|
HC VMA AND HVA 4 HOUR RANDOM URINE
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: ASR Commercial |
$87.07
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$73.50
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.50
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: Nomi Health Commercial |
$73.60
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Medicaid |
$8.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.47
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.98
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Exchange |
$24.02
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP DNSP |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA AND HVA 4 HOUR RANDOM URINE
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100455
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Aetna Commercial |
$80.78
|
| Rate for Payer: ASR ASR |
$87.07
|
| Rate for Payer: ASR Commercial |
$87.07
|
| Rate for Payer: BCBS Trust/PPO |
$73.15
|
| Rate for Payer: BCN Commercial |
$69.59
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$84.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Whirlpool |
$87.07
|
| Rate for Payer: Mclaren Commercial |
$80.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.30
|
| Rate for Payer: Nomi Health Commercial |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.99
|
|
|
HC VMA AND HVA 4 HR RANDOM URINE CMPT
|
Facility
|
IP
|
$50.98
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
|
|
HC VMA AND HVA 4 HR RANDOM URINE CMPT
|
Facility
|
OP
|
$50.98
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
30100217
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Commercial |
$45.88
|
| Rate for Payer: Aetna Medicare |
$22.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.01
|
| Rate for Payer: ASR ASR |
$49.45
|
| Rate for Payer: ASR Commercial |
$49.45
|
| Rate for Payer: BCBS Complete |
$12.61
|
| Rate for Payer: BCBS MAPPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$41.75
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: BCN Medicare Advantage |
$22.41
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cash Price |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$47.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.41
|
| Rate for Payer: Healthscope Commercial |
$50.98
|
| Rate for Payer: Healthscope Whirlpool |
$49.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.41
|
| Rate for Payer: Mclaren Commercial |
$45.88
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Mclaren Medicare |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.53
|
| Rate for Payer: Meridian Medicaid |
$12.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.33
|
| Rate for Payer: Nomi Health Commercial |
$41.80
|
| Rate for Payer: PACE Medicare |
$21.29
|
| Rate for Payer: PACE SWMI |
$22.41
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicaid |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$22.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.67
|
| Rate for Payer: Priority Health Medicare |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$35.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.41
|
| Rate for Payer: UHC Exchange |
$34.74
|
| Rate for Payer: UHC Medicare Advantage |
$22.41
|
| Rate for Payer: UHCCP DNSP |
$22.41
|
| Rate for Payer: UHCCP Medicaid |
$12.01
|
| Rate for Payer: VA VA |
$22.41
|
|
|
HC VMA RANDOM URINE
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC VMA RANDOM URINE
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100454
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$72.47 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Medicaid |
$8.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.47
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.98
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Exchange |
$24.02
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP DNSP |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA URINE
|
Facility
|
OP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$72.47 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Complete |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$15.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Mclaren Medicaid |
$8.31
|
| Rate for Payer: Mclaren Medicare |
$15.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: PACE Medicare |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$17.05
|
| Rate for Payer: PHP Medicaid |
$8.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.47
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow Network |
$57.98
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Exchange |
$24.02
|
| Rate for Payer: UHC Medicare Advantage |
$15.50
|
| Rate for Payer: UHCCP DNSP |
$15.50
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: VA VA |
$15.50
|
|
|
HC VMA URINE
|
Facility
|
IP
|
$47.94
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
30100488
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$47.94 |
| Rate for Payer: Aetna Commercial |
$43.15
|
| Rate for Payer: ASR ASR |
$46.50
|
| Rate for Payer: ASR Commercial |
$46.50
|
| Rate for Payer: BCBS Trust/PPO |
$39.07
|
| Rate for Payer: BCN Commercial |
$37.17
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Cofinity Commercial |
$45.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.35
|
| Rate for Payer: Healthscope Commercial |
$47.94
|
| Rate for Payer: Healthscope Whirlpool |
$46.50
|
| Rate for Payer: Mclaren Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.75
|
| Rate for Payer: Nomi Health Commercial |
$39.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.19
