|
HC POC COVID ABBOTT ID NOW
|
Facility
|
OP
|
$147.90
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600328
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.14
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.09
|
| Rate for Payer: BCCCP Commercial |
$25.00
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Mclaren Medicaid |
$28.07
|
| Rate for Payer: Mclaren Medicare |
$51.31
|
| Rate for Payer: Meridian Medicaid |
$29.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PACE Medicare |
$48.74
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health SBD |
$93.18
|
| Rate for Payer: Railroad Medicare Medicare |
$51.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.57
|
| Rate for Payer: UHC Core |
$61.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Exchange |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
| Rate for Payer: VA VA |
$51.31
|
|
|
HC POC COVID ABBOTT ID NOW
|
Facility
|
IP
|
$147.90
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
30600328
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$133.11 |
| Rate for Payer: Aetna Commercial |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.14
|
| Rate for Payer: Cash Price |
$118.32
|
| Rate for Payer: Cofinity Commercial |
$103.53
|
| Rate for Payer: Cofinity Commercial |
$127.19
|
| Rate for Payer: Healthscope Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.72
|
| Rate for Payer: PHP Commercial |
$125.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.53
|
| Rate for Payer: Priority Health SBD |
$93.18
|
|
|
HC POC CREATININE SERUM
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POC CREATININE SERUM
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82565
|
| Hospital Charge Code |
30100703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.40
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.12
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.12
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.12
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$5.12
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.14
|
| Rate for Payer: UHC Core |
$8.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.12
|
| Rate for Payer: UHC Exchange |
$5.12
|
| Rate for Payer: UHC Medicare Advantage |
$5.27
|
| Rate for Payer: VA VA |
$5.12
|
|
|
HC POC GLUCOSE LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.91
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$2.15
|
| Rate for Payer: Mclaren Medicare |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$2.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$3.73
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Exchange |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$3.93
|
|
|
HC POC GLUCOSE LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
30100702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POC HEMATOCRIT
|
Facility
|
OP
|
$18.93
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500097
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Mclaren Medicaid |
$1.30
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.09
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$4.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Exchange |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC POC HEMATOCRIT
|
Facility
|
IP
|
$18.93
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500097
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$17.04 |
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.09
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.25
|
| Rate for Payer: Priority Health SBD |
$11.93
|
|
|
HC POC HEMOGLOBIN
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500098
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POC HEMOGLOBIN
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500098
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$1.30
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.84
|
| Rate for Payer: UHC Core |
$4.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Exchange |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC POC HEMOGLOBIN; METHEMOGLOBIN, QUANT
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100725
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health SBD |
$12.85
|
|
|
HC POC HEMOGLOBIN; METHEMOGLOBIN, QUANT
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
30100725
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.25
|
| Rate for Payer: BCBS Complete |
$4.71
|
| Rate for Payer: BCBS MAPPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCN Medicare Advantage |
$8.20
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$14.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.20
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$4.49
|
| Rate for Payer: Mclaren Medicare |
$8.20
|
| Rate for Payer: Meridian Medicaid |
$4.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$7.79
|
| Rate for Payer: PACE SWMI |
$8.20
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$8.20
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.84
|
| Rate for Payer: UHC Core |
$12.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.20
|
| Rate for Payer: UHC Exchange |
$8.20
|
| Rate for Payer: UHC Medicare Advantage |
$8.45
|
| Rate for Payer: VA VA |
$8.20
|
|
|
HC POC IONIZED CALCIUM
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health SBD |
$66.40
|
|
|
HC POC IONIZED CALCIUM
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
30100701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$14.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.10
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$10.71
|
| Rate for Payer: BCN Medicare Advantage |
$13.68
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$73.78
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Mclaren Medicare |
$13.68
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Medicare |
$13.00
|
| Rate for Payer: PACE SWMI |
$13.68
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$13.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health Medicare |
$13.68
|
| Rate for Payer: Priority Health SBD |
$66.40
|
| Rate for Payer: Railroad Medicare Medicare |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.42
|
| Rate for Payer: UHC Core |
$23.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.68
|
| Rate for Payer: UHC Exchange |
$13.68
|
| Rate for Payer: UHC Medicare Advantage |
$14.09
|
| Rate for Payer: VA VA |
$13.68
|
|
|
HC POC LACTIC ACID
