|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| 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 |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| 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 |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| 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 |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| 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 ORCHARD GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$24.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.50
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.48
|
| Rate for Payer: BCN Medicare Advantage |
$23.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.60
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Mclaren Medicaid |
$12.91
|
| Rate for Payer: Mclaren Medicare |
$23.60
|
| Rate for Payer: Meridian Medicaid |
$13.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Medicare |
$22.42
|
| Rate for Payer: PACE SWMI |
$23.60
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Medicare Advantage |
$23.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health Medicare |
$23.60
|
| Rate for Payer: Priority Health SBD |
$46.62
|
| Rate for Payer: Railroad Medicare Medicare |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.32
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.60
|
| Rate for Payer: UHC Exchange |
$23.60
|
| Rate for Payer: UHC Medicare Advantage |
$24.31
|
| Rate for Payer: VA VA |
$23.60
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health SBD |
$46.62
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$29.58
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.23
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health SBD |
$18.64
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$29.58
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$28.71 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.23
|
| Rate for Payer: BCBS Complete |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$28.71
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health SBD |
$18.64
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$120.85
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$108.76 |
| Rate for Payer: Aetna Commercial |
$102.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.55
|
| Rate for Payer: BCBS Complete |
$48.34
|
| Rate for Payer: BCBS Trust/PPO |
$42.86
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$103.93
|
| Rate for Payer: Healthscope Commercial |
$108.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.72
|
| Rate for Payer: PHP Commercial |
$102.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.60
|
| Rate for Payer: Priority Health SBD |
$76.14
|
| Rate for Payer: UHC Core |
$61.40
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
IP
|
$120.85
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$108.76 |
| Rate for Payer: Aetna Commercial |
$102.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.55
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$103.93
|
| Rate for Payer: Cofinity Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$108.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.72
|
| Rate for Payer: PHP Commercial |
$102.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.60
|
| Rate for Payer: Priority Health SBD |
$76.14
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.86
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC Core |
$61.40
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
OP
|
$126.91
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.76 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Aetna Commercial |
$107.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.49
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: BCBS Trust/PPO |
$53.18
|
| Rate for Payer: Cash Price |
$101.53
|
| Rate for Payer: Cash Price |
$101.53
|
| Rate for Payer: Cofinity Commercial |
$109.14
|
| Rate for Payer: Cofinity Commercial |
$88.84
|
| Rate for Payer: Healthscope Commercial |
$114.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.87
|
| Rate for Payer: PHP Commercial |
$107.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.55
|
| Rate for Payer: UHC Exchange |
$51.41
|
|
|
HC ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
IP
|
$126.91
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Aetna Commercial |
$107.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.49
|
| Rate for Payer: Cash Price |
$101.53
|
| Rate for Payer: Cofinity Commercial |
$109.14
|
| Rate for Payer: Cofinity Commercial |
$88.84
|
| Rate for Payer: Healthscope Commercial |
$114.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.87
|
| Rate for Payer: PHP Commercial |
$107.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health SBD |
$79.95
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
IP
|
$122.43
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.13 |
| Max. Negotiated Rate |
$110.19 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.58
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cofinity Commercial |
$105.29
|
| Rate for Payer: Cofinity Commercial |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.07
|
| Rate for Payer: PHP Commercial |
$104.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.70
|
| Rate for Payer: Priority Health SBD |
$77.13
|
|
|
HC ORTHOTIC FIT/TRAIN INITIAL EA 15 MIN
|
Facility
|
OP
|
$122.43
|
|
|
Service Code
|
CPT 97760
|
| Hospital Charge Code |
42000039
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$110.19 |
| Rate for Payer: Aetna Commercial |
$104.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.58
|
| Rate for Payer: BCBS Complete |
$48.97
|
| Rate for Payer: BCBS Trust/PPO |
$48.50
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cash Price |
$97.94
|
