|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
IP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,861.68 |
| Max. Negotiated Rate |
$9,802.40 |
| Rate for Payer: Aetna Commercial |
$9,257.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,079.51
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cofinity Commercial |
$7,624.09
|
| Rate for Payer: Cofinity Commercial |
$9,366.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,624.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,713.25
|
| Rate for Payer: Healthscope Commercial |
$9,802.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: PHP Commercial |
$9,257.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: Priority Health SBD |
$6,861.68
|
|
|
HC CRYOABLATION NASAL TISSUE OR NERVES UNI OR BIL
|
Facility
|
OP
|
$10,891.56
|
|
|
Service Code
|
CPT 31243
|
| Hospital Charge Code |
76100399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Commercial |
$9,257.83
|
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,079.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cash Price |
$8,713.25
|
| Rate for Payer: Cofinity Commercial |
$9,366.74
|
| Rate for Payer: Cofinity Commercial |
$7,624.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,624.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,713.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Healthscope Commercial |
$9,802.40
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,257.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Commercial |
$9,257.83
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,079.51
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Priority Health SBD |
$6,861.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
IP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,221.98 |
| Max. Negotiated Rate |
$3,174.26 |
| Rate for Payer: Aetna Commercial |
$2,997.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.52
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$2,468.87
|
| Rate for Payer: Cofinity Commercial |
$3,033.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Healthscope Commercial |
$3,174.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: PHP Commercial |
$2,997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: Priority Health SBD |
$2,221.98
|
|
|
HC CRYOABLATION NEEDLE/PROBE
|
Facility
|
OP
|
$3,526.96
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,410.78 |
| Max. Negotiated Rate |
$3,174.26 |
| Rate for Payer: Aetna Commercial |
$2,997.92
|
| Rate for Payer: Aetna Medicare |
$1,763.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.52
|
| Rate for Payer: BCBS Complete |
$1,410.78
|
| Rate for Payer: Cash Price |
$2,821.57
|
| Rate for Payer: Cofinity Commercial |
$2,468.87
|
| Rate for Payer: Cofinity Commercial |
$3,033.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.57
|
| Rate for Payer: Healthscope Commercial |
$3,174.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.92
|
| Rate for Payer: PHP Commercial |
$2,997.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.52
|
| Rate for Payer: Priority Health SBD |
$2,221.98
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
IP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,153.55 |
| Max. Negotiated Rate |
$7,362.22 |
| Rate for Payer: Aetna Commercial |
$6,953.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,317.16
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$5,726.17
|
| Rate for Payer: Cofinity Commercial |
$7,035.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,726.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Healthscope Commercial |
$7,362.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: PHP Commercial |
$6,953.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: Priority Health SBD |
$5,153.55
|
|
|
HC CRYOABLATION STANDBY
|
Facility
|
OP
|
$8,180.24
|
|
| Hospital Charge Code |
27200283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,272.10 |
| Max. Negotiated Rate |
$7,362.22 |
| Rate for Payer: Aetna Commercial |
$6,953.20
|
| Rate for Payer: Aetna Medicare |
$4,090.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,317.16
|
| Rate for Payer: BCBS Complete |
$3,272.10
|
| Rate for Payer: Cash Price |
$6,544.19
|
| Rate for Payer: Cofinity Commercial |
$5,726.17
|
| Rate for Payer: Cofinity Commercial |
$7,035.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,726.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,544.19
|
| Rate for Payer: Healthscope Commercial |
$7,362.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.20
|
| Rate for Payer: PHP Commercial |
$6,953.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,317.16
|
| Rate for Payer: Priority Health SBD |
$5,153.55
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
OP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,908.87 |
| Max. Negotiated Rate |
$11,044.95 |
| Rate for Payer: Aetna Commercial |
$10,431.34
|
| Rate for Payer: Aetna Medicare |
$6,136.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,976.91
|
| Rate for Payer: BCBS Complete |
$4,908.87
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$10,554.07
|
| Rate for Payer: Cofinity Commercial |
$8,590.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,590.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Healthscope Commercial |
$11,044.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: PHP Commercial |
$10,431.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: Priority Health SBD |
$7,731.47
|
|
|
HC CRYOABLATION SUPPLIES
|
Facility
|
IP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,731.47 |
| Max. Negotiated Rate |
$11,044.95 |
| Rate for Payer: Aetna Commercial |
$10,431.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,976.91
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$10,554.07
|
| Rate for Payer: Cofinity Commercial |
$8,590.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,590.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Healthscope Commercial |
$11,044.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: PHP Commercial |
$10,431.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: Priority Health SBD |
$7,731.47
|
|
|
HC CRYOGLOBULINS
