEVEL
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Aetna Medicare |
$24.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.55
|
| Rate for Payer: BCBS Complete |
$12.98
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$25.20
|
| Rate for Payer: BCN Commercial |
$25.20
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Advantage |
$34.73
|
| Rate for Payer: Cofinity Commercial |
$42.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Mclaren Medicaid |
$12.36
|
| Rate for Payer: Mclaren Medicare |
$23.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Nomi Health Commercial |
$35.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: PACE Medicare |
$22.46
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Commercial |
$42.17
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.64
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health SBD |
$31.25
|
| Rate for Payer: Priority Health Tiered Network |
$18.91
|
| Rate for Payer: Railroad Medicare Medicare |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.46
|
| Rate for Payer: UHC Core |
$35.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.64
|
| Rate for Payer: UHC Exchange |
$35.46
|
| Rate for Payer: UHC Medicaid |
$12.36
|
| Rate for Payer: UHCCP Medicaid |
$12.36
|
| Rate for Payer: VA VA |
$23.64
|
|
|
HC CADMIUM LEVEL
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100124
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.25 |
| Max. Negotiated Rate |
$44.65 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.25
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cofinity Advantage |
$34.73
|
| Rate for Payer: Cofinity Commercial |
$42.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.69
|
| Rate for Payer: Healthscope Commercial |
$44.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.21
|
| Rate for Payer: PHP Commercial |
$42.17
|
| Rate for Payer: Priority Health SBD |
$31.25
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
IP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Aetna Commercial |
$101.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.95
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Advantage |
$83.94
|
| Rate for Payer: Cofinity Commercial |
$103.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Healthscope Commercial |
$107.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: PHP Commercial |
$101.93
|
| Rate for Payer: Priority Health SBD |
$75.55
|
|
|
HC CAFFEINE LEVEL
|
Facility
|
OP
|
$119.92
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
30100063
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$107.93 |
| Rate for Payer: Aetna Commercial |
$101.93
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.21
|
| Rate for Payer: BCBS Complete |
$21.18
|
| Rate for Payer: BCBS MAPPO |
$38.57
|
| Rate for Payer: BCBS Trust/PPO |
$41.13
|
| Rate for Payer: BCN Commercial |
$41.13
|
| Rate for Payer: BCN Medicare Advantage |
$38.57
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cash Price |
$95.94
|
| Rate for Payer: Cofinity Advantage |
$83.94
|
| Rate for Payer: Cofinity Commercial |
$103.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.57
|
| Rate for Payer: Healthscope Commercial |
$107.93
|
| Rate for Payer: Mclaren Medicaid |
$20.17
|
| Rate for Payer: Mclaren Medicare |
$38.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.50
|
| Rate for Payer: Meridian Medicaid |
$40.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.93
|
| Rate for Payer: Nomi Health Commercial |
$57.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.94
|
| Rate for Payer: PACE Medicare |
$36.64
|
| Rate for Payer: PACE SWMI |
$38.57
|
| Rate for Payer: PHP Commercial |
$101.93
|
| Rate for Payer: PHP Medicare Advantage |
$38.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.57
|
| Rate for Payer: Priority Health Medicare |
$38.57
|
| Rate for Payer: Priority Health SBD |
$75.55
|
| Rate for Payer: Priority Health Tiered Network |
$30.86
|
| Rate for Payer: Railroad Medicare Medicare |
$38.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.86
|
| Rate for Payer: UHC Core |
$57.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.57
|
| Rate for Payer: UHC Exchange |
$57.86
|
| Rate for Payer: UHC Medicaid |
$20.17
|
| Rate for Payer: UHCCP Medicaid |
$20.17
|
| Rate for Payer: VA VA |
$38.57
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna Medicare |
$27.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.49
|
| Rate for Payer: BCBS Complete |
$14.71
|
| Rate for Payer: BCBS MAPPO |
$26.79
|
| Rate for Payer: BCBS Trust/PPO |
$28.56
|
| Rate for Payer: BCN Commercial |
$28.56
|
| Rate for Payer: BCN Medicare Advantage |
$26.79
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.79
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Mclaren Medicaid |
$14.01
|
| Rate for Payer: Mclaren Medicare |
$26.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.13
|
| Rate for Payer: Meridian Medicaid |
$28.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Nomi Health Commercial |
$40.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PACE Medicare |
$25.45
|
| Rate for Payer: PACE SWMI |
$26.79
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: PHP Medicare Advantage |
$26.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.79
|
| Rate for Payer: Priority Health Medicare |
$26.79
|
| Rate for Payer: Priority Health SBD |
$44.13
|
| Rate for Payer: Priority Health Tiered Network |
$21.43
|
| Rate for Payer: Railroad Medicare Medicare |
$26.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.19
|
| Rate for Payer: UHC Core |
$40.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.79
|
| Rate for Payer: UHC Exchange |
$40.19
|
| Rate for Payer: UHC Medicaid |
$14.01
|
| Rate for Payer: UHCCP Medicaid |
$14.01
|
| Rate for Payer: VA VA |
$26.79
|
|
|
HC CALCITONIN LEVEL
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
30100128
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$63.04 |
| Rate for Payer: Aetna Commercial |
$59.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Cofinity Advantage |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$60.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.03
|
| Rate for Payer: Healthscope Commercial |
$63.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.53
|
| Rate for Payer: PHP Commercial |
$59.53
|
| Rate for Payer: Priority Health SBD |
$44.13
|
|
|
HC CALCIUM ALGINATE AG 4X4
|
Facility
|
IP
|
$27.42
|
|
| Hospital Charge Code |
27000461
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Cash Price |
$21.94
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$23.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$24.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.57
|
| Rate for Payer: PHP Commercial |
$23.31
|
| Rate for Payer: Priority Health SBD |
$17.27
|
|
