|
HC CRITIC AID 6.5 OZ
|
Facility
|
IP
|
$40.79
|
|
| Hospital Charge Code |
27100008
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.70 |
| Max. Negotiated Rate |
$36.71 |
| Rate for Payer: Aetna Commercial |
$34.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.51
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Cofinity Advantage |
$28.55
|
| Rate for Payer: Cofinity Commercial |
$35.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.63
|
| Rate for Payer: Healthscope Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.59
|
| Rate for Payer: PHP Commercial |
$34.67
|
| Rate for Payer: Priority Health SBD |
$25.70
|
|
|
HC CRITICAL CARE R&B
|
Facility
|
IP
|
$6,464.21
|
|
| Hospital Charge Code |
20000001
|
|
Hospital Revenue Code
|
200
|
| Min. Negotiated Rate |
$4,072.45 |
| Max. Negotiated Rate |
$5,817.79 |
| Rate for Payer: Aetna Commercial |
$5,494.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,201.74
|
| Rate for Payer: Cash Price |
$5,171.37
|
| Rate for Payer: Cofinity Advantage |
$4,524.95
|
| Rate for Payer: Cofinity Commercial |
$5,559.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,171.37
|
| Rate for Payer: Healthscope Commercial |
$5,817.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,494.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,848.16
|
| Rate for Payer: PHP Commercial |
$5,494.58
|
| Rate for Payer: Priority Health SBD |
$4,072.45
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
IP
|
$163.34
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$147.01 |
| Rate for Payer: Aetna Commercial |
$138.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.17
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cofinity Advantage |
$114.34
|
| Rate for Payer: Cofinity Commercial |
$140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.67
|
| Rate for Payer: Healthscope Commercial |
$147.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.50
|
| Rate for Payer: PHP Commercial |
$138.84
|
| Rate for Payer: Priority Health SBD |
$102.90
|
|
|
HC CRMP 5 IGG WB
|
Facility
|
OP
|
$163.34
|
|
|
Service Code
|
CPT 84182
|
| Hospital Charge Code |
30100640
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$147.01 |
| Rate for Payer: Aetna Commercial |
$138.84
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$23.37
|
| Rate for Payer: BCN Commercial |
$23.37
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cash Price |
$130.67
|
| Rate for Payer: Cofinity Advantage |
$114.34
|
| Rate for Payer: Cofinity Commercial |
$140.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Healthscope Commercial |
$147.01
|
| Rate for Payer: Mclaren Medicaid |
$15.28
|
| Rate for Payer: Mclaren Medicare |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Meridian Medicaid |
$30.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.84
|
| Rate for Payer: Nomi Health Commercial |
$43.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.50
|
| Rate for Payer: PACE Medicare |
$27.75
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$138.84
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.21
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Priority Health SBD |
$102.90
|
| Rate for Payer: Priority Health Tiered Network |
$23.37
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.82
|
| Rate for Payer: UHC Core |
$43.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.21
|
| Rate for Payer: UHC Exchange |
$43.82
|
| Rate for Payer: UHC Medicaid |
$15.28
|
| Rate for Payer: UHCCP Medicaid |
$15.28
|
| Rate for Payer: VA VA |
$29.21
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
OP
|
$161.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: Mclaren Medicaid |
$6.30
|
| Rate for Payer: Mclaren Medicare |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Meridian Medicaid |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Nomi Health Commercial |
$18.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PACE Medicare |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.05
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health SBD |
$101.59
|
| Rate for Payer: Priority Health Tiered Network |
$9.64
|
| Rate for Payer: Railroad Medicare Medicare |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.08
|
| Rate for Payer: UHC Core |
$18.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.05
|
| Rate for Payer: UHC Exchange |
$18.08
|
| Rate for Payer: UHC Medicaid |
$6.30
|
| Rate for Payer: UHCCP Medicaid |
$6.30
|
| Rate for Payer: VA VA |
$12.05
|
|
|
HC CRMP 5 IGG WESTERN BLOT
|
Facility
|
IP
|
$161.26
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$145.13 |
| Rate for Payer: Aetna Commercial |
$137.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.82
|
| Rate for Payer: Cash Price |
$129.01
|
| Rate for Payer: Cofinity Advantage |
$112.88
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.01
|
| Rate for Payer: Healthscope Commercial |
$145.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.94
|
| Rate for Payer: PHP Commercial |
$137.07
|
| Rate for Payer: Priority Health SBD |
$101.59
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
IP
|
$188.31
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$169.48 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.40
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cofinity Advantage |
$131.82
|
| Rate for Payer: Cofinity Commercial |
$161.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.65
|
| Rate for Payer: Healthscope Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.23
|
| Rate for Payer: PHP Commercial |
$160.06
|
| Rate for Payer: Priority Health SBD |
$118.64
|
|
|
HC CROSSMATCH COOMBS
|
Facility
|
OP
|
$188.31
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
30200352
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cash Price |
