|
HC F423 RARA H2 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200447
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F424 RARA H3 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200448
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F424 RARA H3 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200448
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F427 RARA H9 LTP PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200451
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F427 RARA H9 LTP PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200451
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F447 RARA H6 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200449
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F447 RARA H6 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200449
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F76 ALPHA-LACTALBUMIN
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F76 ALPHA-LACTALBUMIN
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200442
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F77 BETA-LACTOGLOBULIN
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200445
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC F77 BETA-LACTOGLOBULIN
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200445
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F78 CASEIN
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$18.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.41
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS MAPPO |
$17.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.88
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$9.61
|
| Rate for Payer: Mclaren Medicare |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$10.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$26.90
|
| Rate for Payer: PACE Medicare |
$17.03
|
| Rate for Payer: PACE SWMI |
$17.93
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$17.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.93
|
| Rate for Payer: UHC Medicare Advantage |
$17.93
|
| Rate for Payer: UHCCP Medicaid |
$10.09
|
| Rate for Payer: VA VA |
$17.93
|
|
|
HC F78 CASEIN
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$19.84
|
|
|
HC FACTOR II ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
30500015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.22
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS MAPPO |
$12.98
|
| Rate for Payer: BCBS Trust/PPO |
$11.50
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.98
|
| 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 |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$6.96
|
| Rate for Payer: Mclaren Medicare |
$12.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.63
|
| Rate for Payer: Meridian Medicaid |
$7.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$19.47
|
| Rate for Payer: PACE Medicare |
$12.33
|
| Rate for Payer: PACE SWMI |
$12.98
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$12.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.36
|
| Rate for Payer: Priority Health Medicare |
$12.98
|
| Rate for Payer: Priority Health Narrow Network |
$10.69
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
| Rate for Payer: UHCCP Medicaid |
$7.31
|
| Rate for Payer: VA VA |
$12.98
|
|
|
HC FACTOR II ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
30500015
|
|
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 IX
|
Facility
|
IP
|
$156.78
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Aetna Commercial |
$133.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.91
|
| Rate for Payer: Cash Price |
$125.42
|
| Rate for Payer: Cofinity Commercial |
$109.75
|
| Rate for Payer: Cofinity Commercial |
$134.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.42
|
| Rate for Payer: Healthscope Commercial |
$141.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.26
|
| Rate for Payer: PHP Commercial |
$133.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.91
|
| Rate for Payer: Priority Health SBD |
$98.77
|
|
|
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: BCBS Trust/PPO |
$16.85
|
| Rate for Payer: BCN Commercial |
$16.85
|
| 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: Nomi Health Commercial |
$28.56
|
| 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 HMO/PPO/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health Narrow Network |
$15.23
|
| Rate for Payer: Priority Health SBD |
$98.77
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.85
|
| 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
|
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: BCBS Trust/PPO |
$16.85
|
| Rate for Payer: BCN Commercial |
$16.85
|
| 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: Nomi Health Commercial |
$28.56
|
| 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 HMO/PPO/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health Narrow Network |
$15.23
|
| Rate for Payer: Priority Health SBD |
$62.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.85
|
| 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 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: BCBS Trust/PPO |
$15.63
|
| Rate for Payer: BCN Commercial |
$15.63
|
| 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: Nomi Health Commercial |
$26.48
|
| 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 HMO/PPO/Tiered Network |
$17.65
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow Network |
$14.12
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.18
|
| 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: BCBS Trust/PPO |
$15.85
|
| Rate for Payer: BCN Commercial |
$15.85
|
| 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 |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| 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 HMO/PPO/Tiered Network |
$18.42
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$14.74
|
| Rate for Payer: Priority Health SBD |
$61.05
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| 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: BCBS Trust/PPO |
$15.85
|
| Rate for Payer: BCN Commercial |
$15.85
|
| 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 |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| 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 HMO/PPO/Tiered Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$14.32
|
| Rate for Payer: Priority Health SBD |
$106.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| 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
|
|