| Rate for Payer: Cofinity Commercial |
$85.70
|
| Rate for Payer: Cofinity Commercial |
$105.29
|
| Rate for Payer: Healthscope Commercial |
$110.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.07
|
| Rate for Payer: PHP Commercial |
$104.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.70
|
| Rate for Payer: Priority Health SBD |
$77.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.50
|
| Rate for Payer: UHC Exchange |
$46.82
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
IP
|
$2,363.12
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,488.77 |
| Max. Negotiated Rate |
$2,126.81 |
| Rate for Payer: Aetna Commercial |
$2,008.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,536.03
|
| Rate for Payer: Cash Price |
$1,890.50
|
| Rate for Payer: Cofinity Commercial |
$2,032.28
|
| Rate for Payer: Cofinity Commercial |
$1,654.18
|
| Rate for Payer: Healthscope Commercial |
$2,126.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,008.65
|
| Rate for Payer: PHP Commercial |
$2,008.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.18
|
| Rate for Payer: Priority Health SBD |
$1,488.77
|
|
|
HC OSCILLATOR INIT DAY
|
Facility
|
OP
|
$2,363.12
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000039
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$82.90 |
| Max. Negotiated Rate |
$2,126.81 |
| Rate for Payer: Aetna Commercial |
$2,008.65
|
| Rate for Payer: Aetna Medicare |
$579.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,536.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.00
|
| Rate for Payer: BCBS Complete |
$320.29
|
| Rate for Payer: BCBS MAPPO |
$557.60
|
| Rate for Payer: BCBS Trust/PPO |
$82.90
|
| Rate for Payer: BCN Medicare Advantage |
$557.60
|
| Rate for Payer: Cash Price |
$1,890.50
|
| Rate for Payer: Cash Price |
$1,890.50
|
| Rate for Payer: Cofinity Commercial |
$2,032.28
|
| Rate for Payer: Cofinity Commercial |
$1,654.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$2,126.81
|
| Rate for Payer: Mclaren Medicaid |
$305.01
|
| Rate for Payer: Mclaren Medicare |
$557.60
|
| Rate for Payer: Meridian Medicaid |
$320.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$585.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,008.65
|
| Rate for Payer: PACE Medicare |
$529.72
|
| Rate for Payer: PACE SWMI |
$557.60
|
| Rate for Payer: PHP Commercial |
$2,008.65
|
| Rate for Payer: PHP Medicare Advantage |
$557.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,654.18
|
| Rate for Payer: Priority Health Medicare |
$557.60
|
| Rate for Payer: Priority Health SBD |
$1,488.77
|
| Rate for Payer: Railroad Medicare Medicare |
$557.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.60
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$574.33
|
| Rate for Payer: VA VA |
$557.60
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
IP
|
$1,321.84
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$832.76 |
| Max. Negotiated Rate |
$1,189.66 |
| Rate for Payer: Aetna Commercial |
$1,123.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.20
|
| Rate for Payer: Cash Price |
$1,057.47
|
| Rate for Payer: Cofinity Commercial |
$1,136.78
|
| Rate for Payer: Cofinity Commercial |
$925.29
|
| Rate for Payer: Healthscope Commercial |
$1,189.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,123.56
|
| Rate for Payer: PHP Commercial |
$1,123.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.29
|
| Rate for Payer: Priority Health SBD |
$832.76
|
|
|
HC OSCILLATOR SUB DAY
|
Facility
|
OP
|
$1,321.84
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000040
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,189.66 |
| Rate for Payer: Aetna Commercial |
$1,123.56
|
| Rate for Payer: Aetna Medicare |
$579.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$697.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$697.00
|
| Rate for Payer: BCBS Complete |
$320.29
|
| Rate for Payer: BCBS MAPPO |
$557.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.94
|
| Rate for Payer: BCN Medicare Advantage |
$557.60
|
| Rate for Payer: Cash Price |
$1,057.47
|
| Rate for Payer: Cash Price |
$1,057.47
|
| Rate for Payer: Cofinity Commercial |
$1,136.78
|
| Rate for Payer: Cofinity Commercial |
$925.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.60
|
| Rate for Payer: Healthscope Commercial |
$1,189.66
|
| Rate for Payer: Mclaren Medicaid |
$305.01
|
| Rate for Payer: Mclaren Medicare |
$557.60
|
| Rate for Payer: Meridian Medicaid |
$320.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$585.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$641.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,123.56
|
| Rate for Payer: PACE Medicare |
$529.72
|
| Rate for Payer: PACE SWMI |
$557.60
|
| Rate for Payer: PHP Commercial |
$1,123.56
|
| Rate for Payer: PHP Medicare Advantage |
$557.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.29
|
| Rate for Payer: Priority Health Medicare |
$557.60
|
| Rate for Payer: Priority Health SBD |
$832.76
|
| Rate for Payer: Railroad Medicare Medicare |
$557.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.60
|
| Rate for Payer: UHC Exchange |
$62.21
|
| Rate for Payer: UHC Medicare Advantage |
$574.33
|
| Rate for Payer: VA VA |
$557.60
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
30100378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna Medicare |
$6.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.26
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS MAPPO |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.61
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Mclaren Medicaid |
$3.62
|
| Rate for Payer: Mclaren Medicare |
$6.61
|
| Rate for Payer: Meridian Medicaid |
$3.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PACE Medicare |
$6.28
|
| Rate for Payer: PACE SWMI |
$6.61
