|
HC HEMATOCRIT
|
Facility
|
OP
|
$23.87
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| 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 |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Mclaren Medicaid |
$1.27
|
| 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 |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health SBD |
$15.04
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.33
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$67.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.70
|
| Rate for Payer: BCBS Complete |
$36.78
|
| Rate for Payer: BCBS MAPPO |
$65.36
|
| Rate for Payer: BCN Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Cofinity Commercial |
$185.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.36
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$35.03
|
| Rate for Payer: Mclaren Medicare |
$65.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.63
|
| Rate for Payer: Meridian Medicaid |
$36.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: PACE Medicare |
$62.09
|
| Rate for Payer: PACE SWMI |
$65.36
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$65.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health Medicare |
$65.36
|
| Rate for Payer: Priority Health SBD |
$167.14
|
| Rate for Payer: Railroad Medicare Medicare |
$65.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.36
|
| Rate for Payer: UHC Medicare Advantage |
$65.36
|
| Rate for Payer: UHCCP Medicaid |
$36.80
|
| Rate for Payer: VA VA |
$65.36
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$167.14 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.44
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$185.71
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health SBD |
$167.14
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
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 Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.00
|
| 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: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC HEMO CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$120.00 |
| 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: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.00
|
| 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: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$112.50 |
| 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: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Cofinity Commercial |
$87.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health SBD |
$78.75
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health SBD |
$283.50
|
|
|
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 Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| 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: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$30.00 |
| 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: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$52.50
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.50
|
| 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: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health SBD |
$47.25
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna Medicare |
$116.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.60
|
| Rate for Payer: BCBS Complete |
$93.29
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: Priority Health SBD |
$146.93
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$146.93 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.60
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$163.26
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: Priority Health SBD |
$146.93
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: BCBS Complete |
$102.82
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$149.94
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health SBD |
$134.95
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna Medicare |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.23
|
| Rate for Payer: BCBS Complete |
$85.68
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$149.94
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health SBD |
$134.95
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna Medicare |
$204.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$257.46 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.64
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$286.07
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$286.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health SBD |
$257.46
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| 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 |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$1.27
|
| 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 |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health SBD |
$19.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Medicare Advantage |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.33
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.55
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health SBD |
$19.92
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health SBD |
$17.31
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$50.84 |
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| 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 |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Mclaren Medicaid |
$9.68
|
| 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 |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: PACE Medicare |
$17.16
|
| Rate for Payer: PACE SWMI |
$18.06
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.06
|
| Rate for Payer: UHC Medicare Advantage |
$18.06
|
| Rate for Payer: UHCCP Medicaid |
$10.17
|
| Rate for Payer: VA VA |
$18.06
|
|
