|
HC RBC LEUKO REDUCED
|
Facility
|
OP
|
$711.37
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$640.23 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Medicare |
$175.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.08
|
| Rate for Payer: BCBS Complete |
$96.99
|
| Rate for Payer: BCBS MAPPO |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$549.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.86
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cofinity Commercial |
$611.78
|
| Rate for Payer: Cofinity Commercial |
$497.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.86
|
| Rate for Payer: Healthscope Commercial |
$640.23
|
| Rate for Payer: Mclaren Medicaid |
$92.37
|
| Rate for Payer: Mclaren Medicare |
$168.86
|
| Rate for Payer: Meridian Medicaid |
$96.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$604.66
|
| Rate for Payer: PACE Medicare |
$160.42
|
| Rate for Payer: PACE SWMI |
$168.86
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: PHP Medicare Advantage |
$168.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.36
|
| Rate for Payer: Priority Health Medicare |
$168.86
|
| Rate for Payer: Priority Health Narrow Network |
$453.89
|
| Rate for Payer: Priority Health SBD |
$448.16
|
| Rate for Payer: Railroad Medicare Medicare |
$168.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.86
|
| Rate for Payer: UHC Medicare Advantage |
$173.93
|
| Rate for Payer: VA VA |
$168.86
|
|
|
HC RBC LEUKO REDUCED
|
Facility
|
IP
|
$711.37
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000059
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$640.23 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.39
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cofinity Commercial |
$497.96
|
| Rate for Payer: Cofinity Commercial |
$611.78
|
| Rate for Payer: Healthscope Commercial |
$640.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$604.66
|
| Rate for Payer: PHP Commercial |
$604.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.96
|
| Rate for Payer: Priority Health SBD |
$448.16
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: Aetna Medicare |
$245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$294.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$294.74
|
| Rate for Payer: BCBS Complete |
$135.44
|
| Rate for Payer: BCBS MAPPO |
$235.79
|
| Rate for Payer: BCBS Trust/PPO |
$752.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.79
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$862.71
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.79
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Mclaren Medicaid |
$128.98
|
| Rate for Payer: Mclaren Medicare |
$235.79
|
| Rate for Payer: Meridian Medicaid |
$135.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PACE Medicare |
$224.00
|
| Rate for Payer: PACE SWMI |
$235.79
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: PHP Medicare Advantage |
$235.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$776.97
|
| Rate for Payer: Priority Health Medicare |
$235.79
|
| Rate for Payer: Priority Health Narrow Network |
$621.58
|
| Rate for Payer: Priority Health SBD |
$776.44
|
| Rate for Payer: Railroad Medicare Medicare |
$235.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.79
|
| Rate for Payer: UHC Medicare Advantage |
$242.86
|
| Rate for Payer: VA VA |
$235.79
|
|
|
HC RBC LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$1,232.44
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000072
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$776.44 |
| Max. Negotiated Rate |
$1,109.20 |
| Rate for Payer: Aetna Commercial |
$1,047.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.09
|
| Rate for Payer: Cash Price |
$985.95
|
| Rate for Payer: Cofinity Commercial |
$1,059.90
|
| Rate for Payer: Cofinity Commercial |
$862.71
|
| Rate for Payer: Healthscope Commercial |
$1,109.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,047.57
|
| Rate for Payer: PHP Commercial |
$1,047.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.71
|
| Rate for Payer: Priority Health SBD |
$776.44
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
OP
|
$199.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$179.97 |
| Rate for Payer: Aetna Commercial |
$169.97
|
| Rate for Payer: Aetna Medicare |
$74.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.04
|
| Rate for Payer: BCBS Complete |
$40.91
|
| Rate for Payer: BCBS MAPPO |
$71.23
|
| Rate for Payer: BCBS Trust/PPO |
$55.78
|
| Rate for Payer: BCN Medicare Advantage |
$71.23
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cofinity Commercial |
$171.97
|
| Rate for Payer: Cofinity Commercial |
$139.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.23
|
| Rate for Payer: Healthscope Commercial |
$179.97
|
| Rate for Payer: Mclaren Medicaid |
$38.96
|
| Rate for Payer: Mclaren Medicare |
$71.23
|
| Rate for Payer: Meridian Medicaid |