|
Facility
|
OP
|
$53.59
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100697
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$48.23 |
| Rate for Payer: Aetna Commercial |
$45.55
|
| Rate for Payer: Aetna Medicare |
$12.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.46
|
| Rate for Payer: BCBS Complete |
$6.65
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$37.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$48.23
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Mclaren Medicare |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$6.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.55
|
| Rate for Payer: PACE Medicare |
$10.99
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$45.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: Priority Health Medicare |
$11.57
|
| Rate for Payer: Priority Health SBD |
$33.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.57
|
| Rate for Payer: UHC Exchange |
$11.57
|
| Rate for Payer: UHC Medicare Advantage |
$11.92
|
| Rate for Payer: VA VA |
$11.57
|
|
|
HC POC LACTIC ACID
|
Facility
|
IP
|
$53.59
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
30100697
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$48.23 |
| Rate for Payer: Aetna Commercial |
$45.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$46.09
|
| Rate for Payer: Cofinity Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$48.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.55
|
| Rate for Payer: PHP Commercial |
$45.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.51
|
| Rate for Payer: Priority Health SBD |
$33.76
|
|
|
HC POC POTASSIUM
|
Facility
|
OP
|
$31.60
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$2.73
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$22.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$28.44
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Medicaid |
$2.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.86
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$26.86
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.12
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.71
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.76
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.90
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POC POTASSIUM
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$28.44 |
| Rate for Payer: Aetna Commercial |
$26.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.54
|
| Rate for Payer: Cash Price |
$25.28
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$22.12
|
| Rate for Payer: Healthscope Commercial |
$28.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.86
|
| Rate for Payer: PHP Commercial |
$26.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.12
|
| Rate for Payer: Priority Health SBD |
$19.91
|
|
|
HC POC SODIUM
|
Facility
|
IP
|
$32.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Aetna Commercial |
$27.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.95
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Cofinity Commercial |
$27.72
|
| Rate for Payer: Healthscope Commercial |
$29.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.40
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.56
|
| Rate for Payer: Priority Health SBD |
$20.30
|
|
|
HC POC SODIUM
|
Facility
|
OP
|
$32.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$29.01 |
| Rate for Payer: Aetna Commercial |
$27.40
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: BCBS Complete |
$2.76
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cash Price |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$27.72
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$29.01
|
| Rate for Payer: Mclaren Medicaid |
$2.63
|
| Rate for Payer: Mclaren Medicare |
$4.81
|
| Rate for Payer: Meridian Medicaid |
$2.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.40
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.56
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health SBD |
$20.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.77
|
| Rate for Payer: UHC Core |
$8.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.81
|
| Rate for Payer: UHC Exchange |
$4.81
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: VA VA |
$4.81
|
|
|
HC POC TOTAL CO2
|
Facility
|
OP
|
$17.82
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Mclaren Medicaid |
$2.67
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$2.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.86
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.03
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC POC TOTAL CO2
|
Facility
|
IP
|
$17.82
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$16.04 |
| Rate for Payer: Aetna Commercial |
$15.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Healthscope Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.15
|
| Rate for Payer: PHP Commercial |
$15.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.47
|
| Rate for Payer: Priority Health SBD |
$11.23
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.05
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: PHP Commercial |
$13.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$9.74
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$13.91 |
| Rate for Payer: Aetna Commercial |
$13.14
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cash Price |
$12.37
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.14
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health SBD |
$9.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.74
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Exchange |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC POLARCATH
|
Facility
|
IP
|
$6,937.70
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200064
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,370.75 |
| Max. Negotiated Rate |
$6,243.93 |
| Rate for Payer: Aetna Commercial |
$5,897.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,509.50
|
| Rate for Payer: Cash Price |
$5,550.16
|
| Rate for Payer: Cofinity Commercial |
$4,856.39
|
| Rate for Payer: Cofinity Commercial |
$5,966.42
|
| Rate for Payer: Healthscope Commercial |
$6,243.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,897.04
|
| Rate for Payer: PHP Commercial |
$5,897.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,856.39
|
| Rate for Payer: Priority Health SBD |
$4,370.75
|
|
