|
HC SMITH SM ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$120.35
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Mclaren Medicaid |
$13.96
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Medicaid |
$14.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.84
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health Narrow Network |
$65.47
|
| Rate for Payer: Priority Health SBD |
$75.82
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.53
|
| Rate for Payer: UHC Exchange |
$24.23
|
| Rate for Payer: UHC Medicare Advantage |
$26.30
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
IP
|
$120.35
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health SBD |
$75.82
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
OP
|
$120.35
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.91
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Mclaren Medicaid |
$13.96
|
| Rate for Payer: Mclaren Medicare |
$25.53
|
| Rate for Payer: Meridian Medicaid |
$14.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PACE Medicare |
$24.25
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.84
|
| Rate for Payer: Priority Health Medicare |
$25.53
|
| Rate for Payer: Priority Health Narrow Network |
$65.47
|
| Rate for Payer: Priority Health SBD |
$75.82
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.53
|
| Rate for Payer: UHC Exchange |
$11.46
|
| Rate for Payer: UHC Medicare Advantage |
$26.30
|
| Rate for Payer: VA VA |
$25.53
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
IP
|
$120.35
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Cofinity Commercial |
$84.24
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health SBD |
$75.82
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| 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 SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| 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 |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$6.59
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Medicaid |
$6.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.46
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SMRNP
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.81 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.04
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Mclaren Medicaid |
$9.81
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Medicaid |
$10.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$21.72
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Core |
$30.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$18.47
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SMRNP
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.41
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health SBD |
$21.72
|
|
|
HC SNARE
|
Facility
|
IP
|
$1,263.96
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$796.29 |
| Max. Negotiated Rate |
$1,137.56 |
| Rate for Payer: Aetna Commercial |
$1,074.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.57
|
| Rate for Payer: Cash Price |
$1,011.17
|
| Rate for Payer: Cofinity Commercial |
$1,087.01
|
| Rate for Payer: Cofinity Commercial |
$884.77
|
| Rate for Payer: Healthscope Commercial |
$1,137.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,074.37
|
| Rate for Payer: PHP Commercial |
$1,074.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.77
|
| Rate for Payer: Priority Health SBD |
$796.29
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,263.96
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.58 |
| Max. Negotiated Rate |
$1,137.56 |
| Rate for Payer: Aetna Commercial |
$1,074.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.57
|
| Rate for Payer: BCBS Complete |
$505.58
|
| Rate for Payer: Cash Price |
$1,011.17
|
| Rate for Payer: Cofinity Commercial |
$1,087.01
|
| Rate for Payer: Cofinity Commercial |
$884.77
|
| Rate for Payer: Healthscope Commercial |
$1,137.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,074.37
|
| Rate for Payer: PHP Commercial |
$1,074.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.77
|
| Rate for Payer: Priority Health SBD |
$796.29
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health SBD |
$13.23
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.65
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health SBD |
$13.23
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.26
|
| 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 |
$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 |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| 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 |
$17.34
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$17.34
|
| 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 |
$14.28
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health SBD |
$12.85
|
| 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 SODIUM LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
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 SODIUM OTHER SOURCE
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$2.66
|
| Rate for Payer: Mclaren Medicare |
$4.86
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PACE Medicare |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.83
|
| Rate for Payer: UHC Core |
$8.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.86
|
| Rate for Payer: UHC Exchange |
$4.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.01
|
| Rate for Payer: VA VA |
$4.86
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$34.50
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.15
|
| Rate for Payer: Priority Health SBD |
$21.74
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$34.50
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$31.05 |
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.32
|
| Rate for Payer: BCBS Complete |
$2.91
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Cofinity Commercial |
$24.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$31.05
|
| Rate for Payer: Mclaren Medicaid |
$2.77
|
| Rate for Payer: Mclaren Medicare |
$5.06
|
| Rate for Payer: Meridian Medicaid |
$2.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.32
|
| Rate for Payer: PACE Medicare |
$4.81
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$29.32
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.15
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health SBD |
$21.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.07
|
| Rate for Payer: UHC Core |
$8.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.06
|
| Rate for Payer: UHC Exchange |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$5.21
|
| Rate for Payer: VA VA |
$5.06
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$191.36
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.54 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.38
|
| Rate for Payer: BCBS Complete |
$76.54
|
| Rate for Payer: Cash Price |
$153.09
|
| Rate for Payer: Cofinity Commercial |
$133.95
|
| Rate for Payer: Cofinity Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.66
|
| Rate for Payer: PHP Commercial |
$162.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.95
|
| Rate for Payer: Priority Health SBD |
$120.56
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$191.36
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$162.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.38
|
| Rate for Payer: Cash Price |
$153.09
|
| Rate for Payer: Cofinity Commercial |
$133.95
|
| Rate for Payer: Cofinity Commercial |
$164.57
|
| Rate for Payer: Healthscope Commercial |
$172.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.66
|
| Rate for Payer: PHP Commercial |
$162.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.95
|
| Rate for Payer: Priority Health SBD |
$120.56
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$158.37
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.77 |
| Max. Negotiated Rate |
$142.53 |
| Rate for Payer: Aetna Commercial |
$134.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.94
|
| Rate for Payer: Cash Price |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$110.86
|
| Rate for Payer: Cofinity Commercial |
$136.20
|
| Rate for Payer: Healthscope Commercial |
$142.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.61
|
| Rate for Payer: PHP Commercial |
$134.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.86
|
| Rate for Payer: Priority Health SBD |
$99.77
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$158.37
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.35 |
| Max. Negotiated Rate |
$142.53 |
| Rate for Payer: Aetna Commercial |
$134.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.94
|
| Rate for Payer: BCBS Complete |
$63.35
|
| Rate for Payer: Cash Price |
$126.70
|
| Rate for Payer: Cofinity Commercial |
$110.86
|
| Rate for Payer: Cofinity Commercial |
$136.20
|
| Rate for Payer: Healthscope Commercial |
$142.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.61
|
| Rate for Payer: PHP Commercial |
$134.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.86
|
| Rate for Payer: Priority Health SBD |
$99.77
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$234.51
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$211.06 |
| Rate for Payer: Aetna Commercial |
$199.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.43
|
| Rate for Payer: BCBS Complete |
$93.80
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Cofinity Commercial |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$201.68
|
| Rate for Payer: Healthscope Commercial |
$211.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.33
|
| Rate for Payer: PHP Commercial |
$199.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.16
|
| Rate for Payer: Priority Health SBD |
$147.74
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$234.51
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.74 |
| Max. Negotiated Rate |
$211.06 |
| Rate for Payer: Aetna Commercial |
$199.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.43
|
| Rate for Payer: Cash Price |
$187.61
|
| Rate for Payer: Cofinity Commercial |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$201.68
|
| Rate for Payer: Healthscope Commercial |
$211.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.33
|
| Rate for Payer: PHP Commercial |
$199.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.16
|
| Rate for Payer: Priority Health SBD |
$147.74
|
|