$40.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$74.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.97
|
| Rate for Payer: PACE Medicare |
$67.67
|
| Rate for Payer: PACE SWMI |
$71.23
|
| Rate for Payer: PHP Commercial |
$169.97
|
| Rate for Payer: PHP Medicare Advantage |
$71.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.98
|
| Rate for Payer: Priority Health Medicare |
$71.23
|
| Rate for Payer: Priority Health SBD |
$125.98
|
| Rate for Payer: Railroad Medicare Medicare |
$71.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.48
|
| Rate for Payer: UHC Core |
$88.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.23
|
| Rate for Payer: UHC Exchange |
$71.23
|
| Rate for Payer: UHC Medicare Advantage |
$73.37
|
| Rate for Payer: VA VA |
$71.23
|
|
|
HC RECEPTOR ASSAY OTHER ENDOCRINE
|
Facility
|
IP
|
$199.97
|
|
|
Service Code
|
CPT 84235
|
| Hospital Charge Code |
30100418
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$179.97 |
| Rate for Payer: Aetna Commercial |
$169.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.98
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cofinity Commercial |
$139.98
|
| Rate for Payer: Cofinity Commercial |
$171.97
|
| Rate for Payer: Healthscope Commercial |
$179.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.97
|
| Rate for Payer: PHP Commercial |
$169.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.98
|
| Rate for Payer: Priority Health SBD |
$125.98
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
IP
|
$153.93
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$96.98 |
| Max. Negotiated Rate |
$138.54 |
| Rate for Payer: Aetna Commercial |
$130.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.05
|
| Rate for Payer: Cash Price |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$107.75
|
| Rate for Payer: Cofinity Commercial |
$132.38
|
| Rate for Payer: Healthscope Commercial |
$138.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.84
|
| Rate for Payer: PHP Commercial |
$130.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.75
|
| Rate for Payer: Priority Health SBD |
$96.98
|
|
|
HC RECOVERY 1 ADD'L 15 MIN
|
Facility
|
OP
|
$153.93
|
|
| Hospital Charge Code |
71000020
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$61.57 |
| Max. Negotiated Rate |
$138.54 |
| Rate for Payer: Aetna Commercial |
$130.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.05
|
| Rate for Payer: BCBS Complete |
$61.57
|
| Rate for Payer: Cash Price |
$123.14
|
| Rate for Payer: Cofinity Commercial |
$107.75
|
| Rate for Payer: Cofinity Commercial |
$132.38
|
| Rate for Payer: Healthscope Commercial |
$138.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.84
|
| Rate for Payer: PHP Commercial |
$130.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.75
|
| Rate for Payer: Priority Health SBD |
$96.98
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
IP
|
$363.41
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$327.07 |
| Rate for Payer: Aetna Commercial |
$308.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.22
|
| Rate for Payer: Cash Price |
$290.73
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Commercial |
$312.53
|
| Rate for Payer: Healthscope Commercial |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.90
|
| Rate for Payer: PHP Commercial |
$308.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.39
|
| Rate for Payer: Priority Health SBD |
$228.95
|
|
|
HC RECOVERY 1 INIT 30 MIN
|
Facility
|
OP
|
$363.41
|
|
| Hospital Charge Code |
71000021
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$145.36 |
| Max. Negotiated Rate |
$327.07 |
| Rate for Payer: Aetna Commercial |
$308.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.22
|
| Rate for Payer: BCBS Complete |
$145.36
|
| Rate for Payer: Cash Price |
$290.73
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Cofinity Commercial |
$312.53
|
| Rate for Payer: Healthscope Commercial |
$327.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.90
|
| Rate for Payer: PHP Commercial |
$308.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.39
|
| Rate for Payer: Priority Health SBD |
$228.95
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
IP
|
$180.23
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$162.21 |
| Rate for Payer: Aetna Commercial |
$153.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.15
|
| Rate for Payer: Cash Price |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Cofinity Commercial |
$155.00
|
| Rate for Payer: Healthscope Commercial |
$162.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.20
|
| Rate for Payer: PHP Commercial |
$153.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.16
|
| Rate for Payer: Priority Health SBD |
$113.54
|
|
|
HC RECOVERY 2 ADD'L 15 MIN
|
Facility
|
OP
|
$180.23
|
|
| Hospital Charge Code |
71000022
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$162.21 |
| Rate for Payer: Aetna Commercial |
