|
HC BLEEDING TIME
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
30500001
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$67.86 |
| Rate for Payer: Aetna Commercial |
$64.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.01
|
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Cofinity Commercial |
$52.78
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Healthscope Commercial |
$67.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.09
|
| Rate for Payer: PHP Commercial |
$64.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.78
|
| Rate for Payer: Priority Health SBD |
$47.50
|
|
|
HC BLOOD CULTURE
|
Facility
|
IP
|
$95.78
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.34 |
| Max. Negotiated Rate |
$86.20 |
| Rate for Payer: Aetna Commercial |
$81.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.26
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$67.05
|
| Rate for Payer: Cofinity Commercial |
$82.37
|
| Rate for Payer: Healthscope Commercial |
$86.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.41
|
| Rate for Payer: PHP Commercial |
$81.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.05
|
| Rate for Payer: Priority Health SBD |
$60.34
|
|
|
HC BLOOD CULTURE
|
Facility
|
OP
|
$95.78
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
30600072
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$86.20 |
| Rate for Payer: Aetna Commercial |
$81.41
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.90
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCN Medicare Advantage |
$10.32
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cofinity Commercial |
$82.37
|
| Rate for Payer: Cofinity Commercial |
$67.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$86.20
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.32
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.41
|
| Rate for Payer: PACE Medicare |
$9.80
|
| Rate for Payer: PACE SWMI |
$10.32
|
| Rate for Payer: PHP Commercial |
$81.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.05
|
| Rate for Payer: Priority Health Medicare |
$10.32
|
| Rate for Payer: Priority Health SBD |
$60.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.32
|
| Rate for Payer: UHC Exchange |
$10.32
|
| Rate for Payer: UHC Medicare Advantage |
$10.63
|
| Rate for Payer: VA VA |
$10.32
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
OP
|
$164.48
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$351.10 |
| Rate for Payer: Aetna Commercial |
$139.81
|
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$33.10
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Cash Price |
$131.58
|
| Rate for Payer: Cash Price |
$131.58
|
| Rate for Payer: Cofinity Commercial |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$141.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Healthscope Commercial |
$148.03
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.81
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Commercial |
$139.81
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Priority Health SBD |
$103.62
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$27.18
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
HC BLOOD DRAW IMPLANTED DEVICE
|
Facility
|
IP
|
$164.48
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
76100003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.62 |
| Max. Negotiated Rate |
$148.03 |
| Rate for Payer: Aetna Commercial |
$139.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.91
|
| Rate for Payer: Cash Price |
$131.58
|
| Rate for Payer: Cofinity Commercial |
$115.14
|
| Rate for Payer: Cofinity Commercial |
$141.45
|
| Rate for Payer: Healthscope Commercial |
$148.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.81
|
| Rate for Payer: PHP Commercial |
$139.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.14
|
| Rate for Payer: Priority Health SBD |
$103.62
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
OP
|
$173.50
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna Medicare |
$27.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.59
|
| Rate for Payer: BCBS Complete |
$14.97
|
| Rate for Payer: BCBS MAPPO |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$149.21
|
| Rate for Payer: Cofinity Commercial |
$121.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$156.15
|
| Rate for Payer: Mclaren Medicaid |
$14.26
|
| Rate for Payer: Mclaren Medicare |
$26.07
|
| Rate for Payer: Meridian Medicaid |
$14.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: PACE Medicare |
$24.77
|
| Rate for Payer: PACE SWMI |
$26.07
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: PHP Medicare Advantage |
$26.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: Priority Health Medicare |
$26.07
|
| Rate for Payer: Priority Health SBD |
$109.30
|
| Rate for Payer: Railroad Medicare Medicare |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.28
|
| Rate for Payer: UHC Core |
$32.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.07
|
| Rate for Payer: UHC Exchange |
$26.07
|
| Rate for Payer: UHC Medicare Advantage |
$26.85
|
| Rate for Payer: VA VA |
$26.07
|
|
|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
IP
|
$173.50
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.30 |
| Max. Negotiated Rate |
$156.15 |
| Rate for Payer: Aetna Commercial |
$147.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Cash Price |
$138.80
|
| Rate for Payer: Cofinity Commercial |
$121.45
|
| Rate for Payer: Cofinity Commercial |
$149.21
|
| Rate for Payer: Healthscope Commercial |
$156.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.48
|
| Rate for Payer: PHP Commercial |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.45
|
| Rate for Payer: Priority Health SBD |
$109.30
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
OP
|
$184.31
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$165.88 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Aetna Medicare |
$81.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: BCBS Complete |
$45.25
