|
HC FACTOR IX
|
Facility
|
OP
|
$156.78
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Aetna Commercial |
$133.26
|
| Rate for Payer: Aetna Medicare |
$19.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.80
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.04
|
| Rate for Payer: BCN Medicare Advantage |
$19.04
|
| Rate for Payer: Cash Price |
$125.42
|
| Rate for Payer: Cash Price |
$125.42
|
| Rate for Payer: Cofinity Commercial |
$134.83
|
| Rate for Payer: Cofinity Commercial |
$109.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$141.10
|
| Rate for Payer: Mclaren Medicaid |
$10.21
|
| Rate for Payer: Mclaren Medicare |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.99
|
| Rate for Payer: Meridian Medicaid |
$10.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.26
|
| Rate for Payer: PACE Medicare |
$18.09
|
| Rate for Payer: PACE SWMI |
$19.04
|
| Rate for Payer: PHP Commercial |
$133.26
|
| Rate for Payer: PHP Medicare Advantage |
$19.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.91
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health SBD |
$98.77
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.04
|
| Rate for Payer: UHC Medicare Advantage |
$19.04
|
| Rate for Payer: UHCCP Medicaid |
$10.72
|
| Rate for Payer: VA VA |
$19.04
|
|
|
HC FACTOR IX ASSAY
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health SBD |
$62.27
|
|
|
HC FACTOR IX ASSAY
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$88.96 |
| Rate for Payer: Aetna Commercial |
$84.01
|
| Rate for Payer: Aetna Medicare |
$19.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.80
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.04
|
| Rate for Payer: BCN Medicare Advantage |
$19.04
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$85.00
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$88.96
|
| Rate for Payer: Mclaren Medicaid |
$10.21
|
| Rate for Payer: Mclaren Medicare |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.99
|
| Rate for Payer: Meridian Medicaid |
$10.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: PACE Medicare |
$18.09
|
| Rate for Payer: PACE SWMI |
$19.04
|
| Rate for Payer: PHP Commercial |
$84.01
|
| Rate for Payer: PHP Medicare Advantage |
$19.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health SBD |
$62.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.04
|
| Rate for Payer: UHC Medicare Advantage |
$19.04
|
| Rate for Payer: UHCCP Medicaid |
$10.72
|
| Rate for Payer: VA VA |
$19.04
|
|
|
HC FACTOR V ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC FACTOR V ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS MAPPO |
$17.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.65
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$9.46
|
| Rate for Payer: Mclaren Medicare |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.53
|
| Rate for Payer: Meridian Medicaid |
$9.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PACE Medicare |
$16.77
|
| Rate for Payer: PACE SWMI |
$17.65
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$17.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.65
|
| Rate for Payer: UHC Medicare Advantage |
$17.65
|
| Rate for Payer: UHCCP Medicaid |
$9.94
|
| Rate for Payer: VA VA |
$17.65
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$10.08
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$67.83
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.55 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.93
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$118.38
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health SBD |
$106.55
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.93
|
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Commercial |
$118.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$106.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$10.08
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Cofinity Commercial |
$71.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$10.08
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.23 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.27
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$71.37
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$10.08
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health SBD |
$68.82
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| 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: Cofinity Medicare Advantage |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| 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) |
$50.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$10.08
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health SBD |
$67.47
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.61
|
| 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 |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| 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: Cofinity Medicare Advantage |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.03
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$91.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.61
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.89
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.01
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$127.09
|
| Rate for Payer: Cofinity Commercial |
$156.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Healthscope Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: PHP Commercial |
$154.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$114.38
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$156.14
|
| Rate for Payer: Cofinity Commercial |
$127.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$163.40
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$154.33
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$114.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$9.20
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$72.61
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$9.20
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.61 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.92
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$80.68
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health SBD |
$72.61
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$57.61 |
| Max. Negotiated Rate |
$441.09 |
| Rate for Payer: Aetna Commercial |
$77.73
|
| Rate for Payer: Aetna Medicare |
$162.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$195.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$195.88
|
| Rate for Payer: BCBS Complete |
$88.19
|
| Rate for Payer: BCBS MAPPO |
$156.70
|
| Rate for Payer: BCN Medicare Advantage |
$156.70
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$64.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.70
|
| Rate for Payer: Healthscope Commercial |
$82.31
|
| Rate for Payer: Mclaren Medicaid |
$83.99
|
| Rate for Payer: Mclaren Medicare |
$156.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.53
|
| Rate for Payer: Meridian Medicaid |
$88.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: PACE Medicare |
$148.87
|
| Rate for Payer: PACE SWMI |
$156.70
|
| Rate for Payer: PHP Commercial |
$77.73
|
| Rate for Payer: PHP Medicare Advantage |
$156.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: Priority Health Medicare |
$156.70
|
| Rate for Payer: Priority Health SBD |
$57.61
|
| Rate for Payer: Railroad Medicare Medicare |
$156.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.70
|
| Rate for Payer: UHC Medicare Advantage |
$156.70
|
| Rate for Payer: UHCCP Medicaid |
$88.22
|
| Rate for Payer: VA VA |
$156.70
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$57.61 |
| Max. Negotiated Rate |
$82.31 |
| Rate for Payer: Aetna Commercial |
$77.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.44
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$64.02
|
| Rate for Payer: Cofinity Commercial |
$78.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Healthscope Commercial |
$82.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: PHP Commercial |
$77.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: Priority Health SBD |
$57.61
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,734.60 |
| Max. Negotiated Rate |
$3,902.84 |
| Rate for Payer: Aetna Commercial |
$3,686.02
|
| Rate for Payer: Aetna Medicare |
$2,168.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,818.72
|
| Rate for Payer: BCBS Complete |
$1,734.60
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$3,035.54
|
| Rate for Payer: Cofinity Commercial |
$3,729.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,035.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Healthscope Commercial |
$3,902.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: PHP Commercial |
$3,686.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: Priority Health SBD |
$2,731.99
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,731.99 |
| Max. Negotiated Rate |
$3,902.84 |
| Rate for Payer: Aetna Commercial |
$3,686.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,818.72
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$3,035.54
|
| Rate for Payer: Cofinity Commercial |
$3,729.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,035.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Healthscope Commercial |
$3,902.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: PHP Commercial |
$3,686.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: Priority Health SBD |
$2,731.99
|
|
