|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
IP
|
$80.08
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$72.07 |
| Rate for Payer: Aetna Commercial |
$68.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.05
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$68.87
|
| Rate for Payer: Healthscope Commercial |
$72.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.07
|
| Rate for Payer: PHP Commercial |
$68.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.06
|
| Rate for Payer: Priority Health SBD |
$50.45
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
OP
|
$80.08
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$68.07
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.05
|
| 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 |
$64.06
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$56.06
|
| Rate for Payer: Cofinity Commercial |
$68.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$72.07
|
| 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 |
$68.07
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$68.07
|
| 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 |
$56.06
|
| 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 |
$50.45
|
| 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 WASHED RBC UNIT
|
Facility
|
IP
|
$101.62
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$91.46 |
| Rate for Payer: Aetna Commercial |
$86.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.05
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$71.13
|
| Rate for Payer: Cofinity Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$91.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.38
|
| Rate for Payer: PHP Commercial |
$86.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.13
|
| Rate for Payer: Priority Health SBD |
$64.02
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
OP
|
$101.62
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.02 |
| Max. Negotiated Rate |
$416.95 |
| Rate for Payer: Aetna Commercial |
$86.38
|
| Rate for Payer: Aetna Medicare |
$144.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.05
|
| 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 |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$71.13
|
| Rate for Payer: Cofinity Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.21
|
| Rate for Payer: Healthscope Commercial |
$91.46
|
| 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 |
$86.38
|
| Rate for Payer: PACE Medicare |
$132.25
|
| Rate for Payer: PACE SWMI |
$139.21
|
| Rate for Payer: PHP Commercial |
$86.38
|
| 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 |
$71.13
|
| 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 |
$64.02
|
| 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 TYPING RH
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$37.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.60
|
| Rate for Payer: BCBS Complete |
$20.49
|
| Rate for Payer: BCBS MAPPO |
$35.68
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Medicare Advantage |
$35.68
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.68
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Mclaren Medicaid |
$19.52
|
| Rate for Payer: Mclaren Medicare |
$35.68
|
| Rate for Payer: Meridian Medicaid |
$20.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PACE Medicare |
$33.90
|
| Rate for Payer: PACE SWMI |
$35.68
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$35.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.40
|
| Rate for Payer: Priority Health Medicare |
$35.68
|
| Rate for Payer: Priority Health Narrow Network |
$84.32
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Railroad Medicare Medicare |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$5.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.68
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
| Rate for Payer: VA VA |
$35.68
|
|
|
HC BLOOD TYPING RH
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.75 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$13.75
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$945.00 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,050.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health SBD |
$945.00
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$103.75 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$197.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.09
|
| Rate for Payer: BCBS Complete |
$108.95
|
| Rate for Payer: BCBS MAPPO |
$189.67
|
| Rate for Payer: BCBS Trust/PPO |
$661.37
|
| Rate for Payer: BCN Medicare Advantage |
$189.67
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Cofinity Commercial |
$1,050.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.67
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Mclaren Medicaid |
$103.75
|
| Rate for Payer: Mclaren Medicare |
$189.67
|
| Rate for Payer: Meridian Medicaid |
$108.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PACE Medicare |
$180.19
|
| Rate for Payer: PACE SWMI |
$189.67
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: PHP Medicare Advantage |
$189.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$682.51
|
| Rate for Payer: Priority Health Medicare |
$189.67
|
| Rate for Payer: Priority Health Narrow Network |
$546.01
|
| Rate for Payer: Priority Health SBD |
$945.00
|
| Rate for Payer: Railroad Medicare Medicare |