$150.65
|
| Rate for Payer: Cofinity Advantage |
$131.82
|
| Rate for Payer: Cofinity Commercial |
$161.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$169.48
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.06
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.23
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$160.06
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$118.64
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health SBD |
$40.11
|
|
|
HC CROSSMATCH ELECTRONIC
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 86923
|
| Hospital Charge Code |
30200380
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Advantage |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$40.11
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
OP
|
$93.71
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Advantage |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$59.04
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH IMMED SPIN
|
Facility
|
IP
|
$93.71
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
30200351
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$84.34 |
| Rate for Payer: Aetna Commercial |
$79.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.91
|
| Rate for Payer: Cash Price |
$74.97
|
| Rate for Payer: Cofinity Advantage |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$80.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.28
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: Priority Health SBD |
$59.04
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
OP
|
$237.73
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$202.07
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.40
|
| Rate for Payer: BCN Commercial |
$6.40
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cofinity Advantage |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$204.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$213.96
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.07
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.30
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$202.07
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$149.77
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC CROSSMATCH PREWARM
|
Facility
|
IP
|
$237.73
|
|
|
Service Code
|
CPT 86921
|
| Hospital Charge Code |
30200491
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$149.77 |
| Max. Negotiated Rate |
$213.96 |
| Rate for Payer: Aetna Commercial |
$202.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.52
|
| Rate for Payer: Cash Price |
$190.18
|
| Rate for Payer: Cofinity Advantage |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$204.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.18
|
| Rate for Payer: Healthscope Commercial |
$213.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.30
|
| Rate for Payer: PHP Commercial |
$202.07
|
| Rate for Payer: Priority Health SBD |
$149.77
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health SBD |
$59.25
|
|
|
HC CRP HIGH SENSITIVITY CARDIAC RISK
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 86141
|
| Hospital Charge Code |
30200138
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$13.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.19
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: BCN Commercial |
$13.80
|
| Rate for Payer: BCN Medicare Advantage |
$12.95
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Advantage |
$65.83
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Mclaren Medicaid |
$6.77
|
| Rate for Payer: Mclaren Medicare |
$12.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.60
|
| Rate for Payer: Meridian Medicaid |
$13.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$19.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Medicare |
$12.30
|
| Rate for Payer: PACE SWMI |
$12.95
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$12.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.95
|
| Rate for Payer: Priority Health Medicare |
$12.95
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health Tiered Network |
$10.36
|
| Rate for Payer: Railroad Medicare Medicare |
$12.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.43
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.95
|
| Rate for Payer: UHC Exchange |
$19.43
|
| Rate for Payer: UHC Medicaid |
$6.77
|
| Rate for Payer: UHCCP Medicaid |
$6.77
|
| Rate for Payer: VA VA |
$12.95
|
|
|
HC CRP-SF
|
Facility
|
OP
|
$30.57
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$27.51 |
| Rate for Payer: Aetna Commercial |
$25.98
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cofinity Advantage |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$27.51
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$5.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.98
|
| Rate for Payer: Nomi Health Commercial |
$7.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.93
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$25.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$19.26
|
| Rate for Payer: Priority Health Tiered Network |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.77
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: VA VA |
$5.18
|
|
|
HC CRP-SF
|
Facility
|
IP
|
$30.57
|
|
|
Service Code
|
CPT 86140
|
| Hospital Charge Code |
30200407
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.26 |
| Max. Negotiated Rate |
$27.51 |
| Rate for Payer: Aetna Commercial |
$25.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.87
|
| Rate for Payer: Cash Price |
$24.46
|
| Rate for Payer: Cofinity Advantage |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.46
|
| Rate for Payer: Healthscope Commercial |
$27.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.93
|
| Rate for Payer: PHP Commercial |
$25.98
|
