|
HC OT Z STOCKINGS NON CUSTOM $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300134
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.41 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.04
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health SBD |
$51.41
|
|
|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.72 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC OT Z STOCKINGS NON CUSTOM $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS A6549
|
| Hospital Charge Code |
98300135
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.83 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health SBD |
$57.83
|
|
|
HC OVA & PARASITES
|
Facility
|
IP
|
$87.82
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Commercial |
$75.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Healthscope Commercial |
$79.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: PHP Commercial |
$74.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health SBD |
$55.33
|
|
|
HC OVA & PARASITES
|
Facility
|
OP
|
$87.82
|
|
|
Service Code
|
CPT 87177
|
| Hospital Charge Code |
30600096
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$74.65
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.12
|
| Rate for Payer: BCBS Complete |
$5.01
|
| Rate for Payer: BCBS MAPPO |
$8.90
|
| Rate for Payer: BCN Medicare Advantage |
$8.90
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cash Price |
$70.26
|
| Rate for Payer: Cofinity Commercial |
$75.53
|
| Rate for Payer: Cofinity Commercial |
$61.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$79.04
|
| Rate for Payer: Mclaren Medicaid |
$4.77
|
| Rate for Payer: Mclaren Medicare |
$8.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.35
|
| Rate for Payer: Meridian Medicaid |
$5.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.65
|
| Rate for Payer: PACE Medicare |
$8.46
|
| Rate for Payer: PACE SWMI |
$8.90
|
| Rate for Payer: PHP Commercial |
$74.65
|
| Rate for Payer: PHP Medicare Advantage |
$8.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.08
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health SBD |
$55.33
|
| Rate for Payer: Railroad Medicare Medicare |
$8.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.90
|
| Rate for Payer: UHC Medicare Advantage |
$8.90
|
| Rate for Payer: UHCCP Medicaid |
$5.01
|
| Rate for Payer: VA VA |
$8.90
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.48
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$9.64
|
| Rate for Payer: Mclaren Medicare |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Meridian Medicaid |
$10.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PACE Medicare |
$17.08
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$17.98
|
|
|
HC OVA & PARASITES SPECIAL STAIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
30600190
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.09
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC OXALATE URINE
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health SBD |
$28.84
|
|
|
HC OXALATE URINE
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
30100381
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.06
|
| Rate for Payer: BCBS Complete |
$8.13
|
| Rate for Payer: BCBS MAPPO |
$14.45
|
| Rate for Payer: BCN Medicare Advantage |
$14.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$32.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Mclaren Medicaid |
$7.75
|
| Rate for Payer: Mclaren Medicare |
$14.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.17
|
| Rate for Payer: Meridian Medicaid |
$8.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: PACE Medicare |
$13.73
|
| Rate for Payer: PACE SWMI |
$14.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$14.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health SBD |
$28.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.45
|
| Rate for Payer: UHC Medicare Advantage |
$14.45
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: VA VA |
$14.45
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$46.54
|
|
|
HC OXCARBAZEPINE LEVEL
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
CPT 80183
|
| Hospital Charge Code |
30100472
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC OXYCODONE LVL
|
Facility
|
IP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
|
|
HC OXYCODONE LVL
|
Facility
|
OP
|
$79.56
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100582
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$67.63
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.71
|
| Rate for Payer: BCBS Complete |
$31.82
|
| Rate for Payer: Cash Price |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$55.69
|
| Rate for Payer: Cofinity Commercial |
$68.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.65
|
| Rate for Payer: Healthscope Commercial |
$71.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$67.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.71
|
| Rate for Payer: Priority Health SBD |
$50.12
|
|
|
HC OXYCODONE URINE.
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.31 |
| Max. Negotiated Rate |
$174.92 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.67
|
| Rate for Payer: BCBS Complete |
$34.97
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Mclaren Medicaid |
$33.31
|
| Rate for Payer: Mclaren Medicare |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Meridian Medicaid |
$34.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PACE Medicare |
$59.03
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health SBD |
$64.05
|
| Rate for Payer: Railroad Medicare Medicare |
$62.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UHCCP Medicaid |
$34.98
|
| Rate for Payer: VA VA |
$62.14
|
|
|
HC OXYCODONE URINE.
