|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| 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 |
$257.34
|
| Rate for Payer: ASR Commercial |
$257.34
|
| Rate for Payer: BCBS Complete |
$36.78
|
| Rate for Payer: BCBS MAPPO |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$217.25
|
| Rate for Payer: BCN Commercial |
$205.69
|
| Rate for Payer: BCN Medicare Advantage |
$65.36
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$249.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.36
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Healthscope Whirlpool |
$257.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$65.36
|
| Rate for Payer: Mclaren Commercial |
$238.77
|
| Rate for Payer: Mclaren Medicaid |
$35.03
|
| 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 |
$36.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$217.55
|
| 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 |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.90
|
| Rate for Payer: Priority Health Medicare |
$65.36
|
| Rate for Payer: Priority Health Narrow Network |
$55.92
|
| Rate for Payer: Railroad Medicare Medicare |
$65.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.36
|
| Rate for Payer: UHC Exchange |
$101.31
|
| Rate for Payer: UHC Medicare Advantage |
$65.36
|
| Rate for Payer: UHCCP DNSP |
$65.36
|
| Rate for Payer: UHCCP Medicaid |
$35.03
|
| Rate for Payer: VA VA |
$65.36
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$238.77
|
| Rate for Payer: ASR ASR |
$257.34
|
| Rate for Payer: ASR Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$216.19
|
| Rate for Payer: BCN Commercial |
$205.69
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$249.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Healthscope Whirlpool |
$257.34
|
| Rate for Payer: Mclaren Commercial |
$238.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$217.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.46
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: BCBS Trust/PPO |
$244.47
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| 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 |
$120.00 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: ASR ASR |
$291.00
|
| Rate for Payer: ASR Commercial |
$291.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$245.67
|
| Rate for Payer: BCN Commercial |
$232.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$282.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$300.00
|
| Rate for Payer: Healthscope Whirlpool |
$291.00
|
| Rate for Payer: Mclaren Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: 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
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$211.92 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: ASR Commercial |
$121.25
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$102.36
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.92
|
| Rate for Payer: Priority Health Narrow Network |
$169.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: ASR ASR |
$121.25
|
| Rate for Payer: ASR Commercial |
$121.25
|
| Rate for Payer: BCBS Trust/PPO |
$101.86
|
| Rate for Payer: BCN Commercial |
$96.91
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$117.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$125.00
|
| Rate for Payer: Healthscope Whirlpool |
$121.25
|
| Rate for Payer: Mclaren Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| 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 |
$180.00 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$368.50
|
| Rate for Payer: BCN Commercial |
$348.88
|
| 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 |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| 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: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: 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 |
$292.50 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: ASR ASR |
$436.50
|
| Rate for Payer: ASR Commercial |
$436.50
|
| Rate for Payer: BCBS Trust/PPO |
$366.70
|
| Rate for Payer: BCN Commercial |
$348.88
|
| 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 |
$450.00
|
| Rate for Payer: Healthscope Whirlpool |
$436.50
|
| 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: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$396.00
|
|
|
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 |
$119.69 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.42
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$119.69
|
| Rate for Payer: Priority Health Narrow Network |
$95.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: ASR ASR |
$72.75
|
| Rate for Payer: ASR Commercial |
$72.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.12
|
| Rate for Payer: BCN Commercial |
$58.15
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$75.00
|
| Rate for Payer: Healthscope Whirlpool |
$72.75
|
| Rate for Payer: Mclaren Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$66.00
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$233.23 |
| Rate for Payer: Aetna Commercial |
$209.91
|
| Rate for Payer: Aetna Medicare |
$116.62
|
| Rate for Payer: ASR ASR |
$226.23
|
| Rate for Payer: ASR Commercial |
$226.23
|
| Rate for Payer: BCBS Complete |
$93.29
|
| Rate for Payer: BCBS Trust/PPO |
$190.99
|
| Rate for Payer: BCN Commercial |
$180.82
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$233.23
|
| Rate for Payer: Healthscope Whirlpool |
$226.23
|
| Rate for Payer: Mclaren Commercial |
$209.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.36
|
| Rate for Payer: Priority Health Narrow Network |
$163.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.24
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$233.23 |
| Rate for Payer: Aetna Commercial |
$209.91
|
| Rate for Payer: ASR ASR |
$226.23
|
| Rate for Payer: ASR Commercial |
$226.23
|
| Rate for Payer: BCBS Trust/PPO |
$190.06
|
| Rate for Payer: BCN Commercial |
$180.82
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$219.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$233.23
|
| Rate for Payer: Healthscope Whirlpool |
$226.23
|
| Rate for Payer: Mclaren Commercial |
$209.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.24
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$231.34
|
| Rate for Payer: ASR ASR |
$249.33
|
| Rate for Payer: ASR Commercial |
$249.33
|
| Rate for Payer: BCBS Trust/PPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$199.28
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$241.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Healthscope Whirlpool |
$249.33
|
| Rate for Payer: Mclaren Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.20
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$231.34
|
| Rate for Payer: Aetna Medicare |
$128.52
|
| Rate for Payer: ASR ASR |
$249.33
|
| Rate for Payer: ASR Commercial |
$249.33
|
| Rate for Payer: BCBS Complete |
$102.82
|
| Rate for Payer: BCBS Trust/PPO |
$210.49
|
| Rate for Payer: BCN Commercial |
$199.28
