|
HC BLOOD GAS PKG, CALC O2 SAT
|
Facility
|
OP
|
$180.51
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
30100216
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$162.46 |
| Rate for Payer: Aetna Commercial |
$153.43
|
| Rate for Payer: Aetna Medicare |
$27.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.33
|
| 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 |
$14.32
|
| Rate for Payer: BCBS MAPPO |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$27.79
|
| Rate for Payer: BCN Commercial |
$27.79
|
| Rate for Payer: BCN Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cash Price |
$144.41
|
| Rate for Payer: Cofinity Advantage |
$126.36
|
| Rate for Payer: Cofinity Commercial |
$155.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.07
|
| Rate for Payer: Healthscope Commercial |
$162.46
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$26.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.37
|
| Rate for Payer: Meridian Medicaid |
$27.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.43
|
| Rate for Payer: Nomi Health Commercial |
$39.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.38
|
| Rate for Payer: PACE Medicare |
$24.77
|
| Rate for Payer: PACE SWMI |
$26.07
|
| Rate for Payer: PHP Commercial |
$153.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.07
|
| Rate for Payer: Priority Health Medicare |
$26.07
|
| Rate for Payer: Priority Health SBD |
$113.72
|
| Rate for Payer: Priority Health Tiered Network |
$20.86
|
| Rate for Payer: Railroad Medicare Medicare |
$26.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.11
|
| Rate for Payer: UHC Core |
$39.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.07
|
| Rate for Payer: UHC Exchange |
$39.11
|
| Rate for Payer: UHC Medicaid |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: VA VA |
$26.07
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
OP
|
$191.76
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.58 |
| Rate for Payer: Aetna Commercial |
$163.00
|
| Rate for Payer: Aetna Medicare |
$81.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.64
|
| 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 |
$43.26
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$83.99
|
| Rate for Payer: BCN Commercial |
$83.99
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Advantage |
$134.23
|
| Rate for Payer: Cofinity Commercial |
$164.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Mclaren Medicaid |
$41.20
|
| Rate for Payer: Mclaren Medicare |
$78.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.71
|
| Rate for Payer: Meridian Medicaid |
$82.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.82
|
| Rate for Payer: PACE Medicare |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$78.77
|
| Rate for Payer: Priority Health Medicare |
$78.77
|
| Rate for Payer: Priority Health SBD |
$120.81
|
| Rate for Payer: Priority Health Tiered Network |
$63.02
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.16
|
| Rate for Payer: UHC Core |
$118.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.77
|
| Rate for Payer: UHC Exchange |
$118.16
|
| Rate for Payer: UHC Medicaid |
$41.20
|
| Rate for Payer: UHCCP Medicaid |
$41.20
|
| Rate for Payer: VA VA |
$78.77
|
|
|
HC BLOOD GAS PKG & DIRECT O2 SAT
|
Facility
|
IP
|
$191.76
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
30100218
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$172.58 |
| Rate for Payer: Aetna Commercial |
$163.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.64
|
| Rate for Payer: Cash Price |
$153.41
|
| Rate for Payer: Cofinity Advantage |
$134.23
|
| Rate for Payer: Cofinity Commercial |
$164.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.41
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.82
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: Priority Health SBD |
$120.81
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
IP
|
$31.92
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$28.73 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Advantage |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.94
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: Priority Health SBD |
$20.11
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
OP
|
$31.92
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$27.13
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.75
|
| 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 |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$19.25
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cofinity Advantage |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$27.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$28.73
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.13
|
| Rate for Payer: Nomi Health Commercial |
$54.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.94
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$27.13
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.05
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health SBD |
$20.11
|
| Rate for Payer: Priority Health Tiered Network |
$14.44
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.08
|
| Rate for Payer: UHC Core |
$27.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.08
|
| Rate for Payer: UHC Medicaid |
$9.44
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC BLOOD PATCH
|
Facility
|
OP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,082.17
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$512.37
|
| Rate for Payer: BCN Commercial |
$512.37
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Advantage |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,145.83
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,082.17
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$802.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC BLOOD PATCH
|
Facility
|
IP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.08 |
| Max. Negotiated Rate |
$1,145.83 |
| Rate for Payer: Aetna Commercial |
$1,082.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.54
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Advantage |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Healthscope Commercial |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PHP Commercial |
