|
HC PLATELET CONCENTRATE
|
Facility
|
IP
|
$284.72
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$179.37 |
| Max. Negotiated Rate |
$256.25 |
| Rate for Payer: Aetna Commercial |
$242.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.07
|
| Rate for Payer: Cash Price |
$227.78
|
| Rate for Payer: Cofinity Advantage |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$244.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.78
|
| Rate for Payer: Healthscope Commercial |
$256.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.54
|
| Rate for Payer: PHP Commercial |
$242.01
|
| Rate for Payer: Priority Health SBD |
$179.37
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
OP
|
$284.72
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$455.00 |
| Rate for Payer: Aetna Commercial |
$242.01
|
| Rate for Payer: Aetna Medicare |
$146.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.86
|
| Rate for Payer: BCBS Complete |
$77.27
|
| Rate for Payer: BCBS MAPPO |
$140.69
|
| Rate for Payer: BCBS Trust/PPO |
$349.60
|
| Rate for Payer: BCN Commercial |
$349.60
|
| Rate for Payer: BCN Medicare Advantage |
$140.69
|
| Rate for Payer: Cash Price |
$227.78
|
| Rate for Payer: Cash Price |
$227.78
|
| Rate for Payer: Cofinity Advantage |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$244.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.69
|
| Rate for Payer: Healthscope Commercial |
$256.25
|
| Rate for Payer: Mclaren Medicaid |
$73.58
|
| Rate for Payer: Mclaren Medicare |
$140.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.72
|
| Rate for Payer: Meridian Medicaid |
$147.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.01
|
| Rate for Payer: Nomi Health Commercial |
$422.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.54
|
| Rate for Payer: PACE Medicare |
$133.66
|
| Rate for Payer: PACE SWMI |
$140.69
|
| Rate for Payer: PHP Commercial |
$242.01
|
| Rate for Payer: PHP Medicare Advantage |
$140.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$455.00
|
| Rate for Payer: Priority Health Medicare |
$140.69
|
| Rate for Payer: Priority Health SBD |
$179.37
|
| Rate for Payer: Priority Health Tiered Network |
$364.00
|
| Rate for Payer: Railroad Medicare Medicare |
$140.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.07
|
| Rate for Payer: UHC Core |
$148.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$140.69
|
| Rate for Payer: UHC Exchange |
$111.89
|
| Rate for Payer: UHC Medicaid |
$73.58
|
| Rate for Payer: UHCCP Medicaid |
$73.58
|
| Rate for Payer: VA VA |
$140.69
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$39.43
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| 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 |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.48
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Mclaren Medicare |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.70
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Nomi Health Commercial |
$6.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PACE Medicare |
$4.26
|
| Rate for Payer: PACE SWMI |
$4.48
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$4.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.48
|
| Rate for Payer: Priority Health Medicare |
$4.48
|
| Rate for Payer: Priority Health SBD |
$24.84
|
| Rate for Payer: Priority Health Tiered Network |
$3.58
|
| Rate for Payer: Railroad Medicare Medicare |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.72
|
| Rate for Payer: UHC Core |
$6.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.48
|
| Rate for Payer: UHC Exchange |
$6.72
|
| Rate for Payer: UHC Medicaid |
$2.34
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
| Rate for Payer: VA VA |
$4.48
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$39.43
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.84 |
| Max. Negotiated Rate |
$35.49 |
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.63
|
| Rate for Payer: Cash Price |
$31.54
|
| Rate for Payer: Cofinity Advantage |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$33.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.54
|
| Rate for Payer: Healthscope Commercial |
$35.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.57
|
| Rate for Payer: PHP Commercial |
$33.52
|
| Rate for Payer: Priority Health SBD |
$24.84
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
OP
|
$126.49
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$113.84 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| 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 |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Advantage |
$88.54
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Mclaren Medicaid |
$13.03
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.52
|
| Rate for Payer: Nomi Health Commercial |
$37.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.87
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$79.69
|
| Rate for Payer: Priority Health Tiered Network |
$19.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.37
|
| Rate for Payer: UHC Core |
