|
HC POC SODIUM
|
Facility
|
OP
|
$32.87
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$29.58 |
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.37
|
| 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 |
$2.71
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Cofinity Commercial |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$29.58
|
| Rate for Payer: Mclaren Medicaid |
$2.58
|
| 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 |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.94
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$27.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.37
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health SBD |
$20.71
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.81
|
| Rate for Payer: UHC Medicare Advantage |
$4.81
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$4.81
|
|
|
HC POC SODIUM
|
Facility
|
IP
|
$32.87
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100502
|
|
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 Commercial |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$28.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.01
|
| 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: PHP Commercial |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.37
|
| Rate for Payer: Priority Health SBD |
$20.71
|
|
|
HC POC TOTAL CO2
|
Facility
|
OP
|
$18.18
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.82
|
| 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 |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$15.63
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$16.36
|
| Rate for Payer: Mclaren Medicaid |
$2.62
|
| 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 |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.45
|
| Rate for Payer: PACE Medicare |
$4.64
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$15.45
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.82
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health SBD |
$11.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$2.75
|
| Rate for Payer: VA VA |
$4.88
|
|
|
HC POC TOTAL CO2
|
Facility
|
IP
|
$18.18
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
30100699
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$16.36 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.82
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cofinity Commercial |
$12.73
|
| Rate for Payer: Cofinity Commercial |
$15.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.54
|
| Rate for Payer: Healthscope Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.45
|
| Rate for Payer: PHP Commercial |
$15.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.82
|
| Rate for Payer: Priority Health SBD |
$11.45
|
|
|
HC POC UA DIPSTICK, AUTO
|
Facility
|
IP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700014
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC POC UA DIPSTICK, AUTO
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
30700014
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.79
|
| 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 |
$1.27
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$14.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$19.10
|
| Rate for Payer: Mclaren Medicaid |
$1.21
|
| 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 |
$1.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.04
|
| Rate for Payer: PACE Medicare |
$2.14
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Commercial |
$18.04
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.79
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: Priority Health SBD |
$13.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: VA VA |
$2.25
|
|
|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
OP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| 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 |
$1.96
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$8.74
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Mclaren Medicaid |
$1.87
|
| 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 |
$1.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: PACE Medicare |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
| Rate for Payer: UHCCP Medicaid |
$1.96
|
| Rate for Payer: VA VA |
$3.48
|
|
|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Cofinity Commercial |
$8.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health SBD |
$7.86
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$4.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| 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 |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$3.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.95
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Mclaren Medicaid |
$2.12
|
| 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 |
$2.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: PACE Medicare |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.95
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.95
|
| Rate for Payer: UHC Medicare Advantage |
$3.95
|
| Rate for Payer: UHCCP Medicaid |
$2.22
|
| Rate for Payer: VA VA |
$3.95
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health SBD |
$9.94
|
|
|
HC POC URINE PREG TEST
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| 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 |
$4.85
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Mclaren Medicaid |
$4.61
|
| 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 |
$4.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$18.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UHCCP Medicaid |
$4.85
|
| Rate for Payer: VA VA |
$8.61
|
|
|
HC POC URINE PREG TEST
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.93
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$20.39
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health SBD |
$18.35
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| 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 |
$3.28
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Mclaren Medicaid |
$3.12
|
| 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 |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PACE Medicare |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health SBD |
$32.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: UHCCP Medicaid |
$3.28
|
| Rate for Payer: VA VA |
$5.82
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.33 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.35
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$35.92
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health SBD |
$32.33
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna Medicare |
$137.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: BCBS Complete |
$109.67
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health SBD |
$172.73
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.73 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.21
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$191.92
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health SBD |
$172.73
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health SBD |
$27.40
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.27
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health SBD |
$27.40
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.79 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Aetna Medicare |
$267.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.41
|
| Rate for Payer: BCBS Complete |
$213.79
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$374.13
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health SBD |
$336.72
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$336.72 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.41
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$374.13
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health SBD |
$336.72
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.77
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health SBD |
$115.12
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: Aetna Medicare |
$91.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.77
|
| Rate for Payer: BCBS Complete |
$73.09
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$127.91
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health SBD |
$115.12
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$41.41 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$15.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.39
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS MAPPO |
$14.71
|
| Rate for Payer: BCN Medicare Advantage |
$14.71
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Mclaren Medicare |
$14.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.45
|
| Rate for Payer: Meridian Medicaid |
$8.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PACE Medicare |
$13.97
|
| Rate for Payer: PACE SWMI |
$14.71
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: PHP Medicare Advantage |
$14.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health Medicare |
$14.71
|
| Rate for Payer: Priority Health SBD |
$20.97
|
| Rate for Payer: Railroad Medicare Medicare |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.71
|
| Rate for Payer: UHC Medicare Advantage |
$14.71
|
| Rate for Payer: UHCCP Medicaid |
$8.28
|
| Rate for Payer: VA VA |
$14.71
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.64
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health SBD |
$20.97
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.55
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$8.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.44
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$4.52
|
| Rate for Payer: Mclaren Medicare |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$4.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PACE Medicare |
$8.02
|
| Rate for Payer: PACE SWMI |
$8.44
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$8.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health Medicare |
$8.44
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.44
|
| Rate for Payer: UHC Medicare Advantage |
$8.44
|
| Rate for Payer: UHCCP Medicaid |
$4.75
|
| Rate for Payer: VA VA |
$8.44
|
|
