|
HC CAST SUP SHT ARM PED FBRGLS
|
Facility
|
IP
|
$20.81
|
|
| Hospital Charge Code |
27200330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC CAST SUP SHT ARM SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST SUP SHT ARM SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST SUP SHT ARM SPLINT ADULT PLST
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
27200359
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health SBD |
$6.30
|
|
|
HC CAST SUP SHT ARM SPLINT ADULT PLST
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
27200359
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health SBD |
$6.30
|
|
|
HC CAST SUP SHT ARM SPLINT PED FBRGLS
|
Facility
|
OP
|
$28.09
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
|
|
HC CAST SUP SHT ARM SPLINT PED FBRGLS
|
Facility
|
IP
|
$28.09
|
|
| Hospital Charge Code |
27200335
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
|
|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
IP
|
$57.22
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC CAST SUP SHT GAUNTLET FBRGLS
|
Facility
|
OP
|
$57.22
|
|
| Hospital Charge Code |
27200331
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.89 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: BCBS Complete |
$22.89
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.05
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
IP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC CAST SUP SHT LEG SPLINT ADULT FBRGLS
|
Facility
|
OP
|
$31.21
|
|
| Hospital Charge Code |
27200341
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.29
|
| Rate for Payer: BCBS Complete |
$12.48
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$21.85
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health SBD |
$19.66
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
IP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST SUP SHT LEG SPLINT PED FBRGLS
|
Facility
|
OP
|
$26.01
|
|
| Hospital Charge Code |
27200342
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$13.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health SBD |
$16.39
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
OP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Cofinity Commercial |
$348.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$313.66
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST TOTAL CONTACT
|
Facility
|
IP
|
$497.87
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
70000021
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$313.66 |
| Max. Negotiated Rate |
$448.08 |
| Rate for Payer: Aetna Commercial |
$423.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.62
|
| Rate for Payer: Cash Price |
$398.30
|
| Rate for Payer: Cofinity Commercial |
$348.51
|
| Rate for Payer: Cofinity Commercial |
$428.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$348.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$398.30
|
| Rate for Payer: Healthscope Commercial |
$448.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.19
|
| Rate for Payer: PHP Commercial |
$423.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.62
|
| Rate for Payer: Priority Health SBD |
$313.66
|
|
|
HC CAST WEDGE
|
Facility
|
IP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$225.95 |
| Max. Negotiated Rate |
$322.79 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.12
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$251.06
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Healthscope Commercial |
$322.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health SBD |
$225.95
|
|
|
HC CAST WEDGE
|
Facility
|
OP
|
$358.65
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
70000019
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$729.09 |
| Rate for Payer: Aetna Commercial |
$304.85
|
| Rate for Payer: Aetna Medicare |
$269.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.76
|
| Rate for Payer: BCBS Complete |
$145.77
|
| Rate for Payer: BCBS MAPPO |
$259.01
|
| Rate for Payer: BCN Medicare Advantage |
$259.01
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cash Price |
$286.92
|
| Rate for Payer: Cofinity Commercial |
$308.44
|
| Rate for Payer: Cofinity Commercial |
$251.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.01
|
| Rate for Payer: Healthscope Commercial |
$322.79
|
| Rate for Payer: Mclaren Medicaid |
$138.83
|
| Rate for Payer: Mclaren Medicare |
$259.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$271.96
|
| Rate for Payer: Meridian Medicaid |
$145.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: PACE Medicare |
$246.06
|
| Rate for Payer: PACE SWMI |
$259.01
|
| Rate for Payer: PHP Commercial |
$304.85
|
| Rate for Payer: PHP Medicare Advantage |
$259.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.12
|
| Rate for Payer: Priority Health Medicare |
$259.01
|
| Rate for Payer: Priority Health SBD |
$225.95
|
| Rate for Payer: Railroad Medicare Medicare |
$259.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.01
|
| Rate for Payer: UHC Medicare Advantage |
$259.01
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$259.01
|
|
|
HC CAST WINDOW
|
Facility
|
OP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$433.18 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna Medicare |
$160.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.36
|
| Rate for Payer: BCBS Complete |
$86.61
|
| Rate for Payer: BCBS MAPPO |
$153.89
|
| Rate for Payer: BCN Medicare Advantage |
$153.89
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.89