$37.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.91
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$13.03
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
IP
|
$126.49
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$79.69 |
| Max. Negotiated Rate |
$113.84 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Cash Price |
$101.19
|
| Rate for Payer: Cofinity Advantage |
$88.54
|
| Rate for Payer: Cofinity Commercial |
$108.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.19
|
| Rate for Payer: Healthscope Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.87
|
| Rate for Payer: PHP Commercial |
$107.52
|
| Rate for Payer: Priority Health SBD |
$79.69
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$410.58
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$258.67 |
| Max. Negotiated Rate |
$369.52 |
| Rate for Payer: Aetna Commercial |
$348.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.88
|
| Rate for Payer: Cash Price |
$328.46
|
| Rate for Payer: Cofinity Advantage |
$287.41
|
| Rate for Payer: Cofinity Commercial |
$353.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.46
|
| Rate for Payer: Healthscope Commercial |
$369.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.94
|
| Rate for Payer: PHP Commercial |
$348.99
|
| Rate for Payer: Priority Health SBD |
$258.67
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$410.58
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$597.98 |
| Rate for Payer: Aetna Commercial |
$348.99
|
| Rate for Payer: Aetna Medicare |
$192.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.12
|
| Rate for Payer: BCBS Complete |
$101.55
|
| Rate for Payer: BCBS MAPPO |
$184.90
|
| Rate for Payer: BCBS Trust/PPO |
$570.92
|
| Rate for Payer: BCN Commercial |
$570.92
|
| Rate for Payer: BCN Medicare Advantage |
$184.90
|
| Rate for Payer: Cash Price |
$328.46
|
| Rate for Payer: Cash Price |
$328.46
|
| Rate for Payer: Cofinity Advantage |
$287.41
|
| Rate for Payer: Cofinity Commercial |
$353.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.90
|
| Rate for Payer: Healthscope Commercial |
$369.52
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Mclaren Medicare |
$184.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.15
|
| Rate for Payer: Meridian Medicaid |
$194.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.99
|
| Rate for Payer: Nomi Health Commercial |
$554.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.94
|
| Rate for Payer: PACE Medicare |
$175.66
|
| Rate for Payer: PACE SWMI |
$184.90
|
| Rate for Payer: PHP Commercial |
$348.99
|
| Rate for Payer: PHP Medicare Advantage |
$184.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$597.98
|
| Rate for Payer: Priority Health Medicare |
$184.90
|
| Rate for Payer: Priority Health SBD |
$258.67
|
| Rate for Payer: Priority Health Tiered Network |
$478.38
|
| Rate for Payer: Railroad Medicare Medicare |
$184.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.88
|
| Rate for Payer: UHC Core |
$213.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$184.90
|
| Rate for Payer: UHC Exchange |
$161.36
|
| Rate for Payer: UHC Medicaid |
$96.70
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
| Rate for Payer: VA VA |
$184.90
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$99.23
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: Aetna Commercial |
$84.35
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.50
|
| 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 |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$79.38
|
| Rate for Payer: Cash Price |
$79.38
|
| Rate for Payer: Cofinity Advantage |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$85.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$89.31
|
| Rate for Payer: Mclaren Medicaid |
$13.03
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.35
|
| Rate for Payer: Nomi Health Commercial |
$37.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.42
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$84.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$62.51
|
| Rate for Payer: Priority Health Tiered Network |
$19.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.37
|
| Rate for Payer: UHC Core |
$37.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.91
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$13.03
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$99.23
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$62.51 |
| Max. Negotiated Rate |
$89.31 |
| Rate for Payer: Aetna Commercial |
$84.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.50
|
| Rate for Payer: Cash Price |
$79.38
|
| Rate for Payer: Cofinity Advantage |
$69.46
|
| Rate for Payer: Cofinity Commercial |
$85.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.38
|
| Rate for Payer: Healthscope Commercial |
$89.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.42
|
| Rate for Payer: PHP Commercial |
$84.35
|
| Rate for Payer: Priority Health SBD |
$62.51
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$94.45
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.39
