|
HC POC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$26.53
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200513
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$23.88 |
| Rate for Payer: Healthscope Commercial |
$23.88
|
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.24
|
| Rate for Payer: Cash Price |
$21.22
|
| Rate for Payer: Cofinity Advantage |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$22.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.90
|
| Rate for Payer: PHP Commercial |
$22.55
|
| Rate for Payer: Priority Health SBD |
$16.71
|
|
|
HC POC PH BODY FLUID
|
Facility
|
OP
|
$25.67
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$21.82
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Advantage |
$17.97
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$23.10
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| Rate for Payer: Mclaren Medicare |
$3.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Meridian Medicaid |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Nomi Health Commercial |
$5.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PACE Medicare |
$3.40
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Commercial |
$21.82
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.58
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health SBD |
$16.17
|
| Rate for Payer: Priority Health Tiered Network |
$2.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.37
|
| Rate for Payer: UHC Core |
$5.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.58
|
| Rate for Payer: UHC Exchange |
$5.37
|
| Rate for Payer: UHC Medicaid |
$1.87
|
| Rate for Payer: UHCCP Medicaid |
$1.87
|
| Rate for Payer: VA VA |
$3.58
|
|
|
HC POC PH BODY FLUID
|
Facility
|
IP
|
$25.67
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100760
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$23.10 |
| Rate for Payer: Aetna Commercial |
$21.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.69
|
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Cofinity Advantage |
$17.97
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.54
|
| Rate for Payer: Healthscope Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.25
|
| Rate for Payer: PHP Commercial |
$21.82
|
| Rate for Payer: Priority Health SBD |
$16.17
|
|
|
HC POC POTASSIUM
|
Facility
|
OP
|
$32.87
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Advantage |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$28.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$29.58
|
| Rate for Payer: Mclaren Medicaid |
$2.49
|
| Rate for Payer: Mclaren Medicare |
$4.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.94
|
| Rate for Payer: Nomi Health Commercial |
$7.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.65
|
| Rate for Payer: PACE Medicare |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$27.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.76
|
| Rate for Payer: Priority Health Medicare |
$4.76
|
| Rate for Payer: Priority Health SBD |
$20.71
|
| Rate for Payer: Priority Health Tiered Network |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.14
|
| Rate for Payer: UHC Core |
$7.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.76
|
| Rate for Payer: UHC Exchange |
$7.14
|
| Rate for Payer: UHC Medicaid |
$2.49
|
| Rate for Payer: UHCCP Medicaid |
$2.49
|
| Rate for Payer: VA VA |
$4.76
|
|
|
HC POC POTASSIUM
|
Facility
|
IP
|
$32.87
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.71 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.37
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Advantage |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$28.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Healthscope Commercial |
$29.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.65
|
| Rate for Payer: PHP Commercial |
$27.94
|
| Rate for Payer: Priority Health SBD |
$20.71
|
|
|
HC POC PROTHROMBIN TIME
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500110
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$4.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.58
|
| Rate for Payer: BCN Commercial |
$4.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Advantage |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Mclaren Medicaid |
$2.24
|
| Rate for Payer: Mclaren Medicare |
$4.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Meridian Medicaid |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$6.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: PACE Medicare |
$4.08
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health SBD |
$31.46
|
| Rate for Payer: Priority Health Tiered Network |
$3.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.44
|
| Rate for Payer: UHC Core |
$6.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.29
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicaid |
$2.24
|
| Rate for Payer: UHCCP Medicaid |
$2.24
|
| Rate for Payer: VA VA |
$4.29
|
|
|
HC POC PROTHROMBIN TIME
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
30500110
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.46
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Advantage |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.45
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health SBD |
$31.46
|
|
|
HC POC SODIUM
|
Facility
|
IP
|
$33.53
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$30.18 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.79
|
| Rate for Payer: Cash Price |
$26.82
|
| Rate for Payer: Cofinity Advantage |
$23.47
|
| Rate for Payer: Cofinity Commercial |
$28.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.82
|
| Rate for Payer: Healthscope Commercial |
$30.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.15
|
| Rate for Payer: PHP Commercial |
$28.50
|
| Rate for Payer: Priority Health SBD |
$21.12
|
|
|
HC POC SODIUM
|
Facility
|
OP
|
$33.53
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$30.18 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.79
|
| 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 |
$2.64
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$26.82
|
| Rate for Payer: Cash Price |
$26.82
|
| Rate for Payer: Cofinity Advantage |
$23.47
|
| Rate for Payer: Cofinity Commercial |
$28.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$30.18
|
| Rate for Payer: Mclaren Medicaid |
$2.52
|
| Rate for Payer: Mclaren Medicare |
$4.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| Rate for Payer: Meridian Medicaid |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.50
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.15
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$28.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.81
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health SBD |
$21.12
|
| Rate for Payer: Priority Health Tiered Network |
$3.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.22
|
| Rate for Payer: UHC Core |
$7.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.81
|
| Rate for Payer: UHC Exchange |
$7.22
|
| Rate for Payer: UHC Medicaid |
$2.52
|
| Rate for Payer: UHCCP Medicaid |
$2.52
|
| Rate for Payer: VA VA |
$4.81
|
|
|
HC POC TOTAL CO2
|
Facility
|
OP
|
$18.54
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cofinity Advantage |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Nomi Health Commercial |
$7.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.90
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.88
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health SBD |
$11.68
|
| Rate for Payer: Priority Health Tiered Network |
$3.90
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.32
|
| Rate for Payer: UHC Core |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.88
|
| Rate for Payer: UHC Exchange |
$7.32
|
| Rate for Payer: UHC Medicaid |
$2.55
|
| Rate for Payer: UHCCP Medicaid |
$2.55
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC POC TOTAL CO2
|
Facility