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| 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 |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Commercial |
$13.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOGLOBULINS
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.85
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$13.84
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health SBD |
$12.46
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$14.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| 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 |
$7.96
|
| Rate for Payer: BCBS MAPPO |
$14.14
|
| Rate for Payer: BCN Medicare Advantage |
$14.14
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.14
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Mclaren Medicaid |
$7.58
|
| Rate for Payer: Mclaren Medicare |
$14.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.85
|
| Rate for Payer: Meridian Medicaid |
$7.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PACE Medicare |
$13.43
|
| Rate for Payer: PACE SWMI |
$14.14
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Medicare Advantage |
$14.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Medicare |
$14.14
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Railroad Medicare Medicare |
$14.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.14
|
| Rate for Payer: UHC Medicare Advantage |
$14.14
|
| Rate for Payer: UHCCP Medicaid |
$7.96
|
| Rate for Payer: VA VA |
$14.14
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| 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 |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health SBD |
$27.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: VA VA |
$6.47
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.51
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health SBD |
$27.63
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
IP
|
$143.16
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$90.19 |
| Max. Negotiated Rate |
$128.84 |
| Rate for Payer: Aetna Commercial |
$121.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.05
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$100.21
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.53
|
| Rate for Payer: Healthscope Commercial |
$128.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.69
|
| Rate for Payer: PHP Commercial |
$121.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.05
|
| Rate for Payer: Priority Health SBD |
$90.19
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
OP
|
$143.16
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$174.52 |
| Rate for Payer: Aetna Commercial |
$121.69
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Cofinity Commercial |
$100.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$128.84
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.69
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$121.69
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.05
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$90.19
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$105.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$105.94
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
IP
|
$340.78
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$214.69 |
| Max. Negotiated Rate |
$306.70 |
| Rate for Payer: Aetna Commercial |
$289.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.51
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Cofinity Commercial |
$293.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.62
|
| Rate for Payer: Healthscope Commercial |
$306.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.66
|
| Rate for Payer: PHP Commercial |
$289.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.51
|
| Rate for Payer: Priority Health SBD |
$214.69
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
OP
|
$340.78
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$306.70 |
| Rate for Payer: Aetna Commercial |
$289.66
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cofinity Commercial |
$293.07
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$306.70
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.66
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$289.66
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.51
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$214.69
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$252.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$252.18
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE POOL
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE POOL
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.74 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health SBD |
$156.74
|
|
|
HC CRYOPRECIPITATE POOL CMPT1
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.74 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health SBD |
$156.74
|
|
|
HC CRYOPRECIPITATE POOL CMPT1
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE POOL CMPT2
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
|
HC CRYOPRECIPITATE POOL CMPT2
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$156.74 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health SBD |
$156.74
|
|
|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.50
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$62.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.00
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Cofinity Commercial |
$174.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.00
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$33.23
|
| Rate for Payer: Mclaren Medicare |
$62.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.10
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: PACE Medicare |
$58.90
|
| Rate for Payer: PACE SWMI |
$62.00
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health Medicare |
$62.00
|
| Rate for Payer: Priority Health SBD |
$156.74
|
| Rate for Payer: Railroad Medicare Medicare |
$62.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.52
|
| Rate for Payer: UHC Core |
$184.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.00
|
| Rate for Payer: UHC Exchange |
$184.11
|
| Rate for Payer: UHC Medicare Advantage |
$62.00
|
| Rate for Payer: UHCCP Medicaid |
$34.91
|
| Rate for Payer: VA VA |
$62.00
|
|