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Advantage |
$66.11
|
| Rate for Payer: Cofinity Commercial |
$81.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: PHP Commercial |
$80.28
|
| Rate for Payer: Priority Health SBD |
$59.50
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$94.45
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$25.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.39
|
| 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 |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$19.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cash Price |
$75.56
|
| Rate for Payer: Cofinity Advantage |
$66.11
|
| Rate for Payer: Cofinity Commercial |
$81.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$85.00
|
| Rate for Payer: Mclaren Medicaid |
$13.03
|
| Rate for Payer: Mclaren Medicare |
$24.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.16
|
| Rate for Payer: Meridian Medicaid |
$26.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.28
|
| Rate for Payer: Nomi Health Commercial |
$37.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.84
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$80.28
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.91
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health SBD |
$59.50
|
| Rate for Payer: Priority Health Tiered Network |
$19.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.37
|
| Rate for Payer: UHC Core |
$37.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.91
|
| Rate for Payer: UHC Exchange |
$37.37
|
| Rate for Payer: UHC Medicaid |
$13.03
|
| Rate for Payer: UHCCP Medicaid |
$13.03
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,981.28
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,248.21 |
| Max. Negotiated Rate |
$1,783.15 |
| Rate for Payer: Aetna Commercial |
$1,684.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,287.83
|
| Rate for Payer: Cash Price |
$1,585.02
|
| Rate for Payer: Cofinity Advantage |
$1,386.90
|
| Rate for Payer: Cofinity Commercial |
$1,703.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,585.02
|
| Rate for Payer: Healthscope Commercial |
$1,783.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,485.96
|
| Rate for Payer: PHP Commercial |
$1,684.09
|
| Rate for Payer: Priority Health SBD |
$1,248.21
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,981.28
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$721.30 |
| Max. Negotiated Rate |
$4,460.05 |
| Rate for Payer: Aetna Commercial |
$1,684.09
|
| Rate for Payer: Aetna Medicare |
$1,434.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,287.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,723.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,723.94
|
| Rate for Payer: BCBS Complete |
$757.43
|
| Rate for Payer: BCBS MAPPO |
$1,379.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.38
|
| Rate for Payer: BCN Commercial |
$1,105.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.15
|
| Rate for Payer: Cash Price |
$1,585.02
|
| Rate for Payer: Cash Price |
$1,585.02
|
| Rate for Payer: Cash Price |
$1,585.02
|
| Rate for Payer: Cofinity Advantage |
$1,386.90
|
| Rate for Payer: Cofinity Commercial |
$1,703.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,585.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.15
|
| Rate for Payer: Healthscope Commercial |
$1,783.15
|
| Rate for Payer: Mclaren Medicaid |
$721.30
|
| Rate for Payer: Mclaren Medicare |
$1,379.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.11
|
| Rate for Payer: Meridian Medicaid |
$1,448.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,586.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,517.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,684.09
|
| Rate for Payer: Nomi Health Commercial |
$4,137.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,485.96
|
| Rate for Payer: PACE Medicare |
$1,310.19
|
| Rate for Payer: PACE SWMI |
$1,379.15
|
| Rate for Payer: PHP Commercial |
$1,684.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,460.05
|
| Rate for Payer: Priority Health Medicare |
$1,379.15
|
| Rate for Payer: Priority Health SBD |
$1,248.21
|
| Rate for Payer: Priority Health Tiered Network |
$3,568.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,379.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,287.83
|
| Rate for Payer: UHC Core |
$1,032.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,379.15
|
| Rate for Payer: UHC Exchange |
$778.64
|
| Rate for Payer: UHC Medicaid |
$721.30
|
| Rate for Payer: UHCCP Medicaid |
$721.30
|
| Rate for Payer: VA VA |
$1,379.15
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,248.39
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$260.95 |
| Max. Negotiated Rate |
$2,023.55 |
| Rate for Payer: Aetna Commercial |
$1,911.13
|
| Rate for Payer: Aetna Medicare |
$518.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.67
|
| Rate for Payer: BCBS Complete |
$274.02
|
| Rate for Payer: BCBS MAPPO |
$498.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.99
|
| Rate for Payer: BCN Commercial |
$1,353.99
|
| Rate for Payer: BCN Medicare Advantage |
