|
HC HELMINTHO SETOMELANO IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$25.12
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$25.12
|
| Rate for Payer: Healthscope Whirlpool |
$25.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$23.31
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$18.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC HEMATOCRIT
|
Facility
|
IP
|
$24.35
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$24.35 |
| Rate for Payer: Aetna Commercial |
$21.91
|
| Rate for Payer: ASR ASR |
$23.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.00
|
| Rate for Payer: BCN Commercial |
$20.00
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$22.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Whirlpool |
$24.35
|
| Rate for Payer: Mclaren Commercial |
$21.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.70
|
| Rate for Payer: Nomi Health Commercial |
$19.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.43
|
|
|
HC HEMATOCRIT
|
Facility
|
OP
|
$24.35
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$24.35 |
| Rate for Payer: Aetna Commercial |
$21.91
|
| 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 |
$23.62
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$20.08
|
| Rate for Payer: BCN Commercial |
$20.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cash Price |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$22.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Whirlpool |
$24.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.37
|
| Rate for Payer: Mclaren Commercial |
$21.91
|
| Rate for Payer: Mclaren Medicaid |
$2.37
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: Meridian Medicaid |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.70
|
| Rate for Payer: Nomi Health Commercial |
$19.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.26
|
| 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 |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.89
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.37
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHCCP DNSP |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$270.61
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.18 |
| Max. Negotiated Rate |
$270.61 |
| Rate for Payer: Aetna Commercial |
$243.55
|
| Rate for Payer: Aetna Medicare |
$65.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.70
|
| Rate for Payer: ASR ASR |
$262.49
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS MAPPO |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$223.12
|
| Rate for Payer: BCN Commercial |
$223.12
|
| Rate for Payer: BCN Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$216.49
|
| Rate for Payer: Cash Price |
$216.49
|
| Rate for Payer: Cofinity Commercial |
$254.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.36
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Healthscope Whirlpool |
$270.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$65.36
|
| Rate for Payer: Mclaren Commercial |
$243.55
|
| Rate for Payer: Mclaren Medicaid |
$65.36
|
| Rate for Payer: Mclaren Medicare |
$65.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.63
|
| Rate for Payer: Meridian Medicaid |
$35.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.02
|
| Rate for Payer: Nomi Health Commercial |
$221.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.96
|
| Rate for Payer: PACE Medicare |
$62.09
|
| Rate for Payer: PACE SWMI |
$65.36
|
| Rate for Payer: PHP Commercial |
$71.90
|
| Rate for Payer: PHP Medicaid |
$35.03
|
| Rate for Payer: PHP Medicare Advantage |
$65.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77.07
|
| Rate for Payer: Priority Health Medicare |
$65.36
|
| Rate for Payer: Priority Health Narrow Network |
$61.66
|
| Rate for Payer: Railroad Medicare Medicare |
$65.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.36
|
| Rate for Payer: UHC Exchange |
$101.31
|
| Rate for Payer: UHC Medicaid |
$34.18
|
| Rate for Payer: UHCCP DNSP |
$65.36
|
| Rate for Payer: UHCCP Medicaid |
$34.18
|
| Rate for Payer: VA VA |
$65.36
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$270.61
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.96 |
| Max. Negotiated Rate |
$270.61 |
| Rate for Payer: Aetna Commercial |
$243.55
|
| Rate for Payer: ASR ASR |
$262.49
|
| Rate for Payer: BCBS Trust/PPO |
$222.22
|
| Rate for Payer: BCN Commercial |
$222.22
|
| Rate for Payer: Cash Price |
$216.49
|
| Rate for Payer: Cofinity Commercial |
$254.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.49
|
| Rate for Payer: Healthscope Commercial |
$262.49
|
| Rate for Payer: Healthscope Whirlpool |
$270.61
|
| Rate for Payer: Mclaren Commercial |
$243.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.02
|
| Rate for Payer: Nomi Health Commercial |
$221.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.14
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$225.00 |
| 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 |
$246.36
|
| Rate for Payer: BCN Commercial |
$246.36
|
| 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 |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC HEMO CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$111.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$247.35
|
| Rate for Payer: BCN Commercial |
$247.35
|
| 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 |
$291.00
|
| Rate for Payer: Healthscope Whirlpool |