$153.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.15
|
| Rate for Payer: BCBS Complete |
$72.09
|
| Rate for Payer: Cash Price |
$144.18
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Cofinity Commercial |
$155.00
|
| Rate for Payer: Healthscope Commercial |
$162.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.20
|
| Rate for Payer: PHP Commercial |
$153.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.16
|
| Rate for Payer: Priority Health SBD |
$113.54
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
OP
|
$325.07
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$130.03 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.30
|
| Rate for Payer: BCBS Complete |
$130.03
|
| Rate for Payer: Cash Price |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$227.55
|
| Rate for Payer: Cofinity Commercial |
$279.56
|
| Rate for Payer: Healthscope Commercial |
$292.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.31
|
| Rate for Payer: PHP Commercial |
$276.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.55
|
| Rate for Payer: Priority Health SBD |
$204.79
|
|
|
HC RECOVERY 2 INIT 30 MIN
|
Facility
|
IP
|
$325.07
|
|
| Hospital Charge Code |
71000023
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$276.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.30
|
| Rate for Payer: Cash Price |
$260.06
|
| Rate for Payer: Cofinity Commercial |
$227.55
|
| Rate for Payer: Cofinity Commercial |
$279.56
|
| Rate for Payer: Healthscope Commercial |
$292.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.31
|
| Rate for Payer: PHP Commercial |
$276.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.55
|
| Rate for Payer: Priority Health SBD |
$204.79
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
OP
|
$100.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$90.15 |
| Rate for Payer: Aetna Commercial |
$85.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.11
|
| Rate for Payer: BCBS Complete |
$40.07
|
| Rate for Payer: Cash Price |
$80.14
|
| Rate for Payer: Cofinity Commercial |
$70.12
|
| Rate for Payer: Cofinity Commercial |
$86.15
|
| Rate for Payer: Healthscope Commercial |
$90.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.14
|
| Rate for Payer: PHP Commercial |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.12
|
| Rate for Payer: Priority Health SBD |
$63.11
|
|
|
HC RECOVERY 3 ADD'L 15 MIN
|
Facility
|
IP
|
$100.17
|
|
| Hospital Charge Code |
71000024
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$63.11 |
| Max. Negotiated Rate |
$90.15 |
| Rate for Payer: Aetna Commercial |
$85.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.11
|
| Rate for Payer: Cash Price |
$80.14
|
| Rate for Payer: Cofinity Commercial |
$70.12
|
| Rate for Payer: Cofinity Commercial |
$86.15
|
| Rate for Payer: Healthscope Commercial |
$90.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.14
|
| Rate for Payer: PHP Commercial |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.12
|
| Rate for Payer: Priority Health SBD |
$63.11
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
IP
|
$202.38
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$182.14 |
| Rate for Payer: Aetna Commercial |
$172.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.55
|
| Rate for Payer: Cash Price |
$161.90
|
| Rate for Payer: Cofinity Commercial |
$141.67
|
| Rate for Payer: Cofinity Commercial |
$174.05
|
| Rate for Payer: Healthscope Commercial |
$182.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.02
|
| Rate for Payer: PHP Commercial |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.67
|
| Rate for Payer: Priority Health SBD |
$127.50
|
|
|
HC RECOVERY 3 INIT 30 MIN
|
Facility
|
OP
|
$202.38
|
|
| Hospital Charge Code |
71000025
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$80.95 |
| Max. Negotiated Rate |
$182.14 |
| Rate for Payer: Aetna Commercial |
$172.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.55
|
| Rate for Payer: BCBS Complete |
$80.95
|
| Rate for Payer: Cash Price |
$161.90
|
| Rate for Payer: Cofinity Commercial |
$141.67
|
| Rate for Payer: Cofinity Commercial |
$174.05
|
| Rate for Payer: Healthscope Commercial |
$182.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.02
|
| Rate for Payer: PHP Commercial |
$172.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.67
|
| Rate for Payer: Priority Health SBD |
$127.50
|
|
|
HC RED CEDAR IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$15.68
|
|
|
HC RED CEDAR IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200099
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health SBD |
$15.68
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.26
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
OP
|
$286.73
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$258.06 |
| Rate for Payer: Aetna Commercial |
$243.72
|
| Rate for Payer: Aetna Medicare |
$192.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.50
|
