|
HC FACTOR IX ASSAY
|
Facility
|
IP
|
$98.84
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.25 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: ASR Commercial |
$95.87
|
| Rate for Payer: BCBS Trust/PPO |
$80.54
|
| Rate for Payer: BCN Commercial |
$76.63
|
| 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 |
$98.84
|
| Rate for Payer: Healthscope Whirlpool |
$95.87
|
| 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: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
|
|
HC FACTOR IX ASSAY
|
Facility
|
OP
|
$98.84
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$98.84 |
| Rate for Payer: Aetna Commercial |
$88.96
|
| Rate for Payer: Aetna Medicare |
$19.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.80
|
| Rate for Payer: ASR ASR |
$95.87
|
| Rate for Payer: ASR Commercial |
$95.87
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: BCBS MAPPO |
$19.04
|
| Rate for Payer: BCBS Trust/PPO |
$80.94
|
| Rate for Payer: BCN Commercial |
$76.63
|
| Rate for Payer: BCN Medicare Advantage |
$19.04
|
| 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 |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$98.84
|
| Rate for Payer: Healthscope Whirlpool |
$95.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.04
|
| Rate for Payer: Mclaren Commercial |
$88.96
|
| Rate for Payer: Mclaren Medicaid |
$10.21
|
| Rate for Payer: Mclaren Medicare |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.99
|
| Rate for Payer: Meridian Medicaid |
$10.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.01
|
| Rate for Payer: Nomi Health Commercial |
$81.05
|
| Rate for Payer: PACE Medicare |
$18.09
|
| Rate for Payer: PACE SWMI |
$19.04
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: PHP Medicaid |
$10.21
|
| Rate for Payer: PHP Medicare Advantage |
$19.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.60
|
| Rate for Payer: Priority Health Medicare |
$19.04
|
| Rate for Payer: Priority Health Narrow Network |
$69.29
|
| Rate for Payer: Railroad Medicare Medicare |
$19.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.04
|
| Rate for Payer: UHC Exchange |
$29.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.04
|
| Rate for Payer: UHCCP DNSP |
$19.04
|
| Rate for Payer: UHCCP Medicaid |
$10.21
|
| Rate for Payer: VA VA |
$19.04
|
|
|
HC FACTOR V ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$17.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.06
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS MAPPO |
$17.65
|
| Rate for Payer: BCBS Trust/PPO |
$79.35
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.65
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.65
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$9.46
|
| Rate for Payer: Mclaren Medicare |
$17.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.53
|
| Rate for Payer: Meridian Medicaid |
$9.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: PACE Medicare |
$16.77
|
| Rate for Payer: PACE SWMI |
$17.65
|
| Rate for Payer: PHP Commercial |
$19.42
|
| Rate for Payer: PHP Medicaid |
$9.46
|
| Rate for Payer: PHP Medicare Advantage |
$17.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.90
|
| Rate for Payer: Priority Health Medicare |
$17.65
|
| Rate for Payer: Priority Health Narrow Network |
$67.93
|
| Rate for Payer: Railroad Medicare Medicare |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.65
|
| Rate for Payer: UHC Exchange |
$27.36
|
| Rate for Payer: UHC Medicare Advantage |
$17.65
|
| Rate for Payer: UHCCP DNSP |
$17.65
|
| Rate for Payer: UHCCP Medicaid |
$9.46
|
| Rate for Payer: VA VA |
$17.65
|
|
|
HC FACTOR V ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: ASR ASR |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| 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 |
$93.99
|
| Rate for Payer: ASR Commercial |
$93.99
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$79.35
|
| Rate for Payer: BCN Commercial |
$75.13
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$91.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$96.90
|
| Rate for Payer: Healthscope Whirlpool |
$93.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| 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 |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| 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 |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$67.93
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Aetna Commercial |
$152.21
|
| 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 |
$164.05
|
| Rate for Payer: ASR Commercial |
$164.05
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$138.49
|
| Rate for Payer: BCN Commercial |
$131.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$158.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$169.12
|
| Rate for Payer: Healthscope Whirlpool |
$164.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$152.21
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| 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 |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| 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 |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.18
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$118.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$169.12 |
| Rate for Payer: Aetna Commercial |
$152.21
|
| Rate for Payer: ASR ASR |
$164.05
|
| Rate for Payer: ASR Commercial |
$164.05
|
| Rate for Payer: BCBS Trust/PPO |
$137.82
|
| Rate for Payer: BCN Commercial |
$131.12
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$158.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$169.12
|
| Rate for Payer: Healthscope Whirlpool |
$164.05
|
| Rate for Payer: Mclaren Commercial |
$152.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.83
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| 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 |
