|
HC PLATELET AGGREGATION EA AGENT
|
Facility
|
IP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.99
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$66.76
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health SBD |
$60.08
|
|
|
HC PLATELET AGGREGATION EA AGENT
|
Facility
|
OP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Cofinity Commercial |
$66.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$60.08
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET ANTIBODY
|
Facility
|
IP
|
$97.92
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.69 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.23
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.54
|
| Rate for Payer: Priority Health SBD |
$61.69
|
|
|
HC PLATELET ANTIBODY
|
Facility
|
OP
|
$97.92
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: BCBS Complete |
$10.55
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Cofinity Commercial |
$68.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Mclaren Medicaid |
$10.05
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Medicaid |
$10.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.23
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.54
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health SBD |
$61.69
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.04
|
| Rate for Payer: UHC Core |
$31.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$18.37
|
| Rate for Payer: UHC Medicare Advantage |
$18.92
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
OP
|
$273.67
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$392.49 |
| Rate for Payer: Aetna Commercial |
$232.62
|
| Rate for Payer: Aetna Medicare |
$127.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.79
|
| Rate for Payer: BCBS Complete |
$70.21
|
| Rate for Payer: BCBS MAPPO |
$122.23
|
| Rate for Payer: BCBS Trust/PPO |
$380.33
|
| Rate for Payer: BCN Medicare Advantage |
$122.23
|
| Rate for Payer: Cash Price |
$218.94
|
| Rate for Payer: Cash Price |
$218.94
|
| Rate for Payer: Cofinity Commercial |
$191.57
|
| Rate for Payer: Cofinity Commercial |
$235.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.23
|
| Rate for Payer: Healthscope Commercial |
$246.30
|
| Rate for Payer: Mclaren Medicaid |
$66.86
|
| Rate for Payer: Mclaren Medicare |
$122.23
|
| Rate for Payer: Meridian Medicaid |
$70.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.62
|
| Rate for Payer: PACE Medicare |
$116.12
|
| Rate for Payer: PACE SWMI |
$122.23
|
| Rate for Payer: PHP Commercial |
$232.62
|
| Rate for Payer: PHP Medicare Advantage |
$122.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.49
|
| Rate for Payer: Priority Health Medicare |
$122.23
|
| Rate for Payer: Priority Health Narrow Network |
$313.99
|
| Rate for Payer: Priority Health SBD |
$172.41
|
| Rate for Payer: Railroad Medicare Medicare |
$122.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.23
|
| Rate for Payer: UHC Medicare Advantage |
$125.90
|
| Rate for Payer: VA VA |
$122.23
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
IP
|
$273.67
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.41 |
| Max. Negotiated Rate |
$246.30 |
| Rate for Payer: Aetna Commercial |
$232.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.89
|
| Rate for Payer: Cash Price |
$218.94
|
| Rate for Payer: Cofinity Commercial |
$191.57
|
| Rate for Payer: Cofinity Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$246.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.62
|
| Rate for Payer: PHP Commercial |
$232.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.57
|
| Rate for Payer: Priority Health SBD |
$172.41
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$37.90
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.60
|
| Rate for Payer: BCBS Complete |
$2.57
|
| Rate for Payer: BCBS MAPPO |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.51
|
| Rate for Payer: BCN Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.48
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Mclaren Medicaid |
$2.45
|
| Rate for Payer: Mclaren Medicare |
$4.48
|
| Rate for Payer: Meridian Medicaid |
$2.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PACE Medicare |
$4.26
|
| Rate for Payer: PACE SWMI |
$4.48
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: PHP Medicare Advantage |
$4.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health Medicare |
$4.48
|
| Rate for Payer: Priority Health SBD |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.38
|
| Rate for Payer: UHC Core |
$7.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.48
|
| Rate for Payer: UHC Exchange |
$4.48
|
| Rate for Payer: UHC Medicare Advantage |
$4.61
|
| Rate for Payer: VA VA |
$4.48
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$37.90
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.64
|
