|
HC SNARE
|
Facility
|
IP
|
$1,315.02
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$828.46 |
| Max. Negotiated Rate |
$1,183.52 |
| Rate for Payer: Aetna Commercial |
$1,117.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.76
|
| Rate for Payer: Cash Price |
$1,052.02
|
| Rate for Payer: Cofinity Advantage |
$920.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.02
|
| Rate for Payer: Healthscope Commercial |
$1,183.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$986.26
|
| Rate for Payer: PHP Commercial |
$1,117.77
|
| Rate for Payer: Priority Health SBD |
$828.46
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,315.02
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.80 |
| Max. Negotiated Rate |
$1,183.52 |
| Rate for Payer: Aetna Commercial |
$1,117.77
|
| Rate for Payer: Aetna Medicare |
$657.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.76
|
| Rate for Payer: BCBS Complete |
$526.01
|
| Rate for Payer: Cash Price |
$1,052.02
|
| Rate for Payer: Cofinity Advantage |
$920.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.02
|
| Rate for Payer: Healthscope Commercial |
$1,183.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,052.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$986.26
|
| Rate for Payer: PHP Commercial |
$1,117.77
|
| Rate for Payer: Priority Health SBD |
$828.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.76
|
| Rate for Payer: UHC Core |
$685.13
|
| Rate for Payer: UHC Exchange |
$516.80
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health SBD |
$13.77
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.20
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Advantage |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health SBD |
$13.77
|
|
|
HC SODIUM LEVEL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.37
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.80
|
| 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 |
$16.98
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Advantage |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| 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 |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$7.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$18.05
|
| 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 |
$13.37
|
| 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 SODIUM OTHER SOURCE
|
Facility
|
OP
|
$22.07
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.08
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Advantage |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicare |
$4.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$5.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$7.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PACE Medicare |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.86
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health SBD |
$13.90
|
| Rate for Payer: Priority Health Tiered Network |
$3.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.29
|
| Rate for Payer: UHC Core |
$7.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.86
|
| Rate for Payer: UHC Exchange |
$7.29
|
| Rate for Payer: UHC Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: VA VA |
$4.86
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
IP
|
$22.07
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.35
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Advantage |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: Priority Health SBD |
$13.90
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$35.89
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.51
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.33
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$5.40
|
| Rate for Payer: BCN Commercial |
$5.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Advantage |
$25.12
|
| Rate for Payer: Cofinity Commercial |
$30.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Mclaren Medicare |
$5.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: Meridian Medicaid |
$5.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Nomi Health Commercial |
$7.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: PACE Medicare |
$4.81
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$30.51
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.06
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health SBD |
$22.61
|
| Rate for Payer: Priority Health Tiered Network |
$4.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.06
|
| Rate for Payer: UHC Exchange |
$7.59
|
| Rate for Payer: UHC Medicaid |
$2.65
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$5.06
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$35.89
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.61 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.33
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Advantage |
$25.12
|
| Rate for Payer: Cofinity Commercial |
$30.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: PHP Commercial |
$30.51
|
| Rate for Payer: Priority Health SBD |
$22.61
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$199.09
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$179.18 |
| Rate for Payer: Aetna Commercial |
$169.23
|
| Rate for Payer: Aetna Medicare |
$99.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.41
|
| Rate for Payer: BCBS Complete |
$79.64
|
| Rate for Payer: Cash Price |
$159.27
|
| Rate for Payer: Cofinity Advantage |
$139.36
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.27
|
| Rate for Payer: Healthscope Commercial |
$179.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.32
|
| Rate for Payer: PHP Commercial |
$169.23
|
| Rate for Payer: Priority Health SBD |
$125.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.41
|
| Rate for Payer: UHC Core |
$103.73
|
| Rate for Payer: UHC Exchange |
$78.24
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$199.09
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$179.18 |
| Rate for Payer: Aetna Commercial |
$169.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.41
|
| Rate for Payer: Cash Price |
$159.27
|
| Rate for Payer: Cofinity Advantage |
$139.36
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.27
|
| Rate for Payer: Healthscope Commercial |
$179.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.32
|
| Rate for Payer: PHP Commercial |
$169.23
|
| Rate for Payer: Priority Health SBD |
$125.43
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$164.77
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$148.29 |
| Rate for Payer: Aetna Commercial |
$140.05
|
| Rate for Payer: Aetna Medicare |
$82.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.10
|
| Rate for Payer: BCBS Complete |
$65.91
|
| Rate for Payer: Cash Price |
$131.82
|
| Rate for Payer: Cofinity Advantage |
$115.34
|
| Rate for Payer: Cofinity Commercial |
$141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.82
|
| Rate for Payer: Healthscope Commercial |
$148.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.58
|
| Rate for Payer: PHP Commercial |
$140.05
|
| Rate for Payer: Priority Health SBD |
$103.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC Core |
$85.85
|
| Rate for Payer: UHC Exchange |
$64.75
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$164.77
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.81 |
| Max. Negotiated Rate |