| Rate for Payer: Priority Health SBD |
$19.26
|
|
|
HC CRRT INITIAL
|
Facility
|
IP
|
$728.28
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Advantage |
$509.80
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.21
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health SBD |
$458.82
|
|
|
HC CRRT INITIAL
|
Facility
|
OP
|
$728.28
|
|
| Hospital Charge Code |
27000607
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$286.21 |
| Max. Negotiated Rate |
$655.45 |
| Rate for Payer: Aetna Commercial |
$619.04
|
| Rate for Payer: Aetna Medicare |
$364.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.38
|
| Rate for Payer: BCBS Complete |
$291.31
|
| Rate for Payer: Cash Price |
$582.62
|
| Rate for Payer: Cofinity Advantage |
$509.80
|
| Rate for Payer: Cofinity Commercial |
$626.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.62
|
| Rate for Payer: Healthscope Commercial |
$655.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$582.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$546.21
|
| Rate for Payer: PHP Commercial |
$619.04
|
| Rate for Payer: Priority Health SBD |
$458.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.38
|
| Rate for Payer: UHC Core |
$379.43
|
| Rate for Payer: UHC Exchange |
$286.21
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
IP
|
$1,157.78
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$729.40 |
| Max. Negotiated Rate |
$1,042.00 |
| Rate for Payer: Aetna Commercial |
$984.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.56
|
| Rate for Payer: Cash Price |
$926.22
|
| Rate for Payer: Cofinity Advantage |
$810.45
|
| Rate for Payer: Cofinity Commercial |
$995.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.22
|
| Rate for Payer: Healthscope Commercial |
$1,042.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$868.34
|
| Rate for Payer: PHP Commercial |
$984.11
|
| Rate for Payer: Priority Health SBD |
$729.40
|
|
|
HC CRRT INITIATION/REINITIATION
|
Facility
|
OP
|
$1,157.78
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
88000001
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$1,344.55 |
| Rate for Payer: Aetna Commercial |
$984.11
|
| Rate for Payer: Aetna Medicare |
$432.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$519.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$519.70
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$415.76
|
| Rate for Payer: BCN Medicare Advantage |
$415.76
|
| Rate for Payer: Cash Price |
$926.22
|
| Rate for Payer: Cash Price |
$926.22
|
| Rate for Payer: Cofinity Advantage |
$810.45
|
| Rate for Payer: Cofinity Commercial |
$995.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$926.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.76
|
| Rate for Payer: Healthscope Commercial |
$1,042.00
|
| Rate for Payer: Mclaren Medicaid |
$217.44
|
| Rate for Payer: Mclaren Medicare |
$415.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.55
|
| Rate for Payer: Meridian Medicaid |
$436.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$984.11
|
| Rate for Payer: Nomi Health Commercial |
$1,247.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$868.34
|
| Rate for Payer: PACE Medicare |
$394.97
|
| Rate for Payer: PACE SWMI |
$415.76
|
| Rate for Payer: PHP Commercial |
$984.11
|
| Rate for Payer: PHP Medicare Advantage |
$415.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,344.55
|
| Rate for Payer: Priority Health Medicare |
$415.76
|
| Rate for Payer: Priority Health SBD |
$729.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,075.64
|
| Rate for Payer: Railroad Medicare Medicare |
$415.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.56
|
| Rate for Payer: UHC Core |
$603.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.76
|
| Rate for Payer: UHC Exchange |
$455.01
|
| Rate for Payer: UHC Medicaid |
$217.44
|
| Rate for Payer: UHCCP Medicaid |
$217.44
|
| Rate for Payer: VA VA |
$415.76
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
IP
|
$130.05
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
|
|
HC CRRT MONITOR FEE
|
Facility
|
OP
|
$130.05
|
|
| Hospital Charge Code |
27000609
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.11 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Aetna Commercial |
$110.54
|
| Rate for Payer: Aetna Medicare |
$65.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.53
|
| Rate for Payer: BCBS Complete |
$52.02
|
| Rate for Payer: Cash Price |
$104.04
|
| Rate for Payer: Cofinity Advantage |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.04
|
| Rate for Payer: Healthscope Commercial |
$117.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.54
|
| Rate for Payer: PHP Commercial |
$110.54
|
| Rate for Payer: Priority Health SBD |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.53
|
| Rate for Payer: UHC Core |
$67.76
|
| Rate for Payer: UHC Exchange |
$51.11
|
|
|
HC CRRT MONITORING PER HOUR
|
Facility
|
OP
|
$425.18
|
|
| Hospital Charge Code |
88000002
|
|
Hospital Revenue Code
|
809
|
| Min. Negotiated Rate |
$167.10 |
| Max. Negotiated Rate |
$382.66 |
| Rate for Payer: Aetna Commercial |
$361.40
|
| Rate for Payer: Aetna Medicare |
$212.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.37
|
| Rate for Payer: BCBS Complete |
$170.07
|
| Rate for Payer: Cash Price |
$340.14
|
| Rate for Payer: Cofinity Advantage |
$297.63
|
| Rate for Payer: Cofinity Commercial |
$365.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.14
|
| Rate for Payer: Healthscope Commercial |
$382.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.88
|
| Rate for Payer: PHP Commercial |
$361.40
|
| Rate for Payer: Priority Health SBD |
$267.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.37
|
| Rate for Payer: UHC Core |
$221.52
|
| Rate for Payer: UHC Exchange |
$167.10
|
|
