|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$28.03
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$73.85 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.57
|
| Rate for Payer: ASR ASR |
$27.19
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$23.11
|
| Rate for Payer: BCN Commercial |
$23.11
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$27.19
|
| Rate for Payer: Healthscope Whirlpool |
$28.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$25.23
|
| Rate for Payer: Mclaren Medicaid |
$18.06
|
| Rate for Payer: Mclaren Medicare |
$18.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.96
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Nomi Health Commercial |
$22.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.02
|
| 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 |
$9.68
|
| Rate for Payer: PHP Medicare Advantage |
$18.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.85
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health Narrow Network |
$59.08
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.06
|
| Rate for Payer: UHC Exchange |
$27.99
|
| Rate for Payer: UHC Medicaid |
$9.45
|
| Rate for Payer: UHCCP DNSP |
$18.06
|
| Rate for Payer: UHCCP Medicaid |
$9.45
|
| Rate for Payer: VA VA |
$18.06
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$28.03
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$28.03 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: ASR ASR |
$27.19
|
| Rate for Payer: BCBS Trust/PPO |
$23.02
|
| Rate for Payer: BCN Commercial |
$23.02
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.42
|
| Rate for Payer: Healthscope Commercial |
$27.19
|
| Rate for Payer: Healthscope Whirlpool |
$28.03
|
| Rate for Payer: Mclaren Commercial |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.83
|
| Rate for Payer: Nomi Health Commercial |
$22.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.67
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| 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 |
$96.07
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$81.66
|
| Rate for Payer: BCN Commercial |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.78
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$69.43
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: ASR ASR |
$96.07
|
| Rate for Payer: BCBS Trust/PPO |
$81.33
|
| Rate for Payer: BCN Commercial |
$81.33
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$39.26
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.45 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| Rate for Payer: ASR ASR |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$32.24
|
| Rate for Payer: BCN Commercial |
$32.24
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$39.26
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$39.26 |
| Rate for Payer: Aetna Commercial |
$35.33
|
| 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 |
$38.08
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$32.37
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cash Price |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$36.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$38.08
|
| Rate for Payer: Healthscope Whirlpool |
$39.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$35.33
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.37
|
| Rate for Payer: Nomi Health Commercial |
$32.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.45
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.40
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$27.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: ASR ASR |
$96.07
|
| Rate for Payer: BCBS Trust/PPO |
$81.33
|
| Rate for Payer: BCN Commercial |
$81.33
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$99.04 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| 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 |
$96.07
|
| Rate for Payer: BCBS Complete |
$7.07
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$81.66
|
| Rate for Payer: BCN Commercial |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$93.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$96.07
|
| Rate for Payer: Healthscope Whirlpool |
$99.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$12.87
|
| Rate for Payer: Mclaren Commercial |
$89.14
|
| Rate for Payer: Mclaren Medicaid |
$12.87
|
| Rate for Payer: Mclaren Medicare |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Meridian Medicaid |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: Nomi Health Commercial |
$81.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.28
|
| 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 |
$6.90
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.78
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow Network |
$69.43
|
| Rate for Payer: Railroad Medicare Medicare |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.87
|
| Rate for Payer: UHC Exchange |
$19.95
|
| Rate for Payer: UHC Medicaid |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$12.87
|
| Rate for Payer: UHCCP Medicaid |
$6.73
|
| Rate for Payer: VA VA |
$12.87
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
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 HEM/ONC CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
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 HEM/ONC CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
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 HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
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 HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
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 HEM/ONC CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
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 HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,185.73
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$889.30 |
| Max. Negotiated Rate |
$1,185.73 |
| Rate for Payer: Aetna Commercial |
$1,067.16
|
| Rate for Payer: ASR ASR |
$1,150.16
|
| Rate for Payer: BCBS Trust/PPO |
$973.72
|
| Rate for Payer: BCN Commercial |
$973.72
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Healthscope Commercial |
$1,150.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,185.73
|
| Rate for Payer: Mclaren Commercial |
$1,067.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.44