| Rate for Payer: Cash Price |
$30.32
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Healthscope Commercial |
$34.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.22
|
| Rate for Payer: PHP Commercial |
$32.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.53
|
| Rate for Payer: Priority Health SBD |
$23.88
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
IP
|
$121.58
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$109.42 |
| Rate for Payer: Aetna Commercial |
$103.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.03
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cofinity Commercial |
$104.56
|
| Rate for Payer: Cofinity Commercial |
$85.11
|
| Rate for Payer: Healthscope Commercial |
$109.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.34
|
| Rate for Payer: PHP Commercial |
$103.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.11
|
| Rate for Payer: Priority Health SBD |
$76.60
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
OP
|
$121.58
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$109.42 |
| Rate for Payer: Aetna Commercial |
$103.34
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cofinity Commercial |
$104.56
|
| Rate for Payer: Cofinity Commercial |
$85.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$109.42
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.34
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$103.34
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.11
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$76.60
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$394.64
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$804.69 |
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna Medicare |
$224.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.22
|
| Rate for Payer: BCBS Complete |
$123.71
|
| Rate for Payer: BCBS MAPPO |
$215.38
|
| Rate for Payer: BCBS Trust/PPO |
$779.77
|
| Rate for Payer: BCN Medicare Advantage |
$215.38
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Cofinity Commercial |
$276.25
|
| Rate for Payer: Cofinity Commercial |
$339.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.38
|
| Rate for Payer: Healthscope Commercial |
$355.18
|
| Rate for Payer: Mclaren Medicaid |
$117.81
|
| Rate for Payer: Mclaren Medicare |
$215.38
|
| Rate for Payer: Meridian Medicaid |
$123.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.44
|
| Rate for Payer: PACE Medicare |
$204.61
|
| Rate for Payer: PACE SWMI |
$215.38
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: PHP Medicare Advantage |
$215.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$804.69
|
| Rate for Payer: Priority Health Medicare |
$215.38
|
| Rate for Payer: Priority Health Narrow Network |
$643.75
|
| Rate for Payer: Priority Health SBD |
$248.62
|
| Rate for Payer: Railroad Medicare Medicare |
$215.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.38
|
| Rate for Payer: UHC Medicare Advantage |
$221.84
|
| Rate for Payer: VA VA |
$215.38
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$394.64
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$248.62 |
| Max. Negotiated Rate |
$355.18 |
| Rate for Payer: Aetna Commercial |
$335.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.52
|
| Rate for Payer: Cash Price |
$315.71
|
| Rate for Payer: Cofinity Commercial |
$276.25
|
| Rate for Payer: Cofinity Commercial |
$339.39
|
| Rate for Payer: Healthscope Commercial |
$355.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.44
|
| Rate for Payer: PHP Commercial |
$335.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.25
|
| Rate for Payer: Priority Health SBD |
$248.62
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$66.76
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$60.08
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$95.37
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.08 |
| Max. Negotiated Rate |
$85.83 |
| Rate for Payer: Aetna Commercial |
$81.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.99
|
| Rate for Payer: Cash Price |
$76.30
|
| Rate for Payer: Cofinity Commercial |
$66.76
|
| Rate for Payer: Cofinity Commercial |
$82.02
|
| Rate for Payer: Healthscope Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.06
|
| Rate for Payer: PHP Commercial |
$81.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.76
|
| Rate for Payer: Priority Health SBD |
$60.08
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$57.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.89
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$24.91
|
| Rate for Payer: UHC Medicare Advantage |
$25.66
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$90.78
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Cash Price |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$63.55
|
| Rate for Payer: Cofinity Commercial |
$78.07
|
