|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Advantage |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.75
|
| Rate for Payer: UHC Core |
$39.08
|
| Rate for Payer: UHC Exchange |
$29.48
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Advantage |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$237.89
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.49 |
| Max. Negotiated Rate |
$214.10 |
| Rate for Payer: Aetna Commercial |
$202.21
|
| Rate for Payer: Aetna Medicare |
$118.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.63
|
| Rate for Payer: BCBS Complete |
$95.16
|
| Rate for Payer: Cash Price |
$190.31
|
| Rate for Payer: Cofinity Advantage |
$166.52
|
| Rate for Payer: Cofinity Commercial |
$204.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.31
|
| Rate for Payer: Healthscope Commercial |
$214.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.42
|
| Rate for Payer: PHP Commercial |
$202.21
|
| Rate for Payer: Priority Health SBD |
$149.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.63
|
| Rate for Payer: UHC Core |
$123.94
|
| Rate for Payer: UHC Exchange |
$93.49
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$237.89
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$149.87 |
| Max. Negotiated Rate |
$214.10 |
| Rate for Payer: Aetna Commercial |
$202.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.63
|
| Rate for Payer: Cash Price |
$190.31
|
| Rate for Payer: Cofinity Advantage |
$166.52
|
| Rate for Payer: Cofinity Commercial |
$204.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.31
|
| Rate for Payer: Healthscope Commercial |
$214.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.42
|
| Rate for Payer: PHP Commercial |
$202.21
|
| Rate for Payer: Priority Health SBD |
$149.87
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$262.18
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$165.17 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: Priority Health SBD |
$165.17
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$262.18
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna Medicare |
$131.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: BCBS Complete |
$104.87
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: Priority Health SBD |
$165.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.42
|
| Rate for Payer: UHC Core |
$136.60
|
| Rate for Payer: UHC Exchange |
$103.04
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$218.48
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$196.63 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: Aetna Medicare |
$109.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.01
|
| Rate for Payer: BCBS Complete |
$87.39
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Advantage |
$152.94
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.86
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: Priority Health SBD |
$137.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.01
|
| Rate for Payer: UHC Core |
$113.83
|
| Rate for Payer: UHC Exchange |
$85.86
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$218.48
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.64 |
| Max. Negotiated Rate |
$196.63 |
| Rate for Payer: Aetna Commercial |
$185.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.01
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Advantage |
$152.94
|
| Rate for Payer: Cofinity Commercial |
$187.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$196.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.86
|
| Rate for Payer: PHP Commercial |
$185.71
|
| Rate for Payer: Priority Health SBD |
$137.64
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$988.38
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$622.68 |
| Max. Negotiated Rate |
$889.54 |
| Rate for Payer: Aetna Commercial |
$840.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.45
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Advantage |
$691.87
|
| Rate for Payer: Cofinity Commercial |
$850.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$889.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: PHP Commercial |
$840.12
|
| Rate for Payer: Priority Health SBD |
$622.68
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$988.38
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$388.43 |
| Max. Negotiated Rate |
$889.54 |
| Rate for Payer: Aetna Commercial |
$840.12
|
| Rate for Payer: Aetna Medicare |
$494.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.45
|
| Rate for Payer: BCBS Complete |
$395.35
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Advantage |
$691.87
|
| Rate for Payer: Cofinity Commercial |
$850.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$889.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$790.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: PHP Commercial |
$840.12
|
| Rate for Payer: Priority Health SBD |
$622.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$642.45
|
| Rate for Payer: UHC Core |
$514.95
|
| Rate for Payer: UHC Exchange |
$388.43
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.82 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: Aetna Medicare |
$208.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.95
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Advantage |
$291.79
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: Priority Health SBD |
$262.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.95
|
| Rate for Payer: UHC Core |
$217.17
|
| Rate for Payer: UHC Exchange |
$163.82
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$262.61 |
| Max. Negotiated Rate |
$375.16 |
| Rate for Payer: Aetna Commercial |
$354.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.95
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Advantage |
$291.79
|
| Rate for Payer: Cofinity Commercial |
$358.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: PHP Commercial |
$354.31
|
| Rate for Payer: Priority Health SBD |
$262.61
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health SBD |
$20.32
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Advantage |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$1.24
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: Meridian Medicaid |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$3.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2.37
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health SBD |
$20.32
|
| Rate for Payer: Priority Health Tiered Network |
$1.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.56
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.37
|
| Rate for Payer: UHC Exchange |
$3.56
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$28.03
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.57
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.26
|
| Rate for Payer: BCN Commercial |
$19.26
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cofinity Advantage |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Mclaren Medicaid |
$9.45
|
| Rate for Payer: Mclaren Medicare |
$18.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$18.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Nomi Health Commercial |
$27.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.02
|
| Rate for Payer: PACE Medicare |
$17.16
|
| Rate for Payer: PACE SWMI |
$18.06
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.06
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health SBD |
$17.66
|
| Rate for Payer: Priority Health Tiered Network |
$14.45
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.09
|
| Rate for Payer: UHC Core |
$27.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.06
|
| Rate for Payer: UHC Exchange |
$27.09
|
| Rate for Payer: UHC Medicaid |
$9.45
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: VA VA |
$18.06
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$28.03
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.22
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cofinity Advantage |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$24.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.42
|
| Rate for Payer: Healthscope Commercial |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.02
|
| Rate for Payer: PHP Commercial |
$23.83
|
| Rate for Payer: Priority Health SBD |
$17.66
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health SBD |
$62.40
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$39.26
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$35.33 |
| Rate for Payer: Aetna Commercial |
$33.37
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Advantage |
$27.48
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$35.33
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$33.37
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$24.73
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$39.26
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$35.33 |
| Rate for Payer: Aetna Commercial |
$33.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.52
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Advantage |
$27.48
|
| Rate for Payer: Cofinity Commercial |
$33.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: PHP Commercial |
$33.37
|
| Rate for Payer: Priority Health SBD |
$24.73
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health SBD |
$62.40
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$10.29
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Advantage |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$6.73
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.87
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: Priority Health Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Core |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$117.90 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$211.09
|
| Rate for Payer: BCN Commercial |
$211.09
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.00
|
| Rate for Payer: UHC Core |
$156.30
|
| Rate for Payer: UHC Exchange |
$117.90
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$49.12 |
| Max. Negotiated Rate |
$119.83 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$119.83
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Advantage |
$87.50
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.25
|
| Rate for Payer: UHC Core |
$65.12
|
| Rate for Payer: UHC Exchange |
$49.12
|
|