|
|
|
HC VNUS ABLATION FIRST VEIN
|
Facility
|
OP
|
$5,127.14
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
36100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,652.95 |
| Max. Negotiated Rate |
$5,127.14 |
| Rate for Payer: Aetna Commercial |
$4,614.43
|
| Rate for Payer: Aetna Medicare |
$3,083.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: ASR ASR |
$4,973.33
|
| Rate for Payer: ASR Commercial |
$4,973.33
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,198.61
|
| Rate for Payer: BCN Commercial |
$3,975.07
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cofinity Commercial |
$4,819.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,101.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Healthscope Commercial |
$5,127.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,973.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,083.86
|
| Rate for Payer: Mclaren Commercial |
$4,614.43
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.07
|
| Rate for Payer: Nomi Health Commercial |
$4,204.25
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Commercial |
$3,392.25
|
| Rate for Payer: PHP Medicaid |
$1,652.95
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,492.40
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,594.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,511.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$4,779.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP DNSP |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
HC VNUS ABLATION FIRST VEIN
|
Facility
|
IP
|
$5,127.14
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
36100435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,332.64 |
| Max. Negotiated Rate |
$5,127.14 |
| Rate for Payer: Aetna Commercial |
$4,614.43
|
| Rate for Payer: ASR ASR |
$4,973.33
|
| Rate for Payer: ASR Commercial |
$4,973.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,178.11
|
| Rate for Payer: BCN Commercial |
$3,975.07
|
| Rate for Payer: Cash Price |
$4,101.71
|
| Rate for Payer: Cofinity Commercial |
$4,819.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,101.71
|
| Rate for Payer: Healthscope Commercial |
$5,127.14
|
| Rate for Payer: Healthscope Whirlpool |
$4,973.33
|
| Rate for Payer: Mclaren Commercial |
$4,614.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,358.07
|
| Rate for Payer: Nomi Health Commercial |
$4,204.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,511.88
|
|
|
HC VNUS ABLATION SUBSEQ VEINS
|
Facility
|
IP
|
$2,505.14
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
36100436
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,628.34 |
| Max. Negotiated Rate |
$2,505.14 |
| Rate for Payer: Aetna Commercial |
$2,254.63
|
| Rate for Payer: ASR ASR |
$2,429.99
|
| Rate for Payer: ASR Commercial |
$2,429.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,041.44
|
| Rate for Payer: BCN Commercial |
$1,942.24
|
| Rate for Payer: Cash Price |
$2,004.11
|
| Rate for Payer: Cofinity Commercial |
$2,354.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.11
|
| Rate for Payer: Healthscope Commercial |
$2,505.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,429.99
|
| Rate for Payer: Mclaren Commercial |
$2,254.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,129.37
|
| Rate for Payer: Nomi Health Commercial |
$2,054.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,628.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,204.52
|
|
|
HC VNUS ABLATION SUBSEQ VEINS
|
Facility
|
OP
|
$2,505.14
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
36100436
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,002.06 |
| Max. Negotiated Rate |
$2,505.14 |
| Rate for Payer: Aetna Commercial |
$2,254.63
|
| Rate for Payer: Aetna Medicare |
$1,252.57
|
| Rate for Payer: ASR ASR |
$2,429.99
|
| Rate for Payer: ASR Commercial |
$2,429.99
|
| Rate for Payer: BCBS Complete |
$1,002.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.46
|
| Rate for Payer: BCN Commercial |
$1,942.24
|
| Rate for Payer: Cash Price |
$2,004.11
|
| Rate for Payer: Cofinity Commercial |
$2,354.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,004.11
|
| Rate for Payer: Healthscope Commercial |
$2,505.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,429.99
|
| Rate for Payer: Mclaren Commercial |
$2,254.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,129.37
|
| Rate for Payer: Nomi Health Commercial |
$2,054.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,628.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,195.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,756.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,204.52
|
|
|
HC VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Facility
|
OP
|
$262.22
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
76100193
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$236.00
|
| Rate for Payer: Aetna Medicare |
$131.11
|
| Rate for Payer: ASR ASR |
$254.35
|
| Rate for Payer: ASR Commercial |
$254.35
|
| Rate for Payer: BCBS Complete |
$104.89
|
| Rate for Payer: BCBS Trust/PPO |
$214.73
|
| Rate for Payer: BCN Commercial |
$203.30
|
| Rate for Payer: Cash Price |
$209.78
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.78
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Healthscope Whirlpool |
$254.35
|
| Rate for Payer: Mclaren Commercial |
$236.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.89
|
| Rate for Payer: Nomi Health Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.76
|
| Rate for Payer: Priority Health Narrow Network |