$98.90
|
| Rate for Payer: ASR Commercial |
$98.90
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.50
|
| Rate for Payer: BCN Commercial |
$79.05
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$101.96
|
| Rate for Payer: Healthscope Whirlpool |
$98.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| 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 |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| 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 |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.34
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$71.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$101.96 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: ASR ASR |
$98.90
|
| Rate for Payer: ASR Commercial |
$98.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.09
|
| Rate for Payer: BCN Commercial |
$79.05
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$101.96
|
| Rate for Payer: Healthscope Whirlpool |
$98.90
|
| Rate for Payer: Mclaren Commercial |
$91.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.72
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$109.24 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: ASR ASR |
$105.96
|
| Rate for Payer: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCN Commercial |
$84.69
|
| 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 |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| 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: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.13
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| 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: ASR Commercial |
$105.96
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$89.46
|
| Rate for Payer: BCN Commercial |
$84.69
|
| 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 |
$109.24
|
| Rate for Payer: Healthscope Whirlpool |
$105.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$98.32
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| 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 |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| 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 |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: 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 |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.28
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| 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 |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| 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 |
$10.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| 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 |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.84
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$75.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.90
|
| Rate for Payer: UHCCP DNSP |
$17.90
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: VA VA |
$17.90
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| 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 |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$19.35
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Mclaren Medicaid |
$10.37
|
| 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 |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$21.28
|
| Rate for Payer: PHP Medicaid |
$10.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.84
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$75.08
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.99
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: UHCCP DNSP |
$19.35
|
| Rate for Payer: UHCCP Medicaid |
$10.37
|
| Rate for Payer: VA VA |
$19.35
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.28
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$181.56 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: ASR ASR |
$176.11
|
| Rate for Payer: ASR Commercial |
$176.11
|
| Rate for Payer: BCBS Trust/PPO |
$147.95
|
| Rate for Payer: BCN Commercial |
$140.76
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$170.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Healthscope Commercial |
$181.56
|
| Rate for Payer: Healthscope Whirlpool |
$176.11
|
| Rate for Payer: Mclaren Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: Nomi Health Commercial |
$148.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.77
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$181.56 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: ASR ASR |
$176.11
|
| Rate for Payer: ASR Commercial |
$176.11
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$148.68
|
| Rate for Payer: BCN Commercial |
$140.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$170.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$181.56
|
| Rate for Payer: Healthscope Whirlpool |
$176.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$163.40
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| 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 |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: Nomi Health Commercial |
$148.88
|
| 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 |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.08
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$127.27
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$16.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$94.39
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$16.34
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| 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 |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| 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 |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.99
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$80.80
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$25.33
|
| Rate for Payer: UHC Medicare Advantage |