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.69
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$147.45
|
| Rate for Payer: Cash Price |
$147.45
|
| Rate for Payer: Cofinity Commercial |
$158.51
|
| Rate for Payer: Cofinity Commercial |
$129.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$165.88
|
| Rate for Payer: Mclaren Medicaid |
$43.09
|
| Rate for Payer: Mclaren Medicare |
$78.77
|
| Rate for Payer: Meridian Medicaid |
$45.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.66
|
| Rate for Payer: PACE Medicare |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$156.66
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.02
|
| Rate for Payer: Priority Health Medicare |
$78.77
|
| Rate for Payer: Priority Health SBD |
$116.12
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.52
|
| Rate for Payer: UHC Core |
$48.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.77
|
| Rate for Payer: UHC Exchange |
$78.77
|
| Rate for Payer: UHC Medicare Advantage |
$81.13
|
| Rate for Payer: VA VA |
$78.77
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
IP
|
$184.31
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$116.12 |
| Max. Negotiated Rate |
$165.88 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.80
|
| Rate for Payer: Cash Price |
$147.45
|
| Rate for Payer: Cofinity Commercial |
$129.02
|
| Rate for Payer: Cofinity Commercial |
$158.51
|
| Rate for Payer: Healthscope Commercial |
$165.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.66
|
| Rate for Payer: PHP Commercial |
$156.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.02
|
| Rate for Payer: Priority Health SBD |
$116.12
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
OP
|
$30.68
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna Commercial |
$26.08
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: BCBS Complete |
$10.37
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$14.14
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$21.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$27.61
|
| Rate for Payer: Mclaren Medicaid |
$9.87
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Medicaid |
$10.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.08
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$26.08
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.48
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health SBD |
$19.33
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.66
|
| Rate for Payer: UHC Core |
$27.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Exchange |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$18.59
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
IP
|
$30.68
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$27.61 |
| Rate for Payer: Aetna Commercial |
$26.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.94
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cofinity Commercial |
$21.48
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Healthscope Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.08
|
| Rate for Payer: PHP Commercial |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.48
|
| Rate for Payer: Priority Health SBD |
$19.33
|
|
|
HC BLOOD PATCH
|
Facility
|
OP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$388.46
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Cofinity Commercial |
$832.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health SBD |
$748.91
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.38
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC BLOOD PATCH
|
Facility
|
IP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Cofinity Commercial |
$832.12
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health SBD |
$748.91
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
OP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.35 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$388.46
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Cofinity Commercial |
$832.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Priority Health SBD |
$748.91
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.38
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
IP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.68
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Cofinity Commercial |
$832.12
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health SBD |
$748.91
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
OP
|
$22.60
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Medicare |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.29
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Medicare Advantage |
$3.43
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$20.34
|
| Rate for Payer: Mclaren Medicaid |
$1.88
|
| Rate for Payer: Mclaren Medicare |
$3.43
|
| Rate for Payer: Meridian Medicaid |
$1.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.21
|
| Rate for Payer: PACE Medicare |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.43
|
| Rate for Payer: PHP Commercial |
$19.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.82
|
| Rate for Payer: Priority Health Medicare |
$3.43
|
| Rate for Payer: Priority Health SBD |
$14.24
|
| Rate for Payer: Railroad Medicare Medicare |
$3.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.12
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.43
|
| Rate for Payer: UHC Exchange |
$3.43
|
| Rate for Payer: UHC Medicare Advantage |
$3.53
|
| Rate for Payer: VA VA |
$3.43
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
IP
|
$22.60
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.69
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Cofinity Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$20.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.21
|
| Rate for Payer: PHP Commercial |
$19.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.82
|
| Rate for Payer: Priority Health SBD |
$14.24
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$153.67 |
| Max. Negotiated Rate |