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,185.73
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Aetna Commercial |
$1,067.16
|
| Rate for Payer: Aetna Medicare |
$926.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: ASR ASR |
$1,150.16
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$977.63
|
| Rate for Payer: BCN Commercial |
$977.63
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$1,150.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,185.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$926.61
|
| Rate for Payer: Mclaren Commercial |
$1,067.16
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$508.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$1,019.27
|
| Rate for Payer: PHP Medicaid |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,003.55
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Narrow Network |
$802.84
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,043.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$1,436.25
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP DNSP |
$926.61
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Healthscope Whirlpool |
$23.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.75
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Mclaren Medicaid |
$4.75
|
| Rate for Payer: Mclaren Medicare |
$4.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Medicaid |
$2.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PACE Medicare |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.22
|
| Rate for Payer: PHP Medicaid |
$2.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.97
|
| Rate for Payer: Priority Health Medicare |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
| Rate for Payer: UHC Medicaid |
$2.48
|
| Rate for Payer: UHCCP DNSP |
$4.75
|
| Rate for Payer: UHCCP Medicaid |
$2.48
|
| Rate for Payer: VA VA |
$4.75
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$23.93 |
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: ASR ASR |
$23.21
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: BCN Commercial |
$19.65
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Healthscope Whirlpool |
$23.93
|
| Rate for Payer: Mclaren Commercial |
$21.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.06
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$496.00
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$183.52 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$446.40
|
| Rate for Payer: Aetna Medicare |
$183.52
|
| Rate for Payer: ASR ASR |
$481.12
|
| Rate for Payer: BCBS Complete |
$198.40
|
| Rate for Payer: BCBS Trust/PPO |
$408.95
|
| Rate for Payer: BCN Commercial |
$408.95
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$466.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.80
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Healthscope Whirlpool |
$496.00
|
| Rate for Payer: Mclaren Commercial |
$446.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.60
|
| Rate for Payer: Nomi Health Commercial |
$406.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$434.60
|
| Rate for Payer: Priority Health Narrow Network |
$347.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.48
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$496.00
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$446.40
|
| Rate for Payer: ASR ASR |
$481.12
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$407.32
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$466.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.80
|
| Rate for Payer: Healthscope Commercial |
$481.12
|
| Rate for Payer: Healthscope Whirlpool |
$496.00
|
| Rate for Payer: Mclaren Commercial |
$446.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.60
|
| Rate for Payer: Nomi Health Commercial |
$406.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$436.48
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,464.14
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,098.10 |
| Max. Negotiated Rate |
$5,464.14 |
| Rate for Payer: Aetna Commercial |
$4,917.73
|
| Rate for Payer: ASR ASR |
$5,300.22
|
| Rate for Payer: BCBS Trust/PPO |
$4,487.15
|
| Rate for Payer: BCN Commercial |
$4,487.15
|
| Rate for Payer: Cash Price |
$4,371.31
|
| Rate for Payer: Cofinity Commercial |
$5,136.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,371.31
|
| Rate for Payer: Healthscope Commercial |
$5,300.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,464.14
|
| Rate for Payer: Mclaren Commercial |
$4,917.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,644.52
|
| Rate for Payer: Nomi Health Commercial |
$4,480.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,098.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,808.44
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,464.14
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,021.73 |
| Max. Negotiated Rate |
$5,464.14 |
| Rate for Payer: Aetna Commercial |
$4,917.73
|
| Rate for Payer: Aetna Medicare |
$2,021.73
|
| Rate for Payer: ASR ASR |
$5,300.22
|
| Rate for Payer: BCBS Complete |
$2,185.66
|
| Rate for Payer: BCBS Trust/PPO |
$4,505.18
|
| Rate for Payer: BCN Commercial |
$4,505.18
|
| Rate for Payer: Cash Price |
$4,371.31
|
| Rate for Payer: Cofinity Commercial |
$5,136.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,371.31
|
| Rate for Payer: Healthscope Commercial |
$5,300.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,464.14
|
| Rate for Payer: Mclaren Commercial |
$4,917.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,371.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,644.52
|
| Rate for Payer: Nomi Health Commercial |
$4,480.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,098.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4,787.68
|
| Rate for Payer: Priority Health Narrow Network |
$3,830.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,808.44
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$159.18
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$159.18 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: ASR ASR |
$154.40
|
| Rate for Payer: BCBS Trust/PPO |
$130.72
|
| Rate for Payer: BCN Commercial |
$130.72
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$149.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Healthscope Whirlpool |
$159.18
|
| Rate for Payer: Mclaren Commercial |
$143.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.08
|
|