$189.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.67
|
| Rate for Payer: UHC Medicare Advantage |
$195.36
|
| Rate for Payer: VA VA |
$189.67
|
|
|
HC B.NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30100562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.08
|
| Rate for Payer: BCBS Complete |
$22.55
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$30.75
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Mclaren Medicaid |
$21.48
|
| Rate for Payer: Mclaren Medicare |
$39.26
|
| Rate for Payer: Meridian Medicaid |
$22.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PACE Medicare |
$37.30
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: Railroad Medicare Medicare |
$39.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.11
|
| Rate for Payer: UHC Core |
$57.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Exchange |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$40.44
|
| Rate for Payer: VA VA |
$39.26
|
|
|
HC B.NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30100562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health SBD |
$95.26
|
|
|
HC BONE CEMENT
|
Facility
|
IP
|
$1,995.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.18 |
| Max. Negotiated Rate |
$1,795.97 |
| Rate for Payer: Aetna Commercial |
$1,696.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.09
|
| Rate for Payer: Cash Price |
$1,596.42
|
| Rate for Payer: Cofinity Commercial |
$1,396.86
|
| Rate for Payer: Cofinity Commercial |
$1,716.15
|
| Rate for Payer: Healthscope Commercial |
$1,795.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,696.19
|
| Rate for Payer: PHP Commercial |
$1,696.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.86
|
| Rate for Payer: Priority Health SBD |
$1,257.18
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$1,995.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.21 |
| Max. Negotiated Rate |
$1,795.97 |
| Rate for Payer: Aetna Commercial |
$1,696.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.09
|
| Rate for Payer: BCBS Complete |
$798.21
|
| Rate for Payer: Cash Price |
$1,596.42
|
| Rate for Payer: Cofinity Commercial |
$1,396.86
|
| Rate for Payer: Cofinity Commercial |
$1,716.15
|
| Rate for Payer: Healthscope Commercial |
$1,795.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,696.19
|
| Rate for Payer: PHP Commercial |
$1,696.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.86
|
| Rate for Payer: Priority Health SBD |
$1,257.18
|
|
|
HC BONE MARROW ASPIRATION
|
Facility
|
OP
|
$1,348.03
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
36100184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.16 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Commercial |
$1,806.59
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$876.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$937.37
|
| Rate for Payer: BCBS Trust/PPO |
$937.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cofinity Commercial |
$1,827.84
|
| Rate for Payer: Cofinity Commercial |
$1,159.31
|
| Rate for Payer: Cofinity Commercial |
$943.62
|
| Rate for Payer: Cofinity Commercial |
$1,487.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$1,912.86
|
| Rate for Payer: Healthscope Commercial |
$1,213.23
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,145.83
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$1,806.59
|
| Rate for Payer: PHP Commercial |
$1,145.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,339.00
|
| Rate for Payer: Priority Health SBD |
$849.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Exchange |
$65.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BONE MARROW ASPIRATION
|
Facility
|
IP
|
$1,348.03
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
36100184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$849.26 |
| Max. Negotiated Rate |
$1,213.23 |
| Rate for Payer: Aetna Commercial |
$1,145.83
|
| Rate for Payer: Aetna Commercial |
$1,806.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$876.22
|
| Rate for Payer: Cash Price |
$1,078.42
|
| Rate for Payer: Cash Price |
$1,700.32
|
| Rate for Payer: Cofinity Commercial |
$1,159.31
|
| Rate for Payer: Cofinity Commercial |
$943.62
|
| Rate for Payer: Cofinity Commercial |
$1,487.78
|
| Rate for Payer: Cofinity Commercial |
$1,827.84
|
| Rate for Payer: Healthscope Commercial |
$1,912.86
|
| Rate for Payer: Healthscope Commercial |
$1,213.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,806.59
|
| Rate for Payer: PHP Commercial |
$1,145.83
|
| Rate for Payer: PHP Commercial |
$1,806.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.62
|
| Rate for Payer: Priority Health SBD |
$849.26
|
| Rate for Payer: Priority Health SBD |
$1,339.00
|
|
|
HC BONE MARROW BIOPSY
|
Facility
|
OP
|
$2,024.19
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
36100185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$937.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.92
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$68.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
HC BONE MARROW BIOPSY
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
36100185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.24 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
|
|
HC BONE MARROW BX AND ASP DIAGNOSTIC
|
Facility
|
IP
|
$2,024.19
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
