|
HC PHENOBARB LVL
|
Facility
|
OP
|
$102.58
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$92.32 |
| Rate for Payer: Aetna Commercial |
$87.19
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.32
|
| Rate for Payer: BCN Commercial |
$16.32
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Advantage |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$88.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$92.32
|
| Rate for Payer: Mclaren Medicaid |
$8.00
|
| Rate for Payer: Mclaren Medicare |
$15.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: Meridian Medicaid |
$16.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.19
|
| Rate for Payer: Nomi Health Commercial |
$22.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.94
|
| Rate for Payer: PACE Medicare |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$87.19
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.30
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health SBD |
$64.63
|
| Rate for Payer: Priority Health Tiered Network |
$12.24
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.95
|
| Rate for Payer: UHC Core |
$22.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.30
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: VA VA |
$15.30
|
|
|
HC PHENOBARB LVL
|
Facility
|
IP
|
$102.58
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$92.32 |
| Rate for Payer: Aetna Commercial |
$87.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.68
|
| Rate for Payer: Cash Price |
$82.06
|
| Rate for Payer: Cofinity Advantage |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$88.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.06
|
| Rate for Payer: Healthscope Commercial |
$92.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.94
|
| Rate for Payer: PHP Commercial |
$87.19
|
| Rate for Payer: Priority Health SBD |
$64.63
|
|
|
HC PH GASTRIC
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$7.15
|
| Rate for Payer: BCN Commercial |
$7.15
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Mclaren Medicare |
$6.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: Meridian Medicaid |
$7.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: PACE Medicare |
$6.37
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6.71
|
| Rate for Payer: Priority Health Medicare |
$6.71
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health Tiered Network |
$5.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.07
|
| Rate for Payer: UHC Core |
$10.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.71
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicaid |
$3.51
|
| Rate for Payer: UHCCP Medicaid |
$3.51
|
| Rate for Payer: VA VA |
$6.71
|
|
|
HC PH GASTRIC
|
Facility
|
IP
|
$25.17
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.54 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Advantage |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.13
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health SBD |
$62.27
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Advantage |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.13
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health SBD |
$62.27
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
IP
|
$76.99
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.04
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Advantage |
$53.89
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: Priority Health SBD |
$48.50
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
OP
|
$76.99
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$69.29 |
| Rate for Payer: Aetna Commercial |
$65.44
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$17.61
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cash Price |
$61.59
|
| Rate for Payer: Cofinity Advantage |
$53.89
|
| Rate for Payer: Cofinity Commercial |
$66.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$69.29
|
| Rate for Payer: Mclaren Medicaid |
$8.64
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: Meridian Medicaid |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.44
|
| Rate for Payer: Nomi Health Commercial |
$24.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.74
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$65.44
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.52
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$48.50
|
| Rate for Payer: Priority Health Tiered Network |
$13.22
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.78
|
| Rate for Payer: UHC Core |
$24.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.52
|
| Rate for Payer: UHC Exchange |
$24.78
|
| Rate for Payer: UHC Medicaid |
$8.64
|
| Rate for Payer: UHCCP Medicaid |
$8.64
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: Priority Health SBD |
$54.40
|
|
|
HC PHOSPHATIDYL GLYCEROL-PG
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100391
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$17.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.65
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS MAPPO |
$16.52
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$17.61
|
| Rate for Payer: BCN Medicare Advantage |
$16.52
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Advantage |
$60.45
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$8.64
|
| Rate for Payer: Mclaren Medicare |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.35
|
| Rate for Payer: Meridian Medicaid |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$24.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.76
|
| Rate for Payer: PACE Medicare |
$15.69
|
| Rate for Payer: PACE SWMI |
$16.52
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$16.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.52
|
| Rate for Payer: Priority Health Medicare |
$16.52
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: Priority Health Tiered Network |
$13.22
|
| Rate for Payer: Railroad Medicare Medicare |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.78
|
| Rate for Payer: UHC Core |
$24.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.52
|
| Rate for Payer: UHC Exchange |
$24.78
|
| Rate for Payer: UHC Medicaid |
$8.64
|
| Rate for Payer: UHCCP Medicaid |
$8.64
|
| Rate for Payer: VA VA |
$16.52
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
OP
|
$56.24
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Mclaren Medicaid |
$8.40
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$24.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.07
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$35.43
|
| Rate for Payer: Priority Health Tiered Network |
$12.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.11
|
| Rate for Payer: UHC Core |
$24.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.07
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicaid |
$8.40
|
| Rate for Payer: UHCCP Medicaid |
$8.40
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS
|
Facility
|
IP
|
$56.24
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200147
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: Priority Health SBD |
$35.43
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
OP
|
$55.18
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna Medicare |
$16.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.09
|
| Rate for Payer: BCBS Complete |
$8.83
|
| Rate for Payer: BCBS MAPPO |
$16.07
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.07
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.07
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Mclaren Medicaid |
$8.40
|
| Rate for Payer: Mclaren Medicare |
$16.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.87
|
| Rate for Payer: Meridian Medicaid |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Nomi Health Commercial |
$24.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PACE Medicare |
$15.27
|
| Rate for Payer: PACE SWMI |
$16.07
