|
HC CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,019.84
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,052.50 |
| Max. Negotiated Rate |
$7,217.86 |
| Rate for Payer: Aetna Commercial |
$6,816.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,212.90
|
| Rate for Payer: Cash Price |
$6,415.87
|
| Rate for Payer: Cofinity Commercial |
$5,613.89
|
| Rate for Payer: Cofinity Commercial |
$6,897.06
|
| Rate for Payer: Healthscope Commercial |
$7,217.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,816.86
|
| Rate for Payer: PHP Commercial |
$6,816.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,613.89
|
| Rate for Payer: Priority Health SBD |
$5,052.50
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,019.84
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,207.94 |
| Max. Negotiated Rate |
$7,217.86 |
| Rate for Payer: Aetna Commercial |
$6,816.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,212.90
|
| Rate for Payer: BCBS Complete |
$3,207.94
|
| Rate for Payer: Cash Price |
$6,415.87
|
| Rate for Payer: Cofinity Commercial |
$5,613.89
|
| Rate for Payer: Cofinity Commercial |
$6,897.06
|
| Rate for Payer: Healthscope Commercial |
$7,217.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,816.86
|
| Rate for Payer: PHP Commercial |
$6,816.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,613.89
|
| Rate for Payer: Priority Health SBD |
$5,052.50
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
IP
|
$12,031.54
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,579.87 |
| Max. Negotiated Rate |
$10,828.39 |
| Rate for Payer: Aetna Commercial |
$10,226.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,820.50
|
| Rate for Payer: Cash Price |
$9,625.23
|
| Rate for Payer: Cofinity Commercial |
$10,347.12
|
| Rate for Payer: Cofinity Commercial |
$8,422.08
|
| Rate for Payer: Healthscope Commercial |
$10,828.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,226.81
|
| Rate for Payer: PHP Commercial |
$10,226.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,422.08
|
| Rate for Payer: Priority Health SBD |
$7,579.87
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
OP
|
$12,031.54
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,812.62 |
| Max. Negotiated Rate |
$10,828.39 |
| Rate for Payer: Aetna Commercial |
$10,226.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,820.50
|
| Rate for Payer: BCBS Complete |
$4,812.62
|
| Rate for Payer: Cash Price |
$9,625.23
|
| Rate for Payer: Cofinity Commercial |
$10,347.12
|
| Rate for Payer: Cofinity Commercial |
$8,422.08
|
| Rate for Payer: Healthscope Commercial |
$10,828.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,226.81
|
| Rate for Payer: PHP Commercial |
$10,226.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,422.08
|
| Rate for Payer: Priority Health SBD |
$7,579.87
|
|
|
HC CRYOGLOBULINS
|
Facility
|
OP
|
$19.38
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOGLOBULINS
|
Facility
|
IP
|
$19.38
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.60
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cofinity Commercial |
$13.57
|
| Rate for Payer: Cofinity Commercial |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$17.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.47
|
| Rate for Payer: PHP Commercial |
$16.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$12.21
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
OP
|
$22.44
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.68
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$7.73
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Medicaid |
$8.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health SBD |
$14.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC Core |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.14
|
| Rate for Payer: UHC Exchange |
$14.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.56
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
IP
|
$22.44
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Aetna Commercial |
$19.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.59
|
| Rate for Payer: Cash Price |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.07
|
| Rate for Payer: PHP Commercial |
$19.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.14
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.09 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health SBD |
$27.09
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$38.70
|
| Rate for Payer: Mclaren Medicaid |
$3.54
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Medicaid |
$3.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.55
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$36.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.76
|
| Rate for Payer: UHC Core |
$11.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.66
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
IP
|
$140.35
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.42 |
| Max. Negotiated Rate |
$126.32 |
| Rate for Payer: Aetna Commercial |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.23
|
| Rate for Payer: Cash Price |
$112.28
|
| Rate for Payer: Cofinity Commercial |
$98.24
|
| Rate for Payer: Cofinity Commercial |
$120.70
|
| Rate for Payer: Healthscope Commercial |
$126.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.30
|
| Rate for Payer: PHP Commercial |
$119.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.24
|
| Rate for Payer: Priority Health SBD |
$88.42
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
OP
|
$140.35
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$119.30
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| Rate for Payer: Cash Price |
$112.28
|
| Rate for Payer: Cash Price |
$112.28
|
| Rate for Payer: Cofinity Commercial |
$120.70
|
| Rate for Payer: Cofinity Commercial |
$98.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$126.32
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.30
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$119.30
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$88.42
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
OP
|
$334.10
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$300.69 |
| Rate for Payer: Aetna Commercial |
$283.98
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| Rate for Payer: Cash Price |
$267.28
|
| Rate for Payer: Cash Price |
$267.28
|
| Rate for Payer: Cofinity Commercial |
$233.87
|
| Rate for Payer: Cofinity Commercial |
$287.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$300.69
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.98
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$283.98
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$210.48
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
IP
|
$334.10
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$210.48 |
| Max. Negotiated Rate |
$300.69 |
| Rate for Payer: Aetna Commercial |
$283.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.16
|
| Rate for Payer: Cash Price |
$267.28
|
| Rate for Payer: Cofinity Commercial |
$233.87
|
| Rate for Payer: Cofinity Commercial |
$287.33
|
| Rate for Payer: Healthscope Commercial |
$300.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.98
|
| Rate for Payer: PHP Commercial |
$283.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.87
|
| Rate for Payer: Priority Health SBD |
$210.48
|
|
|
HC CRYOPRECIPITATE POOL
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
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 CRYOPRECIPITATE POOL
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| 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 |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE POOL CMPT1
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
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 CRYOPRECIPITATE POOL CMPT1
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| 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 |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE POOL CMPT2
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
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 CRYOPRECIPITATE POOL CMPT2
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| 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 |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
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 CRYOPRECIPITATE POOL CMPT4
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
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 CRYOPRECIPITATE POOL CMPT4
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$223.06 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.89
|
| Rate for Payer: BCBS Complete |
$32.11
|
| Rate for Payer: BCBS MAPPO |
$55.91
|
| Rate for Payer: BCBS Trust/PPO |
$216.16
|
| Rate for Payer: BCN Medicare Advantage |
$55.91
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Mclaren Medicaid |
$30.58
|
| Rate for Payer: Mclaren Medicare |
$55.91
|
| Rate for Payer: Meridian Medicaid |
$32.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Medicare |
$53.11
|
| Rate for Payer: PACE SWMI |
$55.91
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$55.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.06
|
| Rate for Payer: Priority Health Medicare |
$55.91
|
| Rate for Payer: Priority Health Narrow Network |
$178.45
|
| Rate for Payer: Priority Health SBD |
$153.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.91
|
| Rate for Payer: UHC Medicare Advantage |
$57.59
|
| Rate for Payer: VA VA |
$55.91
|
|
|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
OP
|
$542.50
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$541.49 |
| Rate for Payer: Aetna Commercial |
$461.12
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$61.05
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cofinity Commercial |
$466.55
|
| Rate for Payer: Cofinity Commercial |
$379.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Healthscope Commercial |
$488.25
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.12
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$461.12
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Priority Health SBD |
$341.78
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$140.15
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