|
IP
|
$18.54
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$16.69 |
| Rate for Payer: Aetna Commercial |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.05
|
| Rate for Payer: Cash Price |
$14.83
|
| Rate for Payer: Cofinity Advantage |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$15.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.90
|
| Rate for Payer: PHP Commercial |
$15.76
|
| Rate for Payer: Priority Health SBD |
$11.68
|
|
|
HC POC UA DIPSTICK, AUTO
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700014
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
|
HC POC UA DIPSTICK, AUTO
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700014
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Mclaren Medicare |
$2.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$3.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.23
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.25
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Priority Health Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.38
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.25
|
| Rate for Payer: UHC Exchange |
$3.38
|
| Rate for Payer: UHC Medicaid |
$1.18
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health SBD |
$8.02
|
|
|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.35
|
| Rate for Payer: BCBS Complete |
$1.91
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.71
|
| Rate for Payer: BCN Commercial |
$3.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Advantage |
$8.91
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Mclaren Medicaid |
$1.82
|
| Rate for Payer: Mclaren Medicare |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Meridian Medicaid |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.55
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.48
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: Priority Health Tiered Network |
$2.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.22
|
| Rate for Payer: UHC Core |
$5.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.48
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicaid |
$1.82
|
| Rate for Payer: UHCCP Medicaid |
$1.82
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$16.09
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$14.48 |
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.46
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cofinity Advantage |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.07
|
| Rate for Payer: PHP Commercial |
$13.68
|
| Rate for Payer: Priority Health SBD |
$10.14
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$16.09
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$14.48 |
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cofinity Advantage |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$14.48
|
| Rate for Payer: Mclaren Medicaid |
$2.07
|
| Rate for Payer: Mclaren Medicare |
$3.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.15
|
| Rate for Payer: Meridian Medicaid |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.68
|
| Rate for Payer: Nomi Health Commercial |
$5.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.07
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.68
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.95
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health SBD |
$10.14
|
| Rate for Payer: Priority Health Tiered Network |
$3.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.93
|
| Rate for Payer: UHC Core |
$5.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.95
|
| Rate for Payer: UHC Exchange |
$5.93
|
| Rate for Payer: UHC Medicaid |
$2.07
|
| Rate for Payer: UHCCP Medicaid |
$2.07
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC POC URINE PREG TEST
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: Priority Health SBD |
$18.72
|
|
|
HC POC URINE PREG TEST
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.73
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.18
|
| Rate for Payer: BCCCP Commercial |
$8.61
|
| Rate for Payer: BCN Commercial |
$9.18
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Advantage |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.61
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$18.72
|
| Rate for Payer: Priority Health Tiered Network |
$6.89
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.92
|
| Rate for Payer: UHC Core |
$12.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.61
|
| Rate for Payer: UHC Exchange |
$12.92
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$52.34
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.28
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$6.21
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Mclaren Medicare |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Meridian Medicaid |
$6.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Nomi Health Commercial |
$8.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PACE Medicare |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health SBD |
$32.97
|
| Rate for Payer: Priority Health Tiered Network |
$4.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.73
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.82
|
| Rate for Payer: UHC Exchange |
$8.73
|
| Rate for Payer: UHC Medicaid |
$3.04
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$5.82
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$52.34
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.97 |
| Max. Negotiated Rate |
$47.11 |
| Rate for Payer: Aetna Commercial |
$44.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.02
|
| Rate for Payer: Cash Price |
$41.87
|
| Rate for Payer: Cofinity Advantage |
$36.64
|
| Rate for Payer: Cofinity Commercial |
$45.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$47.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.26
|
| Rate for Payer: PHP Commercial |
$44.49
|
| Rate for Payer: Priority Health SBD |
$32.97
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$279.65
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna Commercial |
$237.70
|
| Rate for Payer: Aetna Medicare |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: BCBS Complete |
$111.86
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Advantage |
$195.75
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$251.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: PHP Commercial |
$237.70
|
| Rate for Payer: Priority Health SBD |
$176.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.77
|
| Rate for Payer: UHC Core |
$145.70
|
| Rate for Payer: UHC Exchange |
$109.90
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$279.65
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.18 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna Commercial |
$237.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Advantage |
$195.75
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$251.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.74
|
| Rate for Payer: PHP Commercial |
$237.70
|
| Rate for Payer: Priority Health SBD |
$176.18
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.83
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Advantage |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$38.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.27
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health SBD |
$27.95
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$117.73 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.83
|
| Rate for Payer: BCBS Complete |
$17.74
|
| Rate for Payer: BCBS Trust/PPO |
$117.73
|
| Rate for Payer: BCN Commercial |
$117.73
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Advantage |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$38.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.27
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.41
|
| Rate for Payer: UHC Core |
$94.41
|
| Rate for Payer: UHC Exchange |
$94.41
|
|