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$241.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Healthscope Whirlpool |
$249.33
|
| Rate for Payer: Mclaren Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.22
|
| Rate for Payer: Priority Health Narrow Network |
$180.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.20
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: Aetna Medicare |
$107.10
|
| Rate for Payer: ASR ASR |
$207.77
|
| Rate for Payer: ASR Commercial |
$207.77
|
| Rate for Payer: BCBS Complete |
$85.68
|
| Rate for Payer: BCBS Trust/PPO |
$175.41
|
| Rate for Payer: BCN Commercial |
$166.07
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$214.20
|
| Rate for Payer: Healthscope Whirlpool |
$207.77
|
| Rate for Payer: Mclaren Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.68
|
| Rate for Payer: Priority Health Narrow Network |
$150.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.50
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: ASR ASR |
$207.77
|
| Rate for Payer: ASR Commercial |
$207.77
|
| Rate for Payer: BCBS Trust/PPO |
$174.55
|
| Rate for Payer: BCN Commercial |
$166.07
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$201.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$214.20
|
| Rate for Payer: Healthscope Whirlpool |
$207.77
|
| Rate for Payer: Mclaren Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.50
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS Trust/PPO |
$793.51
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$849.04
|
| Rate for Payer: Priority Health Narrow Network |
$679.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: ASR ASR |
$939.93
|
| Rate for Payer: ASR Commercial |
$939.93
|
| Rate for Payer: BCBS Trust/PPO |
$789.64
|
| Rate for Payer: BCN Commercial |
$751.27
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$910.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$969.00
|
| Rate for Payer: Healthscope Whirlpool |
$939.93
|
| Rate for Payer: Mclaren Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$852.72
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.64 |
| Max. Negotiated Rate |
$408.67 |
| Rate for Payer: Aetna Commercial |
$367.80
|
| Rate for Payer: ASR ASR |
$396.41
|
| Rate for Payer: ASR Commercial |
$396.41
|
| Rate for Payer: BCBS Trust/PPO |
$333.03
|
| Rate for Payer: BCN Commercial |
$316.84
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$384.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$408.67
|
| Rate for Payer: Healthscope Whirlpool |
$396.41
|
| Rate for Payer: Mclaren Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: Nomi Health Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.63
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$408.67 |
| Rate for Payer: Aetna Commercial |
$367.80
|
| Rate for Payer: Aetna Medicare |
$204.34
|
| Rate for Payer: ASR ASR |
$396.41
|
| Rate for Payer: ASR Commercial |
$396.41
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: BCBS Trust/PPO |
$334.66
|
| Rate for Payer: BCN Commercial |
$316.84
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$384.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$408.67
|
| Rate for Payer: Healthscope Whirlpool |
$396.41
|
| Rate for Payer: Mclaren Commercial |
$367.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: Nomi Health Commercial |
$335.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.08
|
| Rate for Payer: Priority Health Narrow Network |
$286.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.63
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.96
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: ASR Commercial |
$30.67
|
| Rate for Payer: BCBS Complete |
$1.33
|
| Rate for Payer: BCBS MAPPO |
$2.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$2.37
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.37
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.37
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Mclaren Medicaid |
$1.27
|
| 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 |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| 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 |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Medicare |
$2.37
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.37
|
| Rate for Payer: UHC Exchange |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$2.37
|
| Rate for Payer: UHCCP DNSP |
$2.37
|
| Rate for Payer: UHCCP Medicaid |
$1.27
|
| Rate for Payer: VA VA |
$2.37
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: ASR ASR |
$30.67
|
| Rate for Payer: ASR Commercial |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.77
|
| Rate for Payer: BCN Commercial |
$24.51
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$29.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Whirlpool |
$30.67
|
| Rate for Payer: Mclaren Commercial |
$28.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.83
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$27.48 |
| Rate for Payer: Aetna Commercial |
$24.73
|
| Rate for Payer: ASR ASR |
$26.66
|
| Rate for Payer: ASR Commercial |
$26.66
|
| Rate for Payer: BCBS Trust/PPO |
$22.39
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Whirlpool |
$26.66
|
| Rate for Payer: Mclaren Commercial |
$24.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$22.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.18
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$24.73
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.58
|
| Rate for Payer: ASR ASR |
$26.66
|
| Rate for Payer: ASR Commercial |
$26.66
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.50
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.06
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$27.48
|
| Rate for Payer: Healthscope Whirlpool |
$26.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.06
|
| Rate for Payer: Mclaren Commercial |
$24.73
|
| Rate for Payer: Mclaren Medicaid |
$9.68
|
| 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 |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$22.53
|
| 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 |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.98
|
| Rate for Payer: Priority Health Medicare |
$18.06
|
| Rate for Payer: Priority Health Narrow Network |
$53.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.06
|
| Rate for Payer: UHC Exchange |
$27.99
|
| Rate for Payer: UHC Medicare Advantage |
$18.06
|
| Rate for Payer: UHCCP DNSP |
$18.06
|
| Rate for Payer: UHCCP Medicaid |
$9.68
|
| Rate for Payer: VA VA |
$18.06
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$97.10 |
| Rate for Payer: Aetna Commercial |
$87.39
|
| Rate for Payer: ASR ASR |
$94.19
|
| Rate for Payer: ASR Commercial |
$94.19
|
| Rate for Payer: BCBS Trust/PPO |
$79.13
|
| Rate for Payer: BCN Commercial |
$75.28
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$91.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$97.10
|
| Rate for Payer: Healthscope Whirlpool |
$94.19
|
| Rate for Payer: Mclaren Commercial |
$87.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.45
|
|
