|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: Aetna Medicare |
$30.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cofinity Commercial |
$105.57
|
| Rate for Payer: Cofinity Commercial |
$85.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$110.48
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health SBD |
$77.34
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.77
|
| Rate for Payer: UHC Core |
$90.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$90.84
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
IP
|
$122.76
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.79
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cofinity Commercial |
$105.57
|
| Rate for Payer: Cofinity Commercial |
$85.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.21
|
| Rate for Payer: Healthscope Commercial |
$110.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health SBD |
$77.34
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
OP
|
$122.76
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$110.48 |
| Rate for Payer: Aetna Commercial |
$104.35
|
| Rate for Payer: Aetna Medicare |
$30.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.31
|
| Rate for Payer: BCBS Complete |
$16.35
|
| Rate for Payer: BCBS MAPPO |
$29.05
|
| Rate for Payer: BCN Medicare Advantage |
$29.05
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cash Price |
$98.21
|
| Rate for Payer: Cofinity Commercial |
$85.93
|
| Rate for Payer: Cofinity Commercial |
$105.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.05
|
| Rate for Payer: Healthscope Commercial |
$110.48
|
| Rate for Payer: Mclaren Medicaid |
$15.57
|
| Rate for Payer: Mclaren Medicare |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.50
|
| Rate for Payer: Meridian Medicaid |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.35
|
| Rate for Payer: PACE Medicare |
$27.60
|
| Rate for Payer: PACE SWMI |
$29.05
|
| Rate for Payer: PHP Commercial |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$29.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.79
|
| Rate for Payer: Priority Health Medicare |
$29.05
|
| Rate for Payer: Priority Health SBD |
$77.34
|
| Rate for Payer: Railroad Medicare Medicare |
$29.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.77
|
| Rate for Payer: UHC Core |
$90.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.05
|
| Rate for Payer: UHC Exchange |
$90.84
|
| Rate for Payer: UHC Medicare Advantage |
$29.05
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: VA VA |
$29.05
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$33.92 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP Medicaid |
$6.78
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC SMRNP
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.16 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health SBD |
$22.16
|
|
|
HC SMRNP
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Cofinity Commercial |
$24.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health SBD |
$22.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC SNARE
|
Facility
|
IP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$812.22 |
| Max. Negotiated Rate |
$1,160.32 |
| Rate for Payer: Aetna Commercial |
$1,095.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.01
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,108.75
|
| Rate for Payer: Cofinity Commercial |
$902.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$1,160.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: PHP Commercial |
$1,095.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: Priority Health SBD |
$812.22
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$515.70 |
| Max. Negotiated Rate |
$1,160.32 |
| Rate for Payer: Aetna Commercial |
$1,095.85
|
| Rate for Payer: Aetna Medicare |
$644.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.01
|
| Rate for Payer: BCBS Complete |
$515.70
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,108.75
|
| Rate for Payer: Cofinity Commercial |
$902.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$902.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$1,160.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: PHP Commercial |
$1,095.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: Priority Health SBD |
$812.22
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health SBD |
$13.49
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health SBD |
$13.49
|
|
|
HC SODIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.11 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health SBD |
$13.11
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.53
|
| 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 |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| 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 |
$17.69
|
| Rate for Payer: PACE Medicare |
$4.57
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PHP Commercial |
$17.69
|
| 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 |
$13.53
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health SBD |
$13.11
|
| 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 SODIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| 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 Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| 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: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health SBD |
$13.63
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| 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 |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$2.60
|
| 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 |
$2.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: PACE Medicare |
$4.62
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: UHCCP Medicaid |
$2.74
|
| Rate for Payer: VA VA |
$4.86
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health SBD |
$22.17
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.87
|
| 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 |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.06
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.06
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| 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 |
$2.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: PACE Medicare |
$4.81
|
| Rate for Payer: PACE SWMI |
$5.06
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health SBD |
$22.17
|
| Rate for Payer: Railroad Medicare Medicare |
$5.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.06
|
| Rate for Payer: UHC Medicare Advantage |
$5.06
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$5.06
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$175.67 |
| Rate for Payer: Aetna Commercial |
$165.91
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.87
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$136.63
|
| Rate for Payer: Cofinity Commercial |
$167.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Healthscope Commercial |
$175.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: PHP Commercial |
$165.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: Priority Health SBD |
$122.97
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.97 |
| Max. Negotiated Rate |
$175.67 |
| Rate for Payer: Aetna Commercial |
$165.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.87
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$136.63
|
| Rate for Payer: Cofinity Commercial |
$167.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Healthscope Commercial |
$175.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: PHP Commercial |
$165.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: Priority Health SBD |
$122.97
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$101.77 |
| Max. Negotiated Rate |
$145.39 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$113.08
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$145.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: PHP Commercial |
$137.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$101.77
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$64.62 |
| Max. Negotiated Rate |
$145.39 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: Aetna Medicare |
$80.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: BCBS Complete |
$64.62
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$113.08
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$145.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: PHP Commercial |
$137.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health SBD |
$101.77
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.70 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$203.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.48
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$167.44
|
| Rate for Payer: Cofinity Commercial |
$205.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Healthscope Commercial |
$215.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: PHP Commercial |
$203.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: Priority Health SBD |
$150.70
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$203.32
|
| Rate for Payer: Aetna Medicare |
$119.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.48
|
| Rate for Payer: BCBS Complete |
$95.68
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$167.44
|
| Rate for Payer: Cofinity Commercial |
$205.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Healthscope Commercial |
$215.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: PHP Commercial |
$203.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: Priority Health SBD |
$150.70
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$102.94 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| 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 |
$20.58
|
| Rate for Payer: BCBS MAPPO |
$36.57
|
| Rate for Payer: BCN Medicare Advantage |
$36.57
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.57
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Mclaren Medicaid |
$19.60
|
| 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 |
$20.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: PACE Medicare |
$34.74
|
| Rate for Payer: PACE SWMI |
$36.57
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$36.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health Medicare |
$36.57
|
| Rate for Payer: Priority Health SBD |
$37.69
|
| Rate for Payer: Railroad Medicare Medicare |
$36.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.57
|
| Rate for Payer: UHC Medicare Advantage |
$36.57
|
| Rate for Payer: UHCCP Medicaid |
$20.59
|
| Rate for Payer: VA VA |
$36.57
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.69 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.88
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health SBD |
$37.69
|
|