$498.94
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cofinity Advantage |
$1,573.87
|
| Rate for Payer: Cofinity Commercial |
$1,933.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.94
|
| Rate for Payer: Healthscope Commercial |
$2,023.55
|
| Rate for Payer: Mclaren Medicaid |
$260.95
|
| Rate for Payer: Mclaren Medicare |
$498.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.89
|
| Rate for Payer: Meridian Medicaid |
$523.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.13
|
| Rate for Payer: Nomi Health Commercial |
$1,496.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.29
|
| Rate for Payer: PACE Medicare |
$473.99
|
| Rate for Payer: PACE SWMI |
$498.94
|
| Rate for Payer: PHP Commercial |
$1,911.13
|
| Rate for Payer: PHP Medicare Advantage |
$498.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,613.55
|
| Rate for Payer: Priority Health Medicare |
$498.94
|
| Rate for Payer: Priority Health SBD |
$1,416.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,290.84
|
| Rate for Payer: Railroad Medicare Medicare |
$498.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,461.45
|
| Rate for Payer: UHC Core |
$1,171.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.94
|
| Rate for Payer: UHC Exchange |
$883.62
|
| Rate for Payer: UHC Medicaid |
$260.95
|
| Rate for Payer: UHCCP Medicaid |
$260.95
|
| Rate for Payer: VA VA |
$498.94
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,248.39
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,416.49 |
| Max. Negotiated Rate |
$2,023.55 |
| Rate for Payer: Aetna Commercial |
$1,911.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.45
|
| Rate for Payer: Cash Price |
$1,798.71
|
| Rate for Payer: Cofinity Advantage |
$1,573.87
|
| Rate for Payer: Cofinity Commercial |
$1,933.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,798.71
|
| Rate for Payer: Healthscope Commercial |
$2,023.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,911.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,686.29
|
| Rate for Payer: PHP Commercial |
$1,911.13
|
| Rate for Payer: Priority Health SBD |
$1,416.49
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,944.40
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,854.97 |
| Max. Negotiated Rate |
$2,649.96 |
| Rate for Payer: Aetna Commercial |
$2,502.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,913.86
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cofinity Advantage |
$2,061.08
|
| Rate for Payer: Cofinity Commercial |
$2,532.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,355.52
|
| Rate for Payer: Healthscope Commercial |
$2,649.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,502.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,208.30
|
| Rate for Payer: PHP Commercial |
$2,502.74
|
| Rate for Payer: Priority Health SBD |
$1,854.97
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,944.40
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$2,649.96 |
| Rate for Payer: Aetna Commercial |
$2,502.74
|
| Rate for Payer: Aetna Medicare |
$690.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,913.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$829.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$829.74
|
| Rate for Payer: BCBS Complete |
$364.55
|
| Rate for Payer: BCBS MAPPO |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.13
|
| Rate for Payer: BCN Commercial |
$1,878.13
|
| Rate for Payer: BCN Medicare Advantage |
$663.79
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cash Price |
$2,355.52
|
| Rate for Payer: Cofinity Advantage |
$2,061.08
|
| Rate for Payer: Cofinity Commercial |
$2,532.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,355.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.79
|
| Rate for Payer: Healthscope Commercial |
$2,649.96
|
| Rate for Payer: Mclaren Medicaid |
$347.16
|
| Rate for Payer: Mclaren Medicare |
$663.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.98
|
| Rate for Payer: Meridian Medicaid |
$696.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,502.74
|
| Rate for Payer: Nomi Health Commercial |
$1,991.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,208.30
|
| Rate for Payer: PACE Medicare |
$630.60
|
| Rate for Payer: PACE SWMI |
$663.79
|
| Rate for Payer: PHP Commercial |
$2,502.74
|
| Rate for Payer: PHP Medicare Advantage |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,146.63
|
| Rate for Payer: Priority Health Medicare |
$663.79
|
| Rate for Payer: Priority Health SBD |
$1,854.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,717.30
|
| Rate for Payer: Railroad Medicare Medicare |
$663.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,913.86
|
| Rate for Payer: UHC Core |
$1,534.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.79
|
| Rate for Payer: UHC Exchange |
$1,157.15
|
| Rate for Payer: UHC Medicaid |
$347.16
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: VA VA |
$663.79
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,372.14
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$347.16 |
| Max. Negotiated Rate |
$2,146.63 |