$300.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.86
|
| Rate for Payer: Priority Health Narrow Network |
$210.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.65
|
| Rate for Payer: BCN Commercial |
$102.65
|
| 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 |
$121.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.00
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$233.65 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare |
$46.25
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$103.06
|
| 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 |
$121.25
|
| Rate for Payer: Healthscope Whirlpool |
$125.00
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.65
|
| Rate for Payer: Priority Health Narrow Network |
$186.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$166.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$166.50
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$371.02
|
| Rate for Payer: BCN Commercial |
$371.02
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$394.29
|
| Rate for Payer: Priority Health Narrow Network |
$315.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.54
|
| Rate for Payer: BCN Commercial |
$369.54
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$423.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$436.50
|
| Rate for Payer: Healthscope Whirlpool |
$450.00
|
| Rate for Payer: Mclaren Commercial |
$405.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$56.25 |
| 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 |
$61.59
|
| Rate for Payer: BCN Commercial |
$61.59
|
| 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 |
$72.75
|
| Rate for Payer: Healthscope Whirlpool |
$75.00
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$27.75
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.84
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$61.84
|
| 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 |
$72.75
|
| Rate for Payer: Healthscope Whirlpool |
$75.00
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.95
|
| Rate for Payer: Priority Health Narrow Network |
$105.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$237.89
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$237.89 |
| Rate for Payer: Aetna Commercial |
$214.10
|
| Rate for Payer: Aetna Medicare |
$88.02
|
| Rate for Payer: ASR ASR |
$230.75
|
| Rate for Payer: BCBS Complete |
$95.16
|
| Rate for Payer: BCBS Trust/PPO |
$196.14
|
| Rate for Payer: BCN Commercial |
$196.14
|
| Rate for Payer: Cash Price |
$190.31
|
| Rate for Payer: Cofinity Commercial |
$223.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.31
|
| Rate for Payer: Healthscope Commercial |
$230.75
|
| Rate for Payer: Healthscope Whirlpool |
$237.89
|
| Rate for Payer: Mclaren Commercial |
$214.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.21
|
| Rate for Payer: Nomi Health Commercial |
$195.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$208.44
|
| Rate for Payer: Priority Health Narrow Network |
$166.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.34
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$237.89
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.42 |
| Max. Negotiated Rate |
$237.89 |
| Rate for Payer: Aetna Commercial |
$214.10
|
| Rate for Payer: ASR ASR |
$230.75
|
| Rate for Payer: BCBS Trust/PPO |
$195.36
|
| Rate for Payer: BCN Commercial |
$195.36
|
| Rate for Payer: Cash Price |
$190.31
|
| Rate for Payer: Cofinity Commercial |
$223.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.31
|
| Rate for Payer: Healthscope Commercial |
$230.75
|
| Rate for Payer: Healthscope Whirlpool |
$237.89
|
| Rate for Payer: Mclaren Commercial |
$214.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.21
|
| Rate for Payer: Nomi Health Commercial |
$195.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.34
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$262.18
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: Aetna Medicare |
$97.01
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: BCBS Complete |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$216.17
|
| Rate for Payer: BCN Commercial |
$216.17
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Commercial |
$246.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$254.31
|
| Rate for Payer: Healthscope Whirlpool |
$262.18
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$214.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$229.72
|
| Rate for Payer: Priority Health Narrow Network |
$183.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$262.18
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$196.63 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: BCBS Trust/PPO |
$215.30
|
| Rate for Payer: BCN Commercial |
$215.30
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Commercial |
$246.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$254.31
|
| Rate for Payer: Healthscope Whirlpool |
$262.18
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$214.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$218.48
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$218.48 |
| Rate for Payer: Aetna Commercial |
$196.63
|
| Rate for Payer: ASR ASR |
$211.93
|
| Rate for Payer: BCBS Trust/PPO |
$179.42
|
| Rate for Payer: BCN Commercial |
$179.42
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$205.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Healthscope Whirlpool |
$218.48
|
| Rate for Payer: Mclaren Commercial |
