|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$111.86 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.86
|
| Rate for Payer: Priority Health Narrow Network |
$89.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.15
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.46 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$205.79
|
| Rate for Payer: ASR ASR |
$221.80
|
| Rate for Payer: BCBS Complete |
$91.46
|
| Rate for Payer: BCBS Trust/PPO |
$177.28
|
| Rate for Payer: BCN Commercial |
$177.28
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$214.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Healthscope Commercial |
$228.66
|
| Rate for Payer: Healthscope Whirlpool |
$221.80
|
| Rate for Payer: Mclaren Commercial |
$205.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.08
|
| Rate for Payer: Priority Health Narrow Network |
$162.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.22
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.06 |
| Max. Negotiated Rate |
$228.66 |
| Rate for Payer: Aetna Commercial |
$205.79
|
| Rate for Payer: ASR ASR |
$221.80
|
| Rate for Payer: BCBS Trust/PPO |
$177.28
|
| Rate for Payer: BCN Commercial |
$177.28
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$214.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Healthscope Commercial |
$228.66
|
| Rate for Payer: Healthscope Whirlpool |
$221.80
|
| Rate for Payer: Mclaren Commercial |
$205.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.22
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$195.38
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$252.00
|
| Rate for Payer: Healthscope Whirlpool |
$244.44
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.32
|
| Rate for Payer: Priority Health Narrow Network |
$178.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$195.38
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$252.00
|
| Rate for Payer: Healthscope Whirlpool |
$244.44
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: BCBS Trust/PPO |
$162.81
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Healthscope Whirlpool |
$203.70
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$162.81
|
| Rate for Payer: BCN Commercial |
$162.81
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Healthscope Whirlpool |
$203.70
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.10
|
| Rate for Payer: Priority Health Narrow Network |
$149.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$380.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: ASR ASR |
$921.50
|
| Rate for Payer: BCBS Complete |
$380.00
|
| Rate for Payer: BCBS Trust/PPO |
$736.54
|
| Rate for Payer: BCN Commercial |
$736.54
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$893.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$950.00
|
| Rate for Payer: Healthscope Whirlpool |
$921.50
|
| Rate for Payer: Mclaren Commercial |
$855.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$864.50
|
| Rate for Payer: Priority Health Narrow Network |
$674.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.00
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$855.00
|
| Rate for Payer: ASR ASR |
$921.50
|
| Rate for Payer: BCBS Trust/PPO |
$736.54
|
| Rate for Payer: BCN Commercial |
$736.54
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$893.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$950.00
|
| Rate for Payer: Healthscope Whirlpool |
$921.50
|
| Rate for Payer: Mclaren Commercial |
$855.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$836.00
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$400.66
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$280.46 |
| Max. Negotiated Rate |
$400.66 |
| Rate for Payer: Aetna Commercial |
$360.59
|
| Rate for Payer: ASR ASR |
$388.64
|
| Rate for Payer: BCBS Trust/PPO |
$310.63
|
| Rate for Payer: BCN Commercial |
$310.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$400.66
|
| Rate for Payer: Healthscope Whirlpool |
$388.64
|
| Rate for Payer: Mclaren Commercial |
$360.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.58
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$400.66
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$160.26 |
| Max. Negotiated Rate |
$400.66 |
| Rate for Payer: Aetna Commercial |
$360.59
|
| Rate for Payer: ASR ASR |
$388.64
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS Trust/PPO |
$310.63
|
| Rate for Payer: BCN Commercial |
$310.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$400.66
|
| Rate for Payer: Healthscope Whirlpool |
$388.64
|
| Rate for Payer: Mclaren Commercial |
$360.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.60
|
| Rate for Payer: Priority Health Narrow Network |
$284.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.58
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: ASR ASR |
$30.07
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$31.00
|
| Rate for Payer: Healthscope Whirlpool |
$30.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.37
|
| Rate for Payer: Mclaren Commercial |
$27.90
|
| Rate for Payer: Mclaren Medicaid |
$1.30
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Medicaid |
$1.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PACE Medicare |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: PHP Medicaid |
$1.30
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$7.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.28
|
| Rate for Payer: UHC Medicare Advantage |
$2.44
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: ASR ASR |
$30.07
|
| Rate for Payer: BCBS Trust/PPO |
$24.03
|
| Rate for Payer: BCN Commercial |
$24.03
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$29.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$31.00
|
| Rate for Payer: Healthscope Whirlpool |
$30.07
|
| Rate for Payer: Mclaren Commercial |
$27.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.28
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$26.94
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.58
|
| Rate for Payer: ASR ASR |
$26.13
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$25.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$26.94
|
| Rate for Payer: Healthscope Whirlpool |
$26.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$24.25
|
| Rate for Payer: Mclaren Medicaid |
$9.88
|
| Rate for Payer: Mclaren Medicare |
$18.06
|
| Rate for Payer: Meridian Medicaid |
$10.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.90
|
| Rate for Payer: PACE Medicare |
$17.16
|
| Rate for Payer: PACE SWMI |
$18.06
|
| Rate for Payer: PHP Commercial |
$19.87
|
| Rate for Payer: PHP Medicaid |
$9.88
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.60
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health Narrow Network |
$50.08
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.60
|
| Rate for Payer: VA VA |
$18.06
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$26.94
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: ASR ASR |
$26.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCN Commercial |
$20.89
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$25.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$26.94
|
| Rate for Payer: Healthscope Whirlpool |
$26.13
|
| Rate for Payer: Mclaren Commercial |
$24.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.71
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.63
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$36.61
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$29.26
|
| Rate for Payer: BCN Commercial |
$29.26
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$35.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$37.74
|
| Rate for Payer: Healthscope Whirlpool |
$36.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$33.97
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.34
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$26.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.21
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: Aetna Commercial |
$33.97
|
| Rate for Payer: ASR ASR |
$36.61
|
| Rate for Payer: BCBS Trust/PPO |
$29.26
|
| Rate for Payer: BCN Commercial |
$29.26
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$35.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$37.74
|
| Rate for Payer: Healthscope Whirlpool |
$36.61
|
| Rate for Payer: Mclaren Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.21
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: Aetna Medicare |
$12.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.09
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Complete |
$7.39
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Mclaren Medicaid |
$7.04
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Medicaid |
$7.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Medicare |
$12.23
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$14.16
|
| Rate for Payer: PHP Medicaid |
$7.04
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.63
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$67.59
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Aetna Commercial |
$85.68
|
| Rate for Payer: ASR ASR |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$73.81
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$89.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$95.20
|
| Rate for Payer: Healthscope Whirlpool |
$92.34
|
| Rate for Payer: Mclaren Commercial |
$85.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.78
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
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 |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$232.59
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.00
|
| Rate for Payer: Priority Health Narrow Network |
$213.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$96.91
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
