|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Cofinity Commercial |
$67.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$61.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.17 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.12
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$67.97
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health SBD |
$61.17
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health SBD |
$24.25
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$36.23 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$24.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: BCBS Complete |
$7.24
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Cofinity Commercial |
$67.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Mclaren Medicaid |
$6.90
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health SBD |
$61.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$7.25
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.17 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.12
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$67.97
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.53
|
| Rate for Payer: PHP Commercial |
$82.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health SBD |
$61.17
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity 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 HEM/ONC CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
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 HEM/ONC CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
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 HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
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 HEM/ONC CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
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 HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
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 HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,162.48
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$732.36 |
| Max. Negotiated Rate |
$1,046.23 |
| Rate for Payer: Aetna Commercial |
$988.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.61
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$813.74
|
| Rate for Payer: Cofinity Commercial |
$999.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$813.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Healthscope Commercial |
$1,046.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: PHP Commercial |
$988.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: Priority Health SBD |
$732.36
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,162.48
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,502.92 |
| Rate for Payer: Aetna Commercial |
$988.11
|
| Rate for Payer: Aetna Medicare |
$924.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cash Price |
$929.98
|
| Rate for Payer: Cofinity Commercial |
$999.73
|
| Rate for Payer: Cofinity Commercial |
$813.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$813.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$929.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$1,046.23
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$988.11
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$988.11
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$755.61
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health SBD |
$732.36
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,502.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$500.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health SBD |
$14.78
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.46
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.94
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cash Price |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$16.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Mclaren Medicaid |
$2.55
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$2.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.94
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$19.94
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.25
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health SBD |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.67
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.35 |
| Max. Negotiated Rate |
$437.64 |
| Rate for Payer: Aetna Commercial |
$413.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.08
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$340.39
|
| Rate for Payer: Cofinity Commercial |
$418.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$437.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: PHP Commercial |
$413.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: Priority Health SBD |
$306.35
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$486.27
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$437.64 |
| Rate for Payer: Aetna Commercial |
$413.33
|
| Rate for Payer: Aetna Medicare |
$243.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.08
|
| Rate for Payer: BCBS Complete |
$194.51
|
| Rate for Payer: Cash Price |
$389.02
|
| Rate for Payer: Cofinity Commercial |
$340.39
|
| Rate for Payer: Cofinity Commercial |
$418.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$340.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$437.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$413.33
|
| Rate for Payer: PHP Commercial |
$413.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.08
|
| Rate for Payer: Priority Health SBD |
$306.35
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,374.91 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,482.05
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$3,749.90
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,749.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: Priority Health SBD |
$3,374.91
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,885.66 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: Aetna Medicare |
$2,678.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,482.05
|
| Rate for Payer: BCBS Complete |
$2,142.80
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$3,749.90
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,749.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,553.45
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,482.05
|
| Rate for Payer: Priority Health SBD |
$3,374.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,885.66
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: BCBS Complete |
$62.42
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.44
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$109.24
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health SBD |
$98.32
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