$196.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Nomi Health Commercial |
$179.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.26
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$218.48
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.84 |
| Max. Negotiated Rate |
$218.48 |
| Rate for Payer: Aetna Commercial |
$196.63
|
| Rate for Payer: Aetna Medicare |
$80.84
|
| Rate for Payer: ASR ASR |
$211.93
|
| Rate for Payer: BCBS Complete |
$87.39
|
| Rate for Payer: BCBS Trust/PPO |
$180.14
|
| Rate for Payer: BCN Commercial |
$180.14
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cofinity Commercial |
$205.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.78
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Healthscope Whirlpool |
$218.48
|
| Rate for Payer: Mclaren Commercial |
$196.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.71
|
| Rate for Payer: Nomi Health Commercial |
$179.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.43
|
| Rate for Payer: Priority Health Narrow Network |
$153.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.26
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$988.38
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$365.70 |
| Max. Negotiated Rate |
$988.38 |
| Rate for Payer: Aetna Commercial |
$889.54
|
| Rate for Payer: Aetna Medicare |
$365.70
|
| Rate for Payer: ASR ASR |
$958.73
|
| Rate for Payer: BCBS Complete |
$395.35
|
| Rate for Payer: BCBS Trust/PPO |
$814.92
|
| Rate for Payer: BCN Commercial |
$814.92
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Commercial |
$929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$958.73
|
| Rate for Payer: Healthscope Whirlpool |
$988.38
|
| Rate for Payer: Mclaren Commercial |
$889.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$790.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Nomi Health Commercial |
$810.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$866.02
|
| Rate for Payer: Priority Health Narrow Network |
$692.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.77
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$988.38
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$741.28 |
| Max. Negotiated Rate |
$988.38 |
| Rate for Payer: Aetna Commercial |
$889.54
|
| Rate for Payer: ASR ASR |
$958.73
|
| Rate for Payer: BCBS Trust/PPO |
$811.66
|
| Rate for Payer: BCN Commercial |
$811.66
|
| Rate for Payer: Cash Price |
$790.70
|
| Rate for Payer: Cofinity Commercial |
$929.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$790.70
|
| Rate for Payer: Healthscope Commercial |
$958.73
|
| Rate for Payer: Healthscope Whirlpool |
$988.38
|
| Rate for Payer: Mclaren Commercial |
$889.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.12
|
| Rate for Payer: Nomi Health Commercial |
$810.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$741.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$869.77
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$416.84
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: Aetna Medicare |
$154.23
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: BCBS Complete |
$166.74
|
| Rate for Payer: BCBS Trust/PPO |
$343.68
|
| Rate for Payer: BCN Commercial |
$343.68
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$404.33
|
| Rate for Payer: Healthscope Whirlpool |
$416.84
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$365.24
|
| Rate for Payer: Priority Health Narrow Network |
$292.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$416.84
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$312.63 |
| Max. Negotiated Rate |
$416.84 |
| Rate for Payer: Aetna Commercial |
$375.16
|
| Rate for Payer: ASR ASR |
$404.33
|
| Rate for Payer: BCBS Trust/PPO |
$342.31
|
| Rate for Payer: BCN Commercial |
$342.31
|
| Rate for Payer: Cash Price |
$333.47
|
| Rate for Payer: Cofinity Commercial |
$391.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.47
|
| Rate for Payer: Healthscope Commercial |
$404.33
|
| Rate for Payer: Healthscope Whirlpool |
$416.84
|
| Rate for Payer: Mclaren Commercial |
$375.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.31
|
| Rate for Payer: Nomi Health Commercial |
$341.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.82
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| 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 |
$31.28
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$26.59
|
| Rate for Payer: BCN Commercial |
$26.59
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.37
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Mclaren Medicaid |
$2.37
|
| Rate for Payer: Mclaren Medicare |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.49
|
| Rate for Payer: Meridian Medicaid |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| 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 |
$1.27
|
| Rate for Payer: PHP Medicare Advantage |
$2.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10.89
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.37
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHCCP DNSP |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: ASR ASR |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$26.48
|
| Rate for Payer: BCN Commercial |
$26.48
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$31.28
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Mclaren Commercial |
$29.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.38
|
|