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: PHP Medicare Advantage |
$16.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.07
|
| Rate for Payer: Priority Health Medicare |
$16.07
|
| Rate for Payer: Priority Health SBD |
$34.76
|
| Rate for Payer: Priority Health Tiered Network |
$12.86
|
| Rate for Payer: Railroad Medicare Medicare |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.11
|
| Rate for Payer: UHC Core |
$24.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.07
|
| Rate for Payer: UHC Exchange |
$24.11
|
| Rate for Payer: UHC Medicaid |
$8.40
|
| Rate for Payer: UHCCP Medicaid |
$8.40
|
| Rate for Payer: VA VA |
$16.07
|
|
|
HC PHOSPHATIDYLSERINE AUTOABS CMPT
|
Facility
|
IP
|
$55.18
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
30200148
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$49.66 |
| Rate for Payer: Aetna Commercial |
$46.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.87
|
| Rate for Payer: Cash Price |
$44.14
|
| Rate for Payer: Cofinity Advantage |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.38
|
| Rate for Payer: PHP Commercial |
$46.90
|
| Rate for Payer: Priority Health SBD |
$34.76
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
OP
|
$287.77
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$258.99 |
| Rate for Payer: Aetna Commercial |
$244.60
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.05
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$230.22
|
| Rate for Payer: Cash Price |
$230.22
|
| Rate for Payer: Cofinity Advantage |
$201.44
|
| Rate for Payer: Cofinity Commercial |
$247.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$258.99
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.60
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.83
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$244.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$181.30
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 RECEPTOR
|
Facility
|
IP
|
$287.77
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200492
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$258.99 |
| Rate for Payer: Aetna Commercial |
$244.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.05
|
| Rate for Payer: Cash Price |
$230.22
|
| Rate for Payer: Cofinity Advantage |
$201.44
|
| Rate for Payer: Cofinity Commercial |
$247.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$230.22
|
| Rate for Payer: Healthscope Commercial |
$258.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.83
|
| Rate for Payer: PHP Commercial |
$244.60
|
| Rate for Payer: Priority Health SBD |
$181.30
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
OP
|
$214.32
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$192.89 |
| Rate for Payer: Aetna Commercial |
$182.17
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.31
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cofinity Advantage |
$150.02
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$192.89
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.17
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$182.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$135.02
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$214.32
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$135.02 |
| Max. Negotiated Rate |
$192.89 |
| Rate for Payer: Aetna Commercial |
$182.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.31
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cofinity Advantage |
$150.02
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.46
|
| Rate for Payer: Healthscope Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.74
|
| Rate for Payer: PHP Commercial |
$182.17
|
| Rate for Payer: Priority Health SBD |
$135.02
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$214.32
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$135.02 |
| Max. Negotiated Rate |
$192.89 |
| Rate for Payer: Aetna Commercial |
$182.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.31
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cofinity Advantage |
$150.02
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.46
|
| Rate for Payer: Healthscope Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.74
|
| Rate for Payer: PHP Commercial |
$182.17
|
| Rate for Payer: Priority Health SBD |
$135.02
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$214.32
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$192.89 |
| Rate for Payer: Aetna Commercial |
$182.17
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.31
|
| 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 |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cash Price |
$171.46
|
| Rate for Payer: Cofinity Advantage |
$150.02
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$192.89
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.17
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.74
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$182.17
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$135.02
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.92
|
| Rate for Payer: BCBS Complete |
$2.60
|
| Rate for Payer: BCBS MAPPO |
$4.74
|
| Rate for Payer: BCN Medicare Advantage |
$4.74
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Mclaren Medicaid |
$2.48
|
| Rate for Payer: Mclaren Medicare |
$4.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.98
|
| Rate for Payer: Meridian Medicaid |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.74
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$4.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.74
|
| Rate for Payer: Priority Health Medicare |
$4.74
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Priority Health Tiered Network |
$3.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.11
|
| Rate for Payer: UHC Core |
$7.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.74
|
| Rate for Payer: UHC Exchange |
$7.11
|
| Rate for Payer: UHC Medicaid |
$2.48
|
| Rate for Payer: UHCCP Medicaid |
$2.48
|
| Rate for Payer: VA VA |
$4.74
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.22
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$6.17
|
| Rate for Payer: BCN Commercial |
$6.17
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Advantage |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Mclaren Medicaid |
$3.02
|
| Rate for Payer: Mclaren Medicare |
$5.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: Meridian Medicaid |
$6.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.90
|
| Rate for Payer: Nomi Health Commercial |
$8.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.50
|
| Rate for Payer: PACE Medicare |
$5.49
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.78
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health SBD |
$34.02
|
| Rate for Payer: Priority Health Tiered Network |
$4.62
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.67
|
| Rate for Payer: UHC Core |
$8.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.78
|
| Rate for Payer: UHC Exchange |
$8.67
|
| Rate for Payer: UHC Medicaid |
$3.02
|
| Rate for Payer: UHCCP Medicaid |
$3.02
|
| Rate for Payer: VA VA |
$5.78
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$48.60 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.10
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Advantage |
$37.80
|
| Rate for Payer: Cofinity Commercial |
$46.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.20
|
| Rate for Payer: Healthscope Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.50
|
| Rate for Payer: PHP Commercial |
$45.90
|
| Rate for Payer: Priority Health SBD |
$34.02
|
|
|
HC PHOSPHO-TAU 217,P
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 84393
|
| Hospital Charge Code |
30000176
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Advantage |
$262.50
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.25
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health SBD |
$236.25
|
|