$1,082.17
|
| Rate for Payer: Priority Health SBD |
$802.08
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
OP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Commercial |
$1,082.17
|
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$512.37
|
| Rate for Payer: BCN Commercial |
$512.37
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Advantage |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Healthscope Commercial |
$1,145.83
|
| Rate for Payer: Mclaren Medicaid |
$367.85
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Commercial |
$1,082.17
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health SBD |
$802.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
IP
|
$1,273.14
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$802.08 |
| Max. Negotiated Rate |
$1,145.83 |
| Rate for Payer: Aetna Commercial |
$1,082.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$827.54
|
| Rate for Payer: Cash Price |
$1,018.51
|
| Rate for Payer: Cofinity Advantage |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,018.51
|
| Rate for Payer: Healthscope Commercial |
$1,145.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.86
|
| Rate for Payer: PHP Commercial |
$1,082.17
|
| Rate for Payer: Priority Health SBD |
$802.08
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
IP
|
$23.51
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.81
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.63
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.81
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
OP
|
$23.51
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$3.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| 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 |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.65
|
| Rate for Payer: BCN Medicare Advantage |
$3.43
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cash Price |
$18.81
|
| Rate for Payer: Cofinity Advantage |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$21.16
|
| Rate for Payer: Mclaren Medicaid |
$1.79
|
| Rate for Payer: Mclaren Medicare |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.60
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$5.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.63
|
| Rate for Payer: PACE Medicare |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.43
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.43
|
| Rate for Payer: Priority Health Medicare |
$3.43
|
| Rate for Payer: Priority Health SBD |
$14.81
|
| Rate for Payer: Priority Health Tiered Network |
$2.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$5.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.43
|
| Rate for Payer: UHC Exchange |
$5.15
|
| Rate for Payer: UHC Medicaid |
$1.79
|
| Rate for Payer: UHCCP Medicaid |
$1.79
|
| Rate for Payer: VA VA |
$3.43
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
IP
|
$253.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$228.40 |
| Rate for Payer: Aetna Commercial |
$215.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.96
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cofinity Advantage |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$218.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.02
|
| Rate for Payer: Healthscope Commercial |
$228.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.34
|
| Rate for Payer: PHP Commercial |
$215.71
|
| Rate for Payer: Priority Health SBD |
$159.88
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
OP
|
$253.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$215.71
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cash Price |
$203.02
|
| Rate for Payer: Cofinity Advantage |
$177.65
|
| Rate for Payer: Cofinity Commercial |
$218.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$228.40
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.71
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.34
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$215.71
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$159.88
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.96
|
| Rate for Payer: UHC Core |
$132.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$99.74
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
IP
|
$47.36
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$42.62 |
| Rate for Payer: Aetna Commercial |
$40.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.78
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cofinity Advantage |
$33.15
|
| Rate for Payer: Cofinity Commercial |
$40.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.89
|
| Rate for Payer: Healthscope Commercial |
$42.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.52
|
| Rate for Payer: PHP Commercial |
$40.26
|
| Rate for Payer: Priority Health SBD |
$29.84
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
OP
|
$47.36
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$40.26
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cofinity Advantage |
$33.15
|
| Rate for Payer: Cofinity Commercial |
$40.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$42.62
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.26
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.52
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$40.26
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$29.84
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.78
|
| Rate for Payer: UHC Core |
$24.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$18.61
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Advantage |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.31
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health SBD |
$230.42
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Advantage |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.31
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$230.42
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.74
|
| Rate for Payer: UHC Core |
$190.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$143.74
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
OP
|
$306.69
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$79.49 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$260.69