| Rate for Payer: Aetna Commercial |
$1,166.32
|
| Rate for Payer: Aetna Medicare |
$690.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$829.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$829.74
|
| Rate for Payer: BCBS Complete |
$364.55
|
| Rate for Payer: BCBS MAPPO |
$663.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.13
|
| Rate for Payer: BCN Commercial |
$1,878.13
|
| Rate for Payer: BCN Medicare Advantage |
$663.79
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cofinity Advantage |
$960.50
|
| Rate for Payer: Cofinity Commercial |
$1,180.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.79
|
| Rate for Payer: Healthscope Commercial |
$1,234.93
|
| Rate for Payer: Mclaren Medicaid |
$347.16
|
| Rate for Payer: Mclaren Medicare |
$663.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.98
|
| Rate for Payer: Meridian Medicaid |
$696.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.32
|
| Rate for Payer: Nomi Health Commercial |
$1,991.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.11
|
| Rate for Payer: PACE Medicare |
$630.60
|
| Rate for Payer: PACE SWMI |
$663.79
|
| Rate for Payer: PHP Commercial |
$1,166.32
|
| Rate for Payer: PHP Medicare Advantage |
$663.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,146.63
|
| Rate for Payer: Priority Health Medicare |
$663.79
|
| Rate for Payer: Priority Health SBD |
$864.45
|
| Rate for Payer: Priority Health Tiered Network |
$1,717.30
|
| Rate for Payer: Railroad Medicare Medicare |
$663.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.89
|
| Rate for Payer: UHC Core |
$714.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$663.79
|
| Rate for Payer: UHC Exchange |
$539.25
|
| Rate for Payer: UHC Medicaid |
$347.16
|
| Rate for Payer: UHCCP Medicaid |
$347.16
|
| Rate for Payer: VA VA |
$663.79
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,372.14
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$864.45 |
| Max. Negotiated Rate |
$1,234.93 |
| Rate for Payer: Aetna Commercial |
$1,166.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.89
|
| Rate for Payer: Cash Price |
$1,097.71
|
| Rate for Payer: Cofinity Advantage |
$960.50
|
| Rate for Payer: Cofinity Commercial |
$1,180.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.71
|
| Rate for Payer: Healthscope Commercial |
$1,234.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.11
|
| Rate for Payer: PHP Commercial |
$1,166.32
|
| Rate for Payer: Priority Health SBD |
$864.45
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$301.38
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$557.56 |
| Rate for Payer: Aetna Commercial |
$256.17
|
| Rate for Payer: Aetna Medicare |
$150.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.90
|
| Rate for Payer: BCBS Complete |
$120.55
|
| Rate for Payer: BCBS Trust/PPO |
$557.56
|
| Rate for Payer: BCN Commercial |
$557.56
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cofinity Advantage |
$210.97
|
| Rate for Payer: Cofinity Commercial |
$259.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$271.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.03
|
| Rate for Payer: PHP Commercial |
$256.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.99
|
| Rate for Payer: Priority Health SBD |
$189.87
|
| Rate for Payer: Priority Health Tiered Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.45
|
| Rate for Payer: UHC Core |
$425.45
|
| Rate for Payer: UHC Exchange |
$425.45
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$301.38
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$189.87 |
| Max. Negotiated Rate |
$271.24 |
| Rate for Payer: Aetna Commercial |
$256.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.90
|
| Rate for Payer: Cash Price |
$241.10
|
| Rate for Payer: Cofinity Advantage |
$210.97
|
| Rate for Payer: Cofinity Commercial |
$259.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.10
|
| Rate for Payer: Healthscope Commercial |
$271.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.03
|
| Rate for Payer: PHP Commercial |
$256.17
|
| Rate for Payer: Priority Health SBD |
$189.87
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health SBD |
$16.90
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Mclaren Medicaid |
$7.84
|
| Rate for Payer: Mclaren Medicare |
$14.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: Meridian Medicaid |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PACE Medicare |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.99
|
| Rate for Payer: Priority Health Medicare |
$14.99
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: Priority Health Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.49
|
| Rate for Payer: UHC Core |
$22.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.99
|
| Rate for Payer: UHC Exchange |
$22.49
|
| Rate for Payer: UHC Medicaid |
$7.84
|
| Rate for Payer: UHCCP Medicaid |
$7.84
|
| Rate for Payer: VA VA |
$14.99
|
|
|
HC PNEUMOCOCCAL IGG ABS 23 SEROTYPE
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200189
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health SBD |
$16.90
|
|