36100549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,275.24 |
| Max. Negotiated Rate |
$1,821.77 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
|
|
HC BONE MARROW BX AND ASP DIAGNOSTIC
|
Facility
|
OP
|
$2,024.19
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
36100549
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$3,160.42 |
| Rate for Payer: Aetna Commercial |
$1,720.56
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cash Price |
$1,619.35
|
| Rate for Payer: Cofinity Commercial |
$1,740.80
|
| Rate for Payer: Cofinity Commercial |
$1,416.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$1,821.77
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,720.56
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$1,720.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,416.93
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health SBD |
$1,275.24
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.96
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$72.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
HC BONE MARROW SMEAR INTERPRETATION
|
Facility
|
IP
|
$164.44
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
30500069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cofinity Commercial |
$115.11
|
| Rate for Payer: Cofinity Commercial |
$141.42
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.11
|
| Rate for Payer: Priority Health SBD |
$103.60
|
|
|
HC BONE MARROW SMEAR INTERPRETATION
|
Facility
|
OP
|
$164.44
|
|
|
Service Code
|
CPT 85097
|
| Hospital Charge Code |
30500069
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$956.40 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Aetna Medicare |
$795.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$956.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$956.40
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS MAPPO |
$765.12
|
| Rate for Payer: BCBS Trust/PPO |
$84.39
|
| Rate for Payer: BCN Medicare Advantage |
$765.12
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cash Price |
$131.55
|
| Rate for Payer: Cofinity Commercial |
$115.11
|
| Rate for Payer: Cofinity Commercial |
$141.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.12
|
| Rate for Payer: Healthscope Commercial |
$148.00
|
| Rate for Payer: Mclaren Medicaid |
$418.52
|
| Rate for Payer: Mclaren Medicare |
$765.12
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$803.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$879.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.77
|
| Rate for Payer: PACE Medicare |
$726.86
|
| Rate for Payer: PACE SWMI |
$765.12
|
| Rate for Payer: PHP Commercial |
$139.77
|
| Rate for Payer: PHP Medicare Advantage |
$765.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.11
|
| Rate for Payer: Priority Health Medicare |
$765.12
|
| Rate for Payer: Priority Health SBD |
$103.60
|
| Rate for Payer: Railroad Medicare Medicare |
$765.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.79
|
| Rate for Payer: UHC Core |
$44.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.12
|
| Rate for Payer: UHC Exchange |
$46.17
|
| Rate for Payer: UHC Medicare Advantage |
$788.07
|
| Rate for Payer: VA VA |
$765.12
|
|
|
HC BOOT HEEL PROTECT FLUID Z-FLEX
|
Facility
|
IP
|
$145.26
|
|
| Hospital Charge Code |
27000630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.51 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.42
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$101.68
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health SBD |
$91.51
|
|
|
HC BOOT HEEL PROTECT FLUID Z-FLEX
|
Facility
|
OP
|
$145.26
|
|
| Hospital Charge Code |
27000630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$130.73 |
| Rate for Payer: Aetna Commercial |
$123.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.42
|
| Rate for Payer: BCBS Complete |
$58.10
|
| Rate for Payer: Cash Price |
$116.21
|
| Rate for Payer: Cofinity Commercial |
$101.68
|
| Rate for Payer: Cofinity Commercial |
$124.92
|
| Rate for Payer: Healthscope Commercial |
$130.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.47
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.68
|
| Rate for Payer: Priority Health SBD |
$91.51
|
|
|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
OP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: BCBS Complete |
$19.14
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$30.14
|
|
|
HC BOOT STATIC AIR W/STAB Z-FLEX
|
Facility
|
IP
|
$47.84
|
|
| Hospital Charge Code |
27000631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$30.14
|
|
|
HC BOSTON SCI CRT ICD
|
Facility
|
OP
|
$25,806.00
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27500003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$23,225.40 |
| Rate for Payer: Aetna Commercial |
$21,935.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,773.90
|
| Rate for Payer: BCBS Complete |
$10,322.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cash Price |
$20,644.80
|
| Rate for Payer: Cofinity Commercial |
$18,064.20
|
| Rate for Payer: Cofinity Commercial |
$22,193.16
|
| Rate for Payer: Healthscope Commercial |
$23,225.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,935.10
|
| Rate for Payer: PHP Commercial |
$21,935.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,064.20
|
| Rate for Payer: Priority Health SBD |
$16,257.78
|
|