| Rate for Payer: BCBS Complete |
$106.38
|
| Rate for Payer: BCBS MAPPO |
$185.20
|
| Rate for Payer: BCBS Trust/PPO |
$145.03
|
| Rate for Payer: BCN Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cofinity Commercial |
$246.59
|
| Rate for Payer: Cofinity Commercial |
$200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.20
|
| Rate for Payer: Healthscope Commercial |
$258.06
|
| Rate for Payer: Mclaren Medicaid |
$101.30
|
| Rate for Payer: Mclaren Medicare |
$185.20
|
| Rate for Payer: Meridian Medicaid |
$106.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.72
|
| Rate for Payer: PACE Medicare |
$175.94
|
| Rate for Payer: PACE SWMI |
$185.20
|
| Rate for Payer: PHP Commercial |
$243.72
|
| Rate for Payer: PHP Medicare Advantage |
$185.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.71
|
| Rate for Payer: Priority Health Medicare |
$185.20
|
| Rate for Payer: Priority Health SBD |
$180.64
|
| Rate for Payer: Railroad Medicare Medicare |
$185.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.24
|
| Rate for Payer: UHC Core |
$222.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.20
|
| Rate for Payer: UHC Exchange |
$185.20
|
| Rate for Payer: UHC Medicare Advantage |
$190.76
|
| Rate for Payer: VA VA |
$185.20
|
|
|
HC RED CELL GENO MI BLD
|
Facility
|
IP
|
$286.73
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
31000135
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$180.64 |
| Max. Negotiated Rate |
$258.06 |
| Rate for Payer: Aetna Commercial |
$243.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.37
|
| Rate for Payer: Cash Price |
$229.38
|
| Rate for Payer: Cofinity Commercial |
$200.71
|
| Rate for Payer: Cofinity Commercial |
$246.59
|
| Rate for Payer: Healthscope Commercial |
$258.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.72
|
| Rate for Payer: PHP Commercial |
$243.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.71
|
| Rate for Payer: Priority Health SBD |
$180.64
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
OP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$184.22 |
| Rate for Payer: Aetna Commercial |
$173.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.05
|
| Rate for Payer: BCBS Complete |
$81.88
|
| Rate for Payer: BCBS Trust/PPO |
$104.41
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$143.28
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Healthscope Commercial |
$184.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: PHP Commercial |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: Priority Health SBD |
$128.95
|
|
|
HC RED CELL GENO MI BLD CMPT
|
Facility
|
IP
|
$204.69
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
31000136
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$128.95 |
| Max. Negotiated Rate |
$184.22 |
| Rate for Payer: Aetna Commercial |
$173.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.05
|
| Rate for Payer: Cash Price |
$163.75
|
| Rate for Payer: Cofinity Commercial |
$143.28
|
| Rate for Payer: Cofinity Commercial |
$176.03
|
| Rate for Payer: Healthscope Commercial |
$184.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.99
|
| Rate for Payer: PHP Commercial |
$173.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.28
|
| Rate for Payer: Priority Health SBD |
$128.95
|
|
|
HC RED CELLS, DIRECTED, LEUKO RED
|
Facility
|
OP
|
$1,084.60
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
39000061
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$976.14 |
| Rate for Payer: Aetna Commercial |
$921.91
|
| Rate for Payer: Aetna Medicare |
$175.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$704.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.08
|
| Rate for Payer: BCBS Complete |
$96.99
|
| Rate for Payer: BCBS MAPPO |
$168.86
|
| Rate for Payer: BCBS Trust/PPO |
$549.79
|
| Rate for Payer: BCN Medicare Advantage |
$168.86
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cash Price |
$867.68
|
| Rate for Payer: Cofinity Commercial |
$759.22
|
| Rate for Payer: Cofinity Commercial |
$932.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.86
|
| Rate for Payer: Healthscope Commercial |
$976.14
|
| Rate for Payer: Mclaren Medicaid |
$92.37
|
| Rate for Payer: Mclaren Medicare |
$168.86
|
| Rate for Payer: Meridian Medicaid |
$96.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$921.91
|
| Rate for Payer: PACE Medicare |
$160.42
|
| Rate for Payer: PACE SWMI |
$168.86
|
| Rate for Payer: PHP Commercial |
$921.91
|
| Rate for Payer: PHP Medicare Advantage |
$168.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$567.36
|
| Rate for Payer: Priority Health Medicare |
$168.86
|
| Rate for Payer: Priority Health Narrow Network |
$453.89
|
| Rate for Payer: Priority Health SBD |
$683.30
|
| Rate for Payer: Railroad Medicare Medicare |
$168.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.86
|
| Rate for Payer: UHC Medicare Advantage |
$173.93
|
| Rate for Payer: VA VA |
$168.86
|
|