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$245.35
|
| Rate for Payer: Cash Price |
$245.35
|
| Rate for Payer: Cofinity Advantage |
$214.68
|
| Rate for Payer: Cofinity Commercial |
$263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$276.02
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.69
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.02
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$260.69
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$193.21
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.35
|
| Rate for Payer: UHC Core |
$159.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$120.53
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
IP
|
$306.69
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$193.21 |
| Max. Negotiated Rate |
$276.02 |
| Rate for Payer: Aetna Commercial |
$260.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.35
|
| Rate for Payer: Cash Price |
$245.35
|
| Rate for Payer: Cofinity Advantage |
$214.68
|
| Rate for Payer: Cofinity Commercial |
$263.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.35
|
| Rate for Payer: Healthscope Commercial |
$276.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.02
|
| Rate for Payer: PHP Commercial |
$260.69
|
| Rate for Payer: Priority Health SBD |
$193.21
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
IP
|
$83.31
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$74.98 |
| Rate for Payer: Aetna Commercial |
$70.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.15
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cofinity Advantage |
$58.32
|
| Rate for Payer: Cofinity Commercial |
$71.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.65
|
| Rate for Payer: Healthscope Commercial |
$74.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.48
|
| Rate for Payer: PHP Commercial |
$70.81
|
| Rate for Payer: Priority Health SBD |
$52.49
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
OP
|
$83.31
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$70.81
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cash Price |
$66.65
|
| Rate for Payer: Cofinity Advantage |
$58.32
|
| Rate for Payer: Cofinity Commercial |
$71.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$74.98
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.81
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.48
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$70.81
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$52.49
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.15
|
| Rate for Payer: UHC Core |
$43.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$32.74
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
IP
|
$105.72
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$95.15 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.72
|
| Rate for Payer: Cash Price |
$84.58
|
| Rate for Payer: Cofinity Advantage |
$74.00
|
| Rate for Payer: Cofinity Commercial |
$90.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.58
|
| Rate for Payer: Healthscope Commercial |
$95.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.29
|
| Rate for Payer: PHP Commercial |
$89.86
|
| Rate for Payer: Priority Health SBD |
$66.60
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
OP
|
$105.72
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$491.50 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$189.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$189.99
|
| Rate for Payer: BCBS Complete |
$83.47
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS Trust/PPO |
$394.16
|
| Rate for Payer: BCN Commercial |
$394.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$84.58
|
| Rate for Payer: Cash Price |
$84.58
|
| Rate for Payer: Cofinity Advantage |
$74.00
|
| Rate for Payer: Cofinity Commercial |
$90.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Healthscope Commercial |
$95.15
|
| Rate for Payer: Mclaren Medicaid |
$79.49
|
| Rate for Payer: Mclaren Medicare |
$151.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Medicaid |
$159.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.86
|
| Rate for Payer: Nomi Health Commercial |
$455.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.29
|
| Rate for Payer: PACE Medicare |
$144.39
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Commercial |
$89.86
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$491.50
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health SBD |
$66.60
|
| Rate for Payer: Priority Health Tiered Network |
$393.20
|
| Rate for Payer: Railroad Medicare Medicare |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.72
|
| Rate for Payer: UHC Core |
$55.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.99
|
| Rate for Payer: UHC Exchange |
$41.55
|
| Rate for Payer: UHC Medicaid |
$79.49
|
| Rate for Payer: UHCCP Medicaid |
$79.49
|
| Rate for Payer: VA VA |
$151.99
|
|
|
HC BLOOD TYPING RH
|
Facility
|
IP
|
$22.72
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$20.45 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: Priority Health SBD |
$14.31
|
|
|
HC BLOOD TYPING RH
|
Facility
|
OP
|
$22.72
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.74
|
| Rate for Payer: BCBS Complete |
$1.64
|
| Rate for Payer: BCBS MAPPO |
$2.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: BCN Medicare Advantage |
$2.99
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Mclaren Medicaid |
$1.56
|
| Rate for Payer: Mclaren Medicare |
$2.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.14
|
| Rate for Payer: Meridian Medicaid |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$8.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.04
|
| Rate for Payer: PACE Medicare |
$2.84
|
| Rate for Payer: PACE SWMI |
$2.99
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Medicare Advantage |
$2.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$2.99
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.49
|
| Rate for Payer: UHC Core |
$4.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.99
|
| Rate for Payer: UHC Exchange |
$4.49
|
| Rate for Payer: UHC Medicaid |
$1.56
|
| Rate for Payer: UHCCP Medicaid |
$1.56
|
| Rate for Payer: VA VA |
$2.99
|
|