$183.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.75
|
|
|
HC VOIDING PRESS STUDY INTRA-ABDOMINAL VOID
|
Facility
|
IP
|
$262.22
|
|
|
Service Code
|
CPT 51797
|
| Hospital Charge Code |
76100193
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$236.00
|
| Rate for Payer: ASR ASR |
$254.35
|
| Rate for Payer: ASR Commercial |
$254.35
|
| Rate for Payer: BCBS Trust/PPO |
$213.68
|
| Rate for Payer: BCN Commercial |
$203.30
|
| Rate for Payer: Cash Price |
$209.78
|
| Rate for Payer: Cofinity Commercial |
$246.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.78
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Healthscope Whirlpool |
$254.35
|
| Rate for Payer: Mclaren Commercial |
$236.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.89
|
| Rate for Payer: Nomi Health Commercial |
$215.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.75
|
|
|
HC VOLUME MEASUREMENT
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
30700006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$19.67 |
| Rate for Payer: Aetna Commercial |
$17.70
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: ASR ASR |
$19.08
|
| Rate for Payer: ASR Commercial |
$19.08
|
| Rate for Payer: BCBS Complete |
$2.05
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$16.11
|
| Rate for Payer: BCN Commercial |
$15.25
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$19.67
|
| Rate for Payer: Healthscope Whirlpool |
$19.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$17.70
|
| Rate for Payer: Mclaren Medicaid |
$1.95
|
| Rate for Payer: Mclaren Medicare |
$3.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$2.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: PACE Medicare |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: PHP Medicaid |
$1.95
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Medicare |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$5.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP DNSP |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$1.95
|
| Rate for Payer: VA VA |
$3.64
|
|
|
HC VOLUME MEASUREMENT
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
CPT 81050
|
| Hospital Charge Code |
30700006
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$19.67 |
| Rate for Payer: Aetna Commercial |
$17.70
|
| Rate for Payer: ASR ASR |
$19.08
|
| Rate for Payer: ASR Commercial |
$19.08
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$15.25
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$19.67
|
| Rate for Payer: Healthscope Whirlpool |
$19.08
|
| Rate for Payer: Mclaren Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.31
|
|
|
HC VON WILLEBRAND ANTIGEN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$197.64 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$55.38
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.64
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$158.11
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC VON WILLEBRAND ANTIGEN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 85246
|
| Hospital Charge Code |
30500025
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: ASR Commercial |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.11
|
| Rate for Payer: BCN Commercial |
$52.43
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$67.63
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30000059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: ASR Commercial |
$199.82
|
| Rate for Payer: BCBS Trust/PPO |
$167.87
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.10
|
| Rate for Payer: Nomi Health Commercial |
$168.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
|
|
HC VON WILLEBRAND FACTOR ACTIVITY
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30000059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$206.00 |
| Rate for Payer: Aetna Commercial |
$185.40
|
| Rate for Payer: Aetna Medicare |
$30.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: ASR ASR |
$199.82
|
| Rate for Payer: ASR Commercial |
$199.82
|
| Rate for Payer: BCBS Complete |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$168.69
|
| Rate for Payer: BCN Commercial |
$159.71
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$193.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$206.00
|
| Rate for Payer: Healthscope Whirlpool |
$199.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.86
|
| Rate for Payer: Mclaren Commercial |
$185.40
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.10
|
| Rate for Payer: Nomi Health Commercial |
$168.92
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$33.95
|
| Rate for Payer: PHP Medicaid |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.50
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow Network |
$144.41
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Exchange |
$47.83
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP DNSP |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC VON WILLEBRAND MULTIMETRIC ANALYSIS
|
Facility
|
IP
|
$95.88
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
30500028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: ASR ASR |
$93.00
|
| Rate for Payer: ASR Commercial |
$93.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.13
|
| Rate for Payer: BCN Commercial |
$74.34
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cofinity Commercial |
$90.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.70
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Whirlpool |
$93.00
|
| Rate for Payer: Mclaren Commercial |
$86.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.50
|