$148.29 |
| Rate for Payer: Aetna Commercial |
$140.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.10
|
| Rate for Payer: Cash Price |
$131.82
|
| Rate for Payer: Cofinity Advantage |
$115.34
|
| Rate for Payer: Cofinity Commercial |
$141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.82
|
| Rate for Payer: Healthscope Commercial |
$148.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.58
|
| Rate for Payer: PHP Commercial |
$140.05
|
| Rate for Payer: Priority Health SBD |
$103.81
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.71 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$207.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.59
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Advantage |
$170.79
|
| Rate for Payer: Cofinity Commercial |
$209.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: PHP Commercial |
$207.38
|
| Rate for Payer: Priority Health SBD |
$153.71
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.88 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$207.38
|
| Rate for Payer: Aetna Medicare |
$121.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.59
|
| Rate for Payer: BCBS Complete |
$97.59
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Advantage |
$170.79
|
| Rate for Payer: Cofinity Commercial |
$209.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: PHP Commercial |
$207.38
|
| Rate for Payer: Priority Health SBD |
$153.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.59
|
| Rate for Payer: UHC Core |
$127.11
|
| Rate for Payer: UHC Exchange |
$95.88
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$55.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.56
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Advantage |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$56.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Healthscope Commercial |
$58.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: PHP Commercial |
$55.65
|
| Rate for Payer: Priority Health SBD |
$41.25
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$55.65
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.71
|
| Rate for Payer: BCBS Complete |
$20.08
|
| Rate for Payer: BCBS MAPPO |
$36.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| Rate for Payer: BCN Commercial |
$38.99
|
| Rate for Payer: BCN Medicare Advantage |
$36.57
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Advantage |
$45.83
|
| Rate for Payer: Cofinity Commercial |
$56.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$58.92
|
| Rate for Payer: Mclaren Medicaid |
$19.13
|
| Rate for Payer: Mclaren Medicare |
$36.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.40
|
| Rate for Payer: Meridian Medicaid |
$38.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Nomi Health Commercial |
$54.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: PACE Medicare |
$34.74
|
| Rate for Payer: PACE SWMI |
$36.57
|
| Rate for Payer: PHP Commercial |
$55.65
|
| Rate for Payer: PHP Medicare Advantage |
$36.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.57
|
| Rate for Payer: Priority Health Medicare |
$36.57
|
| Rate for Payer: Priority Health SBD |
$41.25
|
| Rate for Payer: Priority Health Tiered Network |
$29.26
|
| Rate for Payer: Railroad Medicare Medicare |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.86
|
| Rate for Payer: UHC Core |
$54.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.57
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UHC Medicaid |
$19.13
|
| Rate for Payer: UHCCP Medicaid |
$19.13
|
| Rate for Payer: VA VA |
$36.57
|
|
|
HC SOMATOMEDIN
|
Facility
|
IP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: Priority Health SBD |
$35.43
|
|
|
HC SOMATOMEDIN
|
Facility
|
OP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$22.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.57
|
| Rate for Payer: BCBS Complete |
$11.68
|
| Rate for Payer: BCBS MAPPO |
$21.26
|
| Rate for Payer: BCBS Trust/PPO |
$22.67
|
| Rate for Payer: BCN Commercial |
$22.67
|
| Rate for Payer: BCN Medicare Advantage |
$21.26
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Advantage |
$39.37
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Mclaren Medicaid |
$11.12
|
| Rate for Payer: Mclaren Medicare |
$21.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.32
|
| Rate for Payer: Meridian Medicaid |
$22.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$31.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PACE Medicare |
$20.20
|
| Rate for Payer: PACE SWMI |
$21.26
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: PHP Medicare Advantage |
$21.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.26
|
| Rate for Payer: Priority Health Medicare |
$21.26
|
| Rate for Payer: Priority Health SBD |
$35.43
|
| Rate for Payer: Priority Health Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$21.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.89
|
| Rate for Payer: UHC Core |
$31.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.26
|
| Rate for Payer: UHC Exchange |
$31.89
|
| Rate for Payer: UHC Medicaid |
$11.12
|
| Rate for Payer: UHCCP Medicaid |
$11.12
|
| Rate for Payer: VA VA |
$21.26
|
|
|
HC SOYBEAN IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.57
|
| Rate for Payer: BCN Commercial |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$7.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.22
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: Priority Health Tiered Network |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.83
|
| Rate for Payer: UHC Core |
$7.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.83 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,010.22
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Advantage |
$4,318.70
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health SBD |
$3,886.83
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna Medicare |
$3,084.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,010.22
|
| Rate for Payer: BCBS Complete |
$2,467.83
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Advantage |
$4,318.70
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,935.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health SBD |
$3,886.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,010.22
|
| Rate for Payer: UHC Core |
$3,214.35
|
| Rate for Payer: UHC Exchange |
$2,424.64
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
OP
|
$3,926.47
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,620.74 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Commercial |
$3,337.50
|
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,552.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.74
|
| Rate for Payer: BCN Commercial |
$1,620.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cash Price |
$3,141.18
|
| Rate for Payer: Cofinity Advantage |
$2,748.53
|
| Rate for Payer: Cofinity Commercial |
$3,376.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,141.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Healthscope Commercial |
$3,533.82
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,337.50
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,944.85
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Commercial |
$3,337.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health SBD |
$2,473.68
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