$16.34
|
| Rate for Payer: UHCCP DNSP |
$16.34
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$16.34
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$115.26 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: ASR ASR |
$111.80
|
| Rate for Payer: ASR Commercial |
$111.80
|
| Rate for Payer: BCBS Trust/PPO |
$93.93
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$108.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$115.26
|
| Rate for Payer: Healthscope Whirlpool |
$111.80
|
| Rate for Payer: Mclaren Commercial |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.43
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$82.30
|
| Rate for Payer: Aetna Medicare |
$157.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$196.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$196.78
|
| Rate for Payer: ASR ASR |
$88.71
|
| Rate for Payer: ASR Commercial |
$88.71
|
| Rate for Payer: BCBS Complete |
$88.60
|
| Rate for Payer: BCBS MAPPO |
$157.42
|
| Rate for Payer: BCBS Trust/PPO |
$74.89
|
| Rate for Payer: BCN Commercial |
$70.90
|
| Rate for Payer: BCN Medicare Advantage |
$157.42
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$85.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.42
|
| Rate for Payer: Healthscope Commercial |
$91.45
|
| Rate for Payer: Healthscope Whirlpool |
$88.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$157.42
|
| Rate for Payer: Mclaren Commercial |
$82.30
|
| Rate for Payer: Mclaren Medicaid |
$84.38
|
| Rate for Payer: Mclaren Medicare |
$157.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$165.29
|
| Rate for Payer: Meridian Medicaid |
$88.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: Nomi Health Commercial |
$74.99
|
| Rate for Payer: PACE Medicare |
$149.55
|
| Rate for Payer: PACE SWMI |
$157.42
|
| Rate for Payer: PHP Commercial |
$173.16
|
| Rate for Payer: PHP Medicaid |
$84.38
|
| Rate for Payer: PHP Medicare Advantage |
$157.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.13
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: Priority Health Narrow Network |
$64.11
|
| Rate for Payer: Railroad Medicare Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.42
|
| Rate for Payer: UHC Exchange |
$244.00
|
| Rate for Payer: UHC Medicare Advantage |
$157.42
|
| Rate for Payer: UHCCP DNSP |
$157.42
|
| Rate for Payer: UHCCP Medicaid |
$84.38
|
| Rate for Payer: VA VA |
$157.42
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$91.45 |
| Rate for Payer: Aetna Commercial |
$82.30
|
| Rate for Payer: ASR ASR |
$88.71
|
| Rate for Payer: ASR Commercial |
$88.71
|
| Rate for Payer: BCBS Trust/PPO |
$74.52
|
| Rate for Payer: BCN Commercial |
$70.90
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$85.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Healthscope Commercial |
$91.45
|
| Rate for Payer: Healthscope Whirlpool |
$88.71
|
| Rate for Payer: Mclaren Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: Nomi Health Commercial |
$74.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.48
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,818.72 |
| Max. Negotiated Rate |
$4,336.49 |
| Rate for Payer: Aetna Commercial |
$3,902.84
|
| Rate for Payer: ASR ASR |
$4,206.40
|
| Rate for Payer: ASR Commercial |
$4,206.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,533.81
|
| Rate for Payer: BCN Commercial |
$3,362.08
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$4,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Healthscope Commercial |
$4,336.49
|
| Rate for Payer: Healthscope Whirlpool |
$4,206.40
|
| Rate for Payer: Mclaren Commercial |
$3,902.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: Nomi Health Commercial |
$3,555.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,816.11
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,734.60 |
| Max. Negotiated Rate |
$4,336.49 |
| Rate for Payer: Aetna Commercial |
$3,902.84
|
| Rate for Payer: Aetna Medicare |
$2,168.24
|
| Rate for Payer: ASR ASR |
$4,206.40
|
| Rate for Payer: ASR Commercial |
$4,206.40
|
| Rate for Payer: BCBS Complete |
$1,734.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,551.15
|
| Rate for Payer: BCN Commercial |
$3,362.08
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$4,076.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Healthscope Commercial |
$4,336.49
|
| Rate for Payer: Healthscope Whirlpool |
$4,206.40
|
| Rate for Payer: Mclaren Commercial |
$3,902.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: Nomi Health Commercial |
$3,555.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,799.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,039.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,816.11
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,726.47
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,703.94 |
| Max. Negotiated Rate |
$8,726.47 |
| Rate for Payer: Aetna Commercial |
$7,853.82
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$8,464.68
|
| Rate for Payer: ASR Commercial |
$8,464.68
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,146.11
|
| Rate for Payer: BCN Commercial |
$6,765.63
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$6,981.18
|
| Rate for Payer: Cash Price |
$6,981.18
|
| Rate for Payer: Cofinity Commercial |
$8,202.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$8,726.47
|
| Rate for Payer: Healthscope Whirlpool |
$8,464.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$7,853.82
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,417.50
|
| Rate for Payer: Nomi Health Commercial |
$7,155.71
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,672.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,646.13
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$6,117.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,679.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