$219.53 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health SBD |
$153.67
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.01
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS MAPPO |
$139.21
|
| Rate for Payer: BCBS Trust/PPO |
$404.04
|
| Rate for Payer: BCN Medicare Advantage |
$139.21
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$76.15
|
| Rate for Payer: Mclaren Medicare |
$139.21
|
| Rate for Payer: Meridian Medicaid |
$79.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$139.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.95
|
| Rate for Payer: Priority Health Medicare |
$139.21
|
| Rate for Payer: Priority Health Narrow Network |
$333.56
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$139.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.21
|
| Rate for Payer: UHC Medicare Advantage |
$143.39
|
| Rate for Payer: VA VA |
$139.21
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
IP
|
$45.52
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$40.97 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$39.15
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Healthscope Commercial |
$40.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.69
|
| Rate for Payer: PHP Commercial |
$38.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health SBD |
$28.68
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
OP
|
$45.52
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.01
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS MAPPO |
$139.21
|
| Rate for Payer: BCBS Trust/PPO |
$404.04
|
| Rate for Payer: BCN Medicare Advantage |
$139.21
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$39.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$40.97
|
| Rate for Payer: Mclaren Medicaid |
$76.15
|
| Rate for Payer: Mclaren Medicare |
$139.21
|
| Rate for Payer: Meridian Medicaid |
$79.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.69
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$38.69
|
| Rate for Payer: PHP Medicare Advantage |
$139.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.95
|
| Rate for Payer: Priority Health Medicare |
$139.21
|
| Rate for Payer: Priority Health Narrow Network |
$333.56
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: Railroad Medicare Medicare |
$139.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.21
|
| Rate for Payer: UHC Medicare Advantage |
$143.39
|
| Rate for Payer: VA VA |
$139.21
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
OP
|
$351.55
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$298.82
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.01
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS MAPPO |
$139.21
|
| Rate for Payer: BCBS Trust/PPO |
$404.04
|
| Rate for Payer: BCN Medicare Advantage |
$139.21
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Cofinity Commercial |
$246.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$316.40
|
| Rate for Payer: Mclaren Medicaid |
$76.15
|
| Rate for Payer: Mclaren Medicare |
$139.21
|
| Rate for Payer: Meridian Medicaid |
$79.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.82
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$298.82
|
| Rate for Payer: PHP Medicare Advantage |
$139.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.95
|
| Rate for Payer: Priority Health Medicare |
$139.21
|
| Rate for Payer: Priority Health Narrow Network |
$333.56
|
| Rate for Payer: Priority Health SBD |
$221.48
|
| Rate for Payer: Railroad Medicare Medicare |
$139.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.21
|
| Rate for Payer: UHC Medicare Advantage |
$143.39
|
| Rate for Payer: VA VA |
$139.21
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
IP
|
$351.55
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$316.40 |
| Rate for Payer: Aetna Commercial |
$298.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.51
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cofinity Commercial |
$246.08
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Healthscope Commercial |
$316.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.82
|
| Rate for Payer: PHP Commercial |
$298.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.08
|
| Rate for Payer: Priority Health SBD |
$221.48
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
OP
|
$294.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$250.56
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$174.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$174.01
|
| Rate for Payer: BCBS Complete |
$79.96
|
| Rate for Payer: BCBS MAPPO |
$139.21
|
| Rate for Payer: BCBS Trust/PPO |
$404.04
|
| Rate for Payer: BCN Medicare Advantage |
$139.21
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cofinity Commercial |
$206.35
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Mclaren Medicaid |
$76.15
|
| Rate for Payer: Mclaren Medicare |
$139.21
|
| Rate for Payer: Meridian Medicaid |
$79.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$146.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.56
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$250.56
|
| Rate for Payer: PHP Medicare Advantage |
$139.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.95
|
| Rate for Payer: Priority Health Medicare |
$139.21
|
| Rate for Payer: Priority Health Narrow Network |
$333.56
|
| Rate for Payer: Priority Health SBD |
$185.71
|
| Rate for Payer: Railroad Medicare Medicare |
$139.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.21
|
| Rate for Payer: UHC Medicare Advantage |
$143.39
|
| Rate for Payer: VA VA |
$139.21
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
IP
|
$294.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$250.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.61
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cofinity Commercial |
$206.35
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.56
|
| Rate for Payer: PHP Commercial |
$250.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.35
|
| Rate for Payer: Priority Health SBD |
$185.71
|
|