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: PHP Medicare Advantage |
$6.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$6.61
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: Railroad Medicare Medicare |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.93
|
| Rate for Payer: UHC Core |
$11.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.61
|
| Rate for Payer: UHC Exchange |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$6.81
|
| Rate for Payer: VA VA |
$6.61
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
30100378
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.01
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$37.70
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health SBD |
$33.93
|
|
|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$52.80
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
30100379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Aetna Commercial |
$44.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.32
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Cofinity Commercial |
$45.41
|
| Rate for Payer: Healthscope Commercial |
$47.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.88
|
| Rate for Payer: PHP Commercial |
$44.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.96
|
| Rate for Payer: Priority Health SBD |
$33.26
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$52.80
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
30100379
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Aetna Commercial |
$44.88
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.52
|
| Rate for Payer: BCBS Complete |
$3.92
|
| Rate for Payer: BCBS MAPPO |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$5.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.82
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cash Price |
$42.24
|
| Rate for Payer: Cofinity Commercial |
$45.41
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.82
|
| Rate for Payer: Healthscope Commercial |
$47.52
|
| Rate for Payer: Mclaren Medicaid |
$3.73
|
| Rate for Payer: Mclaren Medicare |
$6.82
|
| Rate for Payer: Meridian Medicaid |
$3.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.88
|
| Rate for Payer: PACE Medicare |
$6.48
|
| Rate for Payer: PACE SWMI |
$6.82
|
| Rate for Payer: PHP Commercial |
$44.88
|
| Rate for Payer: PHP Medicare Advantage |
$6.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.96
|
| Rate for Payer: Priority Health Medicare |
$6.82
|
| Rate for Payer: Priority Health SBD |
$33.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.18
|
| Rate for Payer: UHC Core |
$11.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.82
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$7.02
|
| Rate for Payer: VA VA |
$6.82
|
|
|
HC OSMOTIC FRAGILITY RBC
|
Facility
|
OP
|
$128.84
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
30500052
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$115.96 |
| Rate for Payer: Aetna Commercial |
$109.51
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.70
|
| Rate for Payer: BCBS Complete |
$7.67
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$10.46
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$103.07
|
| Rate for Payer: Cash Price |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$110.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$115.96
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$13.36
|
| Rate for Payer: Meridian Medicaid |
$7.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.51
|
| Rate for Payer: PACE Medicare |
$12.69
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Commercial |
$109.51
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.19
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: Priority Health SBD |
$81.17
|
| Rate for Payer: Railroad Medicare Medicare |
$13.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.03
|
| Rate for Payer: UHC Core |
$22.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.36
|
| Rate for Payer: UHC Exchange |
$13.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.76
|
| Rate for Payer: VA VA |
$13.36
|
|
|
HC OSMOTIC FRAGILITY RBC
|
Facility
|
IP
|
$128.84
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
30500052
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.17 |
| Max. Negotiated Rate |
$115.96 |
| Rate for Payer: Aetna Commercial |
$109.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.75
|
| Rate for Payer: Cash Price |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$110.80
|
| Rate for Payer: Cofinity Commercial |
$90.19
|
| Rate for Payer: Healthscope Commercial |
$115.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.51
|
| Rate for Payer: PHP Commercial |
$109.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.19
|
| Rate for Payer: Priority Health SBD |
$81.17
|
|
|
HC OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Facility
|
OP
|
$8,200.00
|
|
|
Service Code
|
CPT 28111
|
| Hospital Charge Code |
76100365
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.65 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Commercial |
$6,970.00
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,330.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$6,560.00
|
| Rate for Payer: Cash Price |
$6,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,740.00
|
| Rate for Payer: Cofinity Commercial |
$7,052.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$7,380.00
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,970.00
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$6,970.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,740.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Priority Health SBD |
$5,166.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$315.65
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