| Rate for Payer: Healthscope Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.16
|
| Rate for Payer: PHP Commercial |
$77.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.55
|
| Rate for Payer: Priority Health SBD |
$57.19
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.87 |
| Max. Negotiated Rate |
$1,713.91 |
| Rate for Payer: Aetna Commercial |
$1,618.69
|
| Rate for Payer: Aetna Medicare |
$1,282.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.15
|
| Rate for Payer: BCBS Complete |
$708.19
|
| Rate for Payer: BCBS MAPPO |
$1,232.92
|
| Rate for Payer: BCBS Trust/PPO |
$838.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.92
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,637.73
|
| Rate for Payer: Cofinity Commercial |
$1,333.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.92
|
| Rate for Payer: Healthscope Commercial |
$1,713.91
|
| Rate for Payer: Mclaren Medicaid |
$674.41
|
| Rate for Payer: Mclaren Medicare |
$1,232.92
|
| Rate for Payer: Meridian Medicaid |
$708.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: PACE Medicare |
$1,171.27
|
| Rate for Payer: PACE SWMI |
$1,232.92
|
| Rate for Payer: PHP Commercial |
$1,618.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: Priority Health Medicare |
$1,232.92
|
| Rate for Payer: Priority Health SBD |
$1,199.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.92
|
| Rate for Payer: UHC Exchange |
$99.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.91
|
| Rate for Payer: VA VA |
$1,232.92
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,904.34
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,199.73 |
| Max. Negotiated Rate |
$1,713.91 |
| Rate for Payer: Aetna Commercial |
$1,618.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.82
|
| Rate for Payer: Cash Price |
$1,523.47
|
| Rate for Payer: Cofinity Commercial |
$1,637.73
|
| Rate for Payer: Cofinity Commercial |
$1,333.04
|
| Rate for Payer: Healthscope Commercial |
$1,713.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.69
|
| Rate for Payer: PHP Commercial |
$1,618.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.04
|
| Rate for Payer: Priority Health SBD |
$1,199.73
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$241.28 |
| Max. Negotiated Rate |
$1,944.97 |
| Rate for Payer: Aetna Commercial |
$1,836.92
|
| Rate for Payer: Aetna Medicare |
$458.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$551.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$551.38
|
| Rate for Payer: BCBS Complete |
$253.37
|
| Rate for Payer: BCBS MAPPO |
$441.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,411.18
|
| Rate for Payer: BCN Medicare Advantage |
$441.10
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$1,858.53
|
| Rate for Payer: Cofinity Commercial |
$1,512.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.10
|
| Rate for Payer: Healthscope Commercial |
$1,944.97
|
| Rate for Payer: Mclaren Medicaid |
$241.28
|
| Rate for Payer: Mclaren Medicare |
$441.10
|
| Rate for Payer: Meridian Medicaid |
$253.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$463.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$507.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: PACE Medicare |
$419.04
|
| Rate for Payer: PACE SWMI |
$441.10
|
| Rate for Payer: PHP Commercial |
$1,836.92
|
| Rate for Payer: PHP Medicare Advantage |
$441.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,456.27
|
| Rate for Payer: Priority Health Medicare |
$441.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.02
|
| Rate for Payer: Priority Health SBD |
$1,361.48
|
| Rate for Payer: Railroad Medicare Medicare |
$441.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.10
|
| Rate for Payer: UHC Medicare Advantage |
$454.33
|
| Rate for Payer: VA VA |
$441.10
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,161.08
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,361.48 |
| Max. Negotiated Rate |
$1,944.97 |
| Rate for Payer: Aetna Commercial |
$1,836.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.70
|
| Rate for Payer: Cash Price |
$1,728.86
|
| Rate for Payer: Cofinity Commercial |
$1,512.76
|
| Rate for Payer: Cofinity Commercial |
$1,858.53
|
| Rate for Payer: Healthscope Commercial |
$1,944.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,836.92
|
| Rate for Payer: PHP Commercial |
$1,836.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,512.76
|
| Rate for Payer: Priority Health SBD |
$1,361.48
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.53 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,405.56
|
| Rate for Payer: Aetna Medicare |
$653.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$785.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$785.02
|
| Rate for Payer: BCBS Complete |
$360.73
|
| Rate for Payer: BCBS MAPPO |
$628.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.39
|