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000153
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.08
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$71.16
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health SBD |
$64.05
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
|
|
HC OXYCODONE W/METABOLITE CONF, U
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
CPT 80365
|
| Hospital Charge Code |
30100681
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna Commercial |
$46.82
|
| Rate for Payer: Aetna Medicare |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.80
|
| Rate for Payer: BCBS Complete |
$22.03
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$38.56
|
| Rate for Payer: Cofinity Commercial |
$47.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.06
|
| Rate for Payer: Healthscope Commercial |
$49.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.82
|
| Rate for Payer: PHP Commercial |
$46.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health SBD |
$34.70
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
OP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$587.53 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: Aetna Medicare |
$734.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.74
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,028.18
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health SBD |
$925.36
|
|
|
HC OXYGENATOR FX 15/25 STAND ALONE
|
Facility
|
IP
|
$1,468.83
|
|
| Hospital Charge Code |
27000445
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$925.36 |
| Max. Negotiated Rate |
$1,321.95 |
| Rate for Payer: Aetna Commercial |
$1,248.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.74
|
| Rate for Payer: Cash Price |
$1,175.06
|
| Rate for Payer: Cofinity Commercial |
$1,028.18
|
| Rate for Payer: Cofinity Commercial |
$1,263.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,028.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,175.06
|
| Rate for Payer: Healthscope Commercial |
$1,321.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,248.51
|
| Rate for Payer: PHP Commercial |
$1,248.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.74
|
| Rate for Payer: Priority Health SBD |
$925.36
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
IP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$780.76 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
|
|
HC OXYGENATOR FX15/25 W/RESERV
|
Facility
|
OP
|
$1,239.30
|
|
| Hospital Charge Code |
27000650
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$495.72 |
| Max. Negotiated Rate |
$1,115.37 |
| Rate for Payer: Aetna Commercial |
$1,053.40
|
| Rate for Payer: Aetna Medicare |
$619.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.54
|
| Rate for Payer: BCBS Complete |
$495.72
|
| Rate for Payer: Cash Price |
$991.44
|
| Rate for Payer: Cofinity Commercial |
$1,065.80
|
| Rate for Payer: Cofinity Commercial |
$867.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$867.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$991.44
|
| Rate for Payer: Healthscope Commercial |
$1,115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.40
|
| Rate for Payer: PHP Commercial |
$1,053.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$805.54
|
| Rate for Payer: Priority Health SBD |
$780.76
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
IP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$790.40 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.49
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Cofinity Commercial |
$878.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health SBD |
$790.40
|
|
|
HC OXYGENATOR NX EAST/WEST
|
Facility
|
OP
|
$1,254.60
|
|
| Hospital Charge Code |
27000649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,129.14 |
| Rate for Payer: Aetna Commercial |
$1,066.41
|
| Rate for Payer: Aetna Medicare |
$627.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$815.49
|
| Rate for Payer: BCBS Complete |
$501.84
|
| Rate for Payer: Cash Price |
$1,003.68
|
| Rate for Payer: Cofinity Commercial |
$1,078.96
|
| Rate for Payer: Cofinity Commercial |
$878.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$878.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,003.68
|
| Rate for Payer: Healthscope Commercial |
$1,129.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,066.41
|
| Rate for Payer: PHP Commercial |
$1,066.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.49
|
| Rate for Payer: Priority Health SBD |
$790.40
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
OP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,545.30 |
| Max. Negotiated Rate |
$3,476.93 |
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: Aetna Medicare |
$1,931.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,511.11
|
| Rate for Payer: BCBS Complete |
$1,545.30
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$2,704.28
|
| Rate for Payer: Cofinity Commercial |
$3,322.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,704.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,476.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health SBD |
$2,433.85
|
|
|
HC OXYGENATOR QUADROX
|
Facility
|
IP
|
$3,863.25
|
|
| Hospital Charge Code |
27000652
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,433.85 |
| Max. Negotiated Rate |
$3,476.93 |
| Rate for Payer: Aetna Commercial |
$3,283.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,511.11
|
| Rate for Payer: Cash Price |
$3,090.60
|
| Rate for Payer: Cofinity Commercial |
$2,704.28
|
| Rate for Payer: Cofinity Commercial |
$3,322.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,704.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,090.60
|
| Rate for Payer: Healthscope Commercial |
$3,476.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,283.76
|
| Rate for Payer: PHP Commercial |
$3,283.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,511.11
|
| Rate for Payer: Priority Health SBD |
$2,433.85
|
|
