|
HC FACTOR V ASSAY
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: BCBS Trust/PPO |
$81.17
|
| Rate for Payer: BCN Commercial |
$81.17
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$92.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$95.87
|
| Rate for Payer: Healthscope Whirlpool |
$98.84
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: BCBS Trust/PPO |
$81.17
|
| Rate for Payer: BCN Commercial |
$81.17
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$92.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Healthscope Commercial |
$95.87
|
| Rate for Payer: Healthscope Whirlpool |
$98.84
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$81.49
|
| Rate for Payer: BCN Commercial |
$81.49
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cash Price |
$79.07
|
| Rate for Payer: Cofinity Commercial |
$92.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$95.87
|
| Rate for Payer: Healthscope Whirlpool |
$98.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| 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 |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.13
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.60
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$69.29
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$172.50
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Aetna Commercial |
$155.25
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$167.32
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$142.23
|
| Rate for Payer: BCN Commercial |
$142.23
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Commercial |
$162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$167.32
|
| Rate for Payer: Healthscope Whirlpool |
$172.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$155.25
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| 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 |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$141.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.14
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$120.92
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$172.50
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$172.50 |
| Rate for Payer: Aetna Commercial |
$155.25
|
| Rate for Payer: ASR ASR |
$167.32
|
| Rate for Payer: BCBS Trust/PPO |
$141.66
|
| Rate for Payer: BCN Commercial |
$141.66
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Commercial |
$162.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Healthscope Commercial |
$167.32
|
| Rate for Payer: Healthscope Whirlpool |
$172.50
|
| Rate for Payer: Mclaren Commercial |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$141.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.80
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$85.75
|
| Rate for Payer: BCN Commercial |
$85.75
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| 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 |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.12
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$72.90
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: ASR ASR |
$100.88
|
| Rate for Payer: BCBS Trust/PPO |
$85.40
|
| Rate for Payer: BCN Commercial |
$85.40
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$97.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$100.88
|
| Rate for Payer: Healthscope Whirlpool |
$104.00
|
| Rate for Payer: Mclaren Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.52
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Trust/PPO |
$91.50
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$111.42 |
| Rate for Payer: Aetna Commercial |
$100.28
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$108.08
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$91.87
|
| Rate for Payer: BCN Commercial |
$91.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$108.08
|
| Rate for Payer: Healthscope Whirlpool |
$111.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$100.28
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| 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 |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$91.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$97.63
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$78.11
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.71
|
| Rate for Payer: BCN Commercial |
$89.71
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$90.07
|
| Rate for Payer: BCN Commercial |
$90.07
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| 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 |
$9.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$19.69
|
| Rate for Payer: PHP Medicaid |
$9.59
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.75
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Complete |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$90.07
|
| Rate for Payer: BCN Commercial |
$90.07
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$19.35
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.29
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.72
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$76.58
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.71
|
| Rate for Payer: BCN Commercial |
$89.71
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$102.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$105.96
|
| Rate for Payer: Healthscope Whirlpool |
$109.24
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$185.19
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$166.67
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: ASR ASR |
$179.63
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$152.69
|
| Rate for Payer: BCN Commercial |
$152.69
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cofinity Commercial |
$174.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: Healthscope Whirlpool |
$185.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$166.67
|
| Rate for Payer: Mclaren Medicaid |
$16.34
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.41
|
| Rate for Payer: Nomi Health Commercial |
$151.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.89
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicaid |
$8.76
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.26
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$129.82
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$185.19
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$138.89 |
| Max. Negotiated Rate |
$185.19 |
| Rate for Payer: Aetna Commercial |
$166.67
|
| Rate for Payer: ASR ASR |
$179.63
|
| Rate for Payer: BCBS Trust/PPO |
$152.08
|
| Rate for Payer: BCN Commercial |
$152.08
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cofinity Commercial |
$174.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.15
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: Healthscope Whirlpool |
$185.19
|
| Rate for Payer: Mclaren Commercial |
$166.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.41
|
| Rate for Payer: Nomi Health Commercial |
$151.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.97
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.18 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Trust/PPO |
$96.55
|
| Rate for Payer: BCN Commercial |
$96.55
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$105.81
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: ASR ASR |
$114.04
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$96.94
|
| Rate for Payer: BCN Commercial |
$96.94
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$110.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$114.04
|
| Rate for Payer: Healthscope Whirlpool |
$117.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$105.81
|
| Rate for Payer: Mclaren Medicaid |
$16.34
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$8.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$17.97
|
| Rate for Payer: PHP Medicaid |
$8.76
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$103.01
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$82.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$93.28
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$221.07 |
