|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$30.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$30.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$32.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$112.14 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.70
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health SBD |
$112.14
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$112.14
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$27.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.19 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$89.66
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$80.69 |
| Rate for Payer: Aetna Commercial |
$76.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.28
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cofinity Commercial |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$80.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.21
|
| Rate for Payer: PHP Commercial |
$76.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.76
|
| Rate for Payer: Priority Health SBD |
$56.49
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$89.66
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$53.73 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Aetna Commercial |
$76.21
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.34
|
| Rate for Payer: BCBS Complete |
$81.49
|
| Rate for Payer: BCBS MAPPO |
$141.87
|
| Rate for Payer: BCBS Trust/PPO |
$53.73
|
| Rate for Payer: BCN Medicare Advantage |
$141.87
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cofinity Commercial |
$62.76
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.87
|
| Rate for Payer: Healthscope Commercial |
$80.69
|
| Rate for Payer: Mclaren Medicaid |
$77.60
|
| Rate for Payer: Mclaren Medicare |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$81.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.21
|
| Rate for Payer: PACE Medicare |
$134.78
|
| Rate for Payer: PACE SWMI |
$141.87
|
| Rate for Payer: PHP Commercial |
$76.21
|
| Rate for Payer: PHP Medicare Advantage |
$141.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.76
|
| Rate for Payer: Priority Health Medicare |
$141.87
|
| Rate for Payer: Priority Health SBD |
$56.49
|
| Rate for Payer: Railroad Medicare Medicare |
$141.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.87
|
| Rate for Payer: UHC Exchange |
$95.61
|
| Rate for Payer: UHC Medicare Advantage |
$146.13
|
| Rate for Payer: VA VA |
$141.87
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,251.46
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,678.42 |
| Max. Negotiated Rate |
$3,826.31 |
| Rate for Payer: Aetna Commercial |
$3,613.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.45
|
| Rate for Payer: Cash Price |
$3,401.17
|
| Rate for Payer: Cofinity Commercial |
$2,976.02
|
| Rate for Payer: Cofinity Commercial |
$3,656.26
|
| Rate for Payer: Healthscope Commercial |
$3,826.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,613.74
|
| Rate for Payer: PHP Commercial |
$3,613.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,976.02
|
| Rate for Payer: Priority Health SBD |
$2,678.42
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,251.46
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,700.58 |
| Max. Negotiated Rate |
$3,826.31 |
| Rate for Payer: Aetna Commercial |
$3,613.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.45
|
| Rate for Payer: BCBS Complete |
$1,700.58
|
| Rate for Payer: Cash Price |
$3,401.17
|
| Rate for Payer: Cofinity Commercial |
$2,976.02
|
| Rate for Payer: Cofinity Commercial |
$3,656.26
|
| Rate for Payer: Healthscope Commercial |
$3,826.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,613.74
|
| Rate for Payer: PHP Commercial |
$3,613.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,976.02
|
| Rate for Payer: Priority Health SBD |
$2,678.42
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
IP
|
$8,555.36
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,389.88 |
| Max. Negotiated Rate |
$7,699.82 |
| Rate for Payer: Aetna Commercial |
$7,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,560.98
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cofinity Commercial |
$5,988.75
|
| Rate for Payer: Cofinity Commercial |
$7,357.61
|
| Rate for Payer: Healthscope Commercial |
$7,699.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,272.06
|
| Rate for Payer: PHP Commercial |
$7,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,988.75
|
| Rate for Payer: Priority Health SBD |
$5,389.88
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,555.36
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$8,817.68 |
| Rate for Payer: Aetna Commercial |
$7,272.06
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,560.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cofinity Commercial |
$5,988.75
|
| Rate for Payer: Cofinity Commercial |
$7,357.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$7,699.82
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,272.06
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$7,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,988.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
| Rate for Payer: Priority Health SBD |
$5,389.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.92
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$291.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
OP
|
$151.08
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$135.97 |
| Rate for Payer: Aetna Commercial |
$128.42
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$135.97
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.42
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$128.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$95.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Core |
$22.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Exchange |
$18.77
|
| Rate for Payer: UHC Medicare Advantage |
$19.33
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
IP
|
$151.08
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.18 |
| Max. Negotiated Rate |
$135.97 |
| Rate for Payer: Aetna Commercial |
$128.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.20
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Healthscope Commercial |
$135.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.42
|
| Rate for Payer: PHP Commercial |
$128.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health SBD |
$95.18
|
|
|
HC FDG PER DOSE
|
Facility
|
IP
|
$762.71
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$480.51 |
| Max. Negotiated Rate |
$686.44 |
| Rate for Payer: Aetna Commercial |
$648.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cofinity Commercial |
$533.90
|
| Rate for Payer: Cofinity Commercial |
$655.93
|
| Rate for Payer: Healthscope Commercial |
$686.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.30
|
| Rate for Payer: PHP Commercial |
$648.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.90
|
| Rate for Payer: Priority Health SBD |
$480.51
|
|
|
HC FDG PER DOSE
|
Facility
|
OP
|
$762.71
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$206.48 |
| Max. Negotiated Rate |
$686.44 |
| Rate for Payer: Aetna Commercial |
$648.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: BCBS Complete |
$305.08
|
| Rate for Payer: BCBS Trust/PPO |
$206.48
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cofinity Commercial |
$655.93
|
| Rate for Payer: Cofinity Commercial |
$533.90
|
| Rate for Payer: Healthscope Commercial |
$686.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.30
|
| Rate for Payer: PHP Commercial |
$648.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.90
|
| Rate for Payer: Priority Health SBD |
$480.51
|
|
|
HC FECAL FAT QUALITATIVE
|
Facility
|
OP
|
$33.55
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
30100198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna Commercial |
$28.52
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$2.93
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$28.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Mclaren Medicaid |
$2.79
|
| Rate for Payer: Mclaren Medicare |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$2.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.52
|
| Rate for Payer: PACE Medicare |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$28.52
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.48
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.12
|
| Rate for Payer: UHC Core |
$8.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Exchange |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
|
|
HC FECAL FAT QUALITATIVE
|
Facility
|
IP
|
$33.55
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
30100198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna Commercial |
$28.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$28.85
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.52
|
| Rate for Payer: PHP Commercial |
$28.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.48
|
| Rate for Payer: Priority Health SBD |
$21.14
|
|
|
HC FECAL FAT QUANTITATIVE
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
30100200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.00
|
| Rate for Payer: BCBS Complete |
$9.65
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.16
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Mclaren Medicaid |
$9.19
|
| Rate for Payer: Mclaren Medicare |
$16.80
|
| Rate for Payer: Meridian Medicaid |
$9.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PACE Medicare |
$15.96
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: Railroad Medicare Medicare |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.16
|
| Rate for Payer: UHC Core |
$28.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.30
|
| Rate for Payer: VA VA |
$16.80
|
|
|
HC FECAL FAT QUANTITATIVE
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
30100200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
|