| Rate for Payer: BCN Medicare Advantage |
$628.02
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$2,433.86
|
| Rate for Payer: Cofinity Commercial |
$1,981.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.02
|
| Rate for Payer: Healthscope Commercial |
$2,547.06
|
| Rate for Payer: Mclaren Medicaid |
$343.53
|
| Rate for Payer: Mclaren Medicare |
$628.02
|
| Rate for Payer: Meridian Medicaid |
$360.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$659.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$722.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: PACE Medicare |
$596.62
|
| Rate for Payer: PACE SWMI |
$628.02
|
| Rate for Payer: PHP Commercial |
$2,405.56
|
| Rate for Payer: PHP Medicare Advantage |
$628.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.64
|
| Rate for Payer: Priority Health Medicare |
$628.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,530.91
|
| Rate for Payer: Priority Health SBD |
$1,782.94
|
| Rate for Payer: Railroad Medicare Medicare |
$628.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.02
|
| Rate for Payer: UHC Medicare Advantage |
$646.86
|
| Rate for Payer: VA VA |
$628.02
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,830.07
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,782.94 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,405.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.55
|
| Rate for Payer: Cash Price |
$2,264.06
|
| Rate for Payer: Cofinity Commercial |
$1,981.05
|
| Rate for Payer: Cofinity Commercial |
$2,433.86
|
| Rate for Payer: Healthscope Commercial |
$2,547.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,405.56
|
| Rate for Payer: PHP Commercial |
$2,405.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,981.05
|
| Rate for Payer: Priority Health SBD |
$1,782.94
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$343.53 |
| Max. Negotiated Rate |
$1,913.64 |
| Rate for Payer: Aetna Commercial |
$1,121.03
|
| Rate for Payer: Aetna Medicare |
$653.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$785.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$785.02
|
| Rate for Payer: BCBS Complete |
$360.73
|
| Rate for Payer: BCBS MAPPO |
$628.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,854.39
|
| Rate for Payer: BCN Medicare Advantage |
$628.02
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$1,134.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.02
|
| Rate for Payer: Healthscope Commercial |
$1,186.97
|
| Rate for Payer: Mclaren Medicaid |
$343.53
|
| Rate for Payer: Mclaren Medicare |
$628.02
|
| Rate for Payer: Meridian Medicaid |
$360.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$659.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$722.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: PACE Medicare |
$596.62
|
| Rate for Payer: PACE SWMI |
$628.02
|
| Rate for Payer: PHP Commercial |
$1,121.03
|
| Rate for Payer: PHP Medicare Advantage |
$628.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$343.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,913.64
|
| Rate for Payer: Priority Health Medicare |
$628.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,530.91
|
| Rate for Payer: Priority Health SBD |
$830.88
|
| Rate for Payer: Railroad Medicare Medicare |
$628.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.02
|
| Rate for Payer: UHC Medicare Advantage |
$646.86
|
| Rate for Payer: VA VA |
$628.02
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,318.86
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$830.88 |
| Max. Negotiated Rate |
$1,186.97 |
| Rate for Payer: Aetna Commercial |
$1,121.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.26
|
| Rate for Payer: Cash Price |
$1,055.09
|
| Rate for Payer: Cofinity Commercial |
$1,134.22
|
| Rate for Payer: Cofinity Commercial |
$923.20
|
| Rate for Payer: Healthscope Commercial |
$1,186.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,121.03
|
| Rate for Payer: PHP Commercial |
$1,121.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.20
|
| Rate for Payer: Priority Health SBD |
$830.88
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$289.68
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.87 |
| Max. Negotiated Rate |
$784.54 |
| Rate for Payer: Aetna Commercial |
$246.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.29
|
| Rate for Payer: BCBS Complete |
$115.87
|
| Rate for Payer: BCBS Trust/PPO |
$784.54
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cash Price |
$231.74
|
| Rate for Payer: Cofinity Commercial |
$202.78
|
| Rate for Payer: Cofinity Commercial |
$249.12
|
| Rate for Payer: Healthscope Commercial |
$260.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.23
|
| Rate for Payer: PHP Commercial |
$246.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.78
|
| Rate for Payer: Priority Health SBD |
$182.50
|
|