| Rate for Payer: Aetna Commercial |
$83.95
|
| Rate for Payer: Aetna Medicare |
$176.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: ASR ASR |
$90.48
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$76.91
|
| Rate for Payer: BCN Commercial |
$76.91
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$90.48
|
| Rate for Payer: Healthscope Whirlpool |
$93.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$176.86
|
| Rate for Payer: Mclaren Commercial |
$83.95
|
| Rate for Payer: Mclaren Medicaid |
$176.86
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$97.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.29
|
| Rate for Payer: Nomi Health Commercial |
$76.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.96
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$194.55
|
| Rate for Payer: PHP Medicaid |
$94.80
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$81.73
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health Narrow Network |
$65.39
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP DNSP |
$176.86
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: VA VA |
$176.86
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$93.28
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$93.28 |
| Rate for Payer: Aetna Commercial |
$83.95
|
| Rate for Payer: ASR ASR |
$90.48
|
| Rate for Payer: BCBS Trust/PPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$76.60
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.62
|
| Rate for Payer: Healthscope Commercial |
$90.48
|
| Rate for Payer: Healthscope Whirlpool |
$93.28
|
| Rate for Payer: Mclaren Commercial |
$83.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.29
|
| Rate for Payer: Nomi Health Commercial |
$76.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.96
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,423.22
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,636.59 |
| Max. Negotiated Rate |
$4,423.22 |
| Rate for Payer: Aetna Commercial |
$3,980.90
|
| Rate for Payer: Aetna Medicare |
$1,636.59
|
| Rate for Payer: ASR ASR |
$4,290.52
|
| Rate for Payer: BCBS Complete |
$1,769.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,646.94
|
| Rate for Payer: BCN Commercial |
$3,646.94
|
| Rate for Payer: Cash Price |
$3,538.58
|
| Rate for Payer: Cofinity Commercial |
$4,157.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,538.58
|
| Rate for Payer: Healthscope Commercial |
$4,290.52
|
| Rate for Payer: Healthscope Whirlpool |
$4,423.22
|
| Rate for Payer: Mclaren Commercial |
$3,980.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,538.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,759.74
|
| Rate for Payer: Nomi Health Commercial |
$3,627.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,317.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3,875.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,100.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,892.43
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,423.22
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,317.41 |
| Max. Negotiated Rate |
$4,423.22 |
| Rate for Payer: Aetna Commercial |
$3,980.90
|
| Rate for Payer: ASR ASR |
$4,290.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,632.35
|
| Rate for Payer: BCN Commercial |
$3,632.35
|
| Rate for Payer: Cash Price |
$3,538.58
|
| Rate for Payer: Cofinity Commercial |
$4,157.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,538.58
|
| Rate for Payer: Healthscope Commercial |
$4,290.52
|
| Rate for Payer: Healthscope Whirlpool |
$4,423.22
|
| Rate for Payer: Mclaren Commercial |
$3,980.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,759.74
|
| Rate for Payer: Nomi Health Commercial |
$3,627.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,317.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,892.43
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,901.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$8,901.00 |
| Rate for Payer: Aetna Commercial |
$8,010.90
|
| Rate for Payer: Aetna Medicare |
$3,260.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: ASR ASR |
$8,633.97
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,338.87
|
| Rate for Payer: BCN Commercial |
$7,338.87
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cofinity Commercial |
$8,366.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,120.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$8,633.97
|
| Rate for Payer: Healthscope Whirlpool |
$8,901.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,260.23
|
| Rate for Payer: Mclaren Commercial |
$8,010.90
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$1,790.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,565.85
|
| Rate for Payer: Nomi Health Commercial |
$7,298.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,675.75
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$3,586.25
|
| Rate for Payer: PHP Medicaid |
$1,747.48
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7,799.06
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Narrow Network |
$6,239.60
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,832.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Exchange |
$5,053.36
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP DNSP |
$3,260.23
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
IP
|
$8,901.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,675.75 |
| Max. Negotiated Rate |
$8,901.00 |
| Rate for Payer: Aetna Commercial |
$8,010.90
|
| Rate for Payer: ASR ASR |
$8,633.97
|
| Rate for Payer: BCBS Trust/PPO |
$7,309.50
|
| Rate for Payer: BCN Commercial |
$7,309.50
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cofinity Commercial |
$8,366.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,120.80
|
| Rate for Payer: Healthscope Commercial |
$8,633.97
|
| Rate for Payer: Healthscope Whirlpool |
$8,901.00
|
| Rate for Payer: Mclaren Commercial |
$8,010.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,565.85
|
| Rate for Payer: Nomi Health Commercial |
$7,298.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,675.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,832.88
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
OP
|
$157.18
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Aetna Commercial |
$141.46
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: ASR ASR |
$152.46
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$129.59
|
| Rate for Payer: BCN Commercial |
$129.59
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cofinity Commercial |
$147.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$152.46
|
| Rate for Payer: Healthscope Whirlpool |
$157.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.77
|
| Rate for Payer: Mclaren Commercial |
$141.46
|
| Rate for Payer: Mclaren Medicaid |
$18.77
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$10.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.60
|
| Rate for Payer: Nomi Health Commercial |
$128.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.89
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$20.65
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.72
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$110.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$29.09
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP DNSP |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
IP
|
$157.18
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.89 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Aetna Commercial |
$141.46
|
| Rate for Payer: ASR ASR |
$152.46
|
| Rate for Payer: BCBS Trust/PPO |
$129.08
|
| Rate for Payer: BCN Commercial |
$129.08
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cofinity Commercial |
$147.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.74
|
| Rate for Payer: Healthscope Commercial |
$152.46
|
| Rate for Payer: Healthscope Whirlpool |
$157.18
|
| Rate for Payer: Mclaren Commercial |
$141.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.60
|
| Rate for Payer: Nomi Health Commercial |
$128.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.32
|
|