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Mclaren Medicaid |
$82.49
|
| Rate for Payer: Mclaren Medicare |
$153.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.58
|
| Rate for Payer: Meridian Medicaid |
$86.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: PACE Medicare |
$146.20
|
| Rate for Payer: PACE SWMI |
$153.89
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: PHP Medicare Advantage |
$153.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health Medicare |
$153.89
|
| Rate for Payer: Priority Health SBD |
$122.16
|
| Rate for Payer: Railroad Medicare Medicare |
$153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.89
|
| Rate for Payer: UHC Medicare Advantage |
$153.89
|
| Rate for Payer: UHCCP Medicaid |
$86.64
|
| Rate for Payer: VA VA |
$153.89
|
|
|
HC CAST WINDOW
|
Facility
|
IP
|
$193.91
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
70000018
|
|
Hospital Revenue Code
|
700
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$164.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.04
|
| Rate for Payer: Cash Price |
$155.13
|
| Rate for Payer: Cofinity Commercial |
$135.74
|
| Rate for Payer: Cofinity Commercial |
$166.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.13
|
| Rate for Payer: Healthscope Commercial |
$174.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.82
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.04
|
| Rate for Payer: Priority Health SBD |
$122.16
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
IP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$54.31 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health SBD |
$38.01
|
|
|
HC CATECHOLAMINE FRACTION URINE
|
Facility
|
OP
|
$60.34
|
|
|
Service Code
|
CPT 82384
|
| Hospital Charge Code |
30100139
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$71.08 |
| Rate for Payer: Aetna Commercial |
$51.29
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.22
|
| 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 |
$14.21
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cash Price |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$51.89
|
| Rate for Payer: Cofinity Commercial |
$42.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$54.31
|
| Rate for Payer: Mclaren Medicaid |
$13.53
|
| Rate for Payer: Mclaren Medicare |
$25.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Medicaid |
$14.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.29
|
| Rate for Payer: PACE Medicare |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$51.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.22
|
| Rate for Payer: Priority Health Medicare |
$25.25
|
| Rate for Payer: Priority Health SBD |
$38.01
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.25
|
| Rate for Payer: UHC Medicare Advantage |
$25.25
|
| Rate for Payer: UHCCP Medicaid |
$14.22
|
| Rate for Payer: VA VA |
$25.25
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
OP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$76.85 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: Aetna Medicare |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.60
|
| 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 |
$15.36
|
| Rate for Payer: BCBS MAPPO |
$27.30
|
| Rate for Payer: BCN Medicare Advantage |
$27.30
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Cofinity Commercial |
$40.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.30
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Mclaren Medicaid |
$14.63
|
| Rate for Payer: Mclaren Medicare |
$27.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.66
|
| Rate for Payer: Meridian Medicaid |
$15.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: PACE Medicare |
$25.93
|
| Rate for Payer: PACE SWMI |
$27.30
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: PHP Medicare Advantage |
$27.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health SBD |
$36.44
|
| Rate for Payer: Railroad Medicare Medicare |
$27.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.30
|
| Rate for Payer: UHC Medicare Advantage |
$27.30
|
| Rate for Payer: UHCCP Medicaid |
$15.37
|
| Rate for Payer: VA VA |
$27.30
|
|
|
HC CATECHOLAMINES RANDOM URINE
|
Facility
|
IP
|
$57.84
|
|
|
Service Code
|
CPT 82382
|
| Hospital Charge Code |
30100138
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$52.06 |
| Rate for Payer: Aetna Commercial |
$49.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.60
|
| Rate for Payer: Cash Price |
$46.27
|
| Rate for Payer: Cofinity Commercial |
$40.49
|
| Rate for Payer: Cofinity Commercial |
$49.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.16
|
| Rate for Payer: PHP Commercial |
$49.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health SBD |
$36.44
|
|
|
HC CATFISH IGE
|
Facility
|
OP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$45.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.94
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC CATFISH IGE
|
Facility
|
IP
|
$72.83
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200480
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$61.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: Cash Price |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$50.98
|
| Rate for Payer: Cofinity Commercial |
$62.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.26
|
| Rate for Payer: Healthscope Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.91
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.34
|
| Rate for Payer: Priority Health SBD |
$45.88
|
|