| Rate for Payer: Nomi Health Commercial |
$78.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.37
|
|
|
HC VON WILLEBRAND MULTIMETRIC ANALYSIS
|
Facility
|
OP
|
$95.88
|
|
|
Service Code
|
CPT 85247
|
| Hospital Charge Code |
30500028
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$95.88 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.68
|
| Rate for Payer: ASR ASR |
$93.00
|
| Rate for Payer: ASR Commercial |
$93.00
|
| Rate for Payer: BCBS Complete |
$12.91
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS Trust/PPO |
$78.52
|
| Rate for Payer: BCN Commercial |
$74.34
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cash Price |
$76.70
|
| Rate for Payer: Cofinity Commercial |
$90.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Healthscope Commercial |
$95.88
|
| Rate for Payer: Healthscope Whirlpool |
$93.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$22.94
|
| Rate for Payer: Mclaren Commercial |
$86.29
|
| Rate for Payer: Mclaren Medicaid |
$12.30
|
| Rate for Payer: Mclaren Medicare |
$22.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Medicaid |
$12.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.50
|
| Rate for Payer: Nomi Health Commercial |
$78.62
|
| Rate for Payer: PACE Medicare |
$21.79
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Commercial |
$25.23
|
| Rate for Payer: PHP Medicaid |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.01
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow Network |
$67.21
|
| Rate for Payer: Railroad Medicare Medicare |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Exchange |
$35.56
|
| Rate for Payer: UHC Medicare Advantage |
$22.94
|
| Rate for Payer: UHCCP DNSP |
$22.94
|
| Rate for Payer: UHCCP Medicaid |
$12.30
|
| Rate for Payer: VA VA |
$22.94
|
|
|
HC VON WILLEBRAND PANEL
|
Facility
|
IP
|
$129.01
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$83.86 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$116.11
|
| Rate for Payer: ASR ASR |
$125.14
|
| Rate for Payer: ASR Commercial |
$125.14
|
| Rate for Payer: BCBS Trust/PPO |
$105.13
|
| Rate for Payer: BCN Commercial |
$100.02
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cofinity Commercial |
$121.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.21
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Healthscope Whirlpool |
$125.14
|
| Rate for Payer: Mclaren Commercial |
$116.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.66
|
| Rate for Payer: Nomi Health Commercial |
$105.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.53
|
|
|
HC VON WILLEBRAND PANEL
|
Facility
|
OP
|
$129.01
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
31000001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$116.11
|
| Rate for Payer: Aetna Medicare |
$30.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.58
|
| Rate for Payer: ASR ASR |
$125.14
|
| Rate for Payer: ASR Commercial |
$125.14
|
| Rate for Payer: BCBS Complete |
$17.37
|
| Rate for Payer: BCBS MAPPO |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$105.65
|
| Rate for Payer: BCN Commercial |
$100.02
|
| Rate for Payer: BCN Medicare Advantage |
$30.86
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cash Price |
$103.21
|
| Rate for Payer: Cofinity Commercial |
$121.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.86
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Healthscope Whirlpool |
$125.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$30.86
|
| Rate for Payer: Mclaren Commercial |
$116.11
|
| Rate for Payer: Mclaren Medicaid |
$16.54
|
| Rate for Payer: Mclaren Medicare |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.40
|
| Rate for Payer: Meridian Medicaid |
$17.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.66
|
| Rate for Payer: Nomi Health Commercial |
$105.79
|
| Rate for Payer: PACE Medicare |
$29.32
|
| Rate for Payer: PACE SWMI |
$30.86
|
| Rate for Payer: PHP Commercial |
$33.95
|
| Rate for Payer: PHP Medicaid |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.04
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow Network |
$90.44
|
| Rate for Payer: Railroad Medicare Medicare |
$30.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$113.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.86
|
| Rate for Payer: UHC Exchange |
$47.83
|
| Rate for Payer: UHC Medicare Advantage |
$30.86
|
| Rate for Payer: UHCCP DNSP |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$16.54
|
| Rate for Payer: VA VA |
$30.86
|
|
|
HC VON WILLEBRAND PANEL CMPT1
|
Facility
|
OP
|
$97.80
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500020
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$97.80 |
| Rate for Payer: Aetna Commercial |
$88.02
|
| 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 |
$94.87
|
| Rate for Payer: ASR Commercial |
$94.87
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$80.09
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cash Price |
$78.24
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$97.80
|
| Rate for Payer: Healthscope Whirlpool |
$94.87
|
| Rate for Payer: Humana Choice PPO Medicare |
$17.90
|
| Rate for Payer: Mclaren Commercial |
$88.02
|
| 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 |
$83.13
|
| Rate for Payer: Nomi Health Commercial |
$80.20
|
| 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 |
$63.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.69
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$68.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.06
|
| 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
|
|
