|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.56
|
| Rate for Payer: ASR ASR |
$30.35
|
| Rate for Payer: ASR Commercial |
$30.35
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$25.62
|
| Rate for Payer: BCN Commercial |
$24.26
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$31.29
|
| Rate for Payer: Healthscope Whirlpool |
$30.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.05
|
| Rate for Payer: Mclaren Commercial |
$28.16
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Mclaren Medicare |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Meridian Medicaid |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: PACE Medicare |
$17.15
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: PHP Medicaid |
$9.67
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.42
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: Priority Health Narrow Network |
$21.93
|
| Rate for Payer: Railroad Medicare Medicare |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Exchange |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
| Rate for Payer: UHCCP DNSP |
$18.05
|
| Rate for Payer: UHCCP Medicaid |
$9.67
|
| Rate for Payer: VA VA |
$18.05
|
|
|
HC BLOOD,OCLT,FECES IMMUNO SCREEN
|
Facility
|
IP
|
$31.29
|
|
|
Service Code
|
HCPCS G0328
|
| Hospital Charge Code |
30100000
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: ASR ASR |
$30.35
|
| Rate for Payer: ASR Commercial |
$30.35
|
| Rate for Payer: BCBS Trust/PPO |
$25.50
|
| Rate for Payer: BCN Commercial |
$24.26
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$31.29
|
| Rate for Payer: Healthscope Whirlpool |
$30.35
|
| Rate for Payer: Mclaren Commercial |
$28.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.54
|
|
|
HC BLOOD PATCH
|
Facility
|
IP
|
$1,212.51
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.13 |
| Max. Negotiated Rate |
$1,212.51 |
| Rate for Payer: Aetna Commercial |
$1,091.26
|
| Rate for Payer: ASR ASR |
$1,176.13
|
| Rate for Payer: ASR Commercial |
$1,176.13
|
| Rate for Payer: BCBS Trust/PPO |
$988.07
|
| Rate for Payer: BCN Commercial |
$940.06
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cofinity Commercial |
$1,139.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.01
|
| Rate for Payer: Healthscope Commercial |
$1,212.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.13
|
| Rate for Payer: Mclaren Commercial |
$1,091.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.63
|
| Rate for Payer: Nomi Health Commercial |
$994.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.01
|
|
|
HC BLOOD PATCH
|
Facility
|
OP
|
$1,212.51
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,319.80 |
| Rate for Payer: Aetna Commercial |
$1,091.26
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$1,176.13
|
| Rate for Payer: ASR Commercial |
$1,176.13
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$992.92
|
| Rate for Payer: BCN Commercial |
$940.06
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cofinity Commercial |
$1,139.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,212.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$1,091.26
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.63
|
| Rate for Payer: Nomi Health Commercial |
$994.26
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.80
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,055.84
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
IP
|
$1,212.51
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$788.13 |
| Max. Negotiated Rate |
$1,212.51 |
| Rate for Payer: Aetna Commercial |
$1,091.26
|
| Rate for Payer: ASR ASR |
$1,176.13
|
| Rate for Payer: ASR Commercial |
$1,176.13
|
| Rate for Payer: BCBS Trust/PPO |
$988.07
|
| Rate for Payer: BCN Commercial |
$940.06
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cofinity Commercial |
$1,139.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.01
|
| Rate for Payer: Healthscope Commercial |
$1,212.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.13
|
| Rate for Payer: Mclaren Commercial |
$1,091.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.63
|
| Rate for Payer: Nomi Health Commercial |
$994.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.01
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
OP
|
$1,212.51
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,319.80 |
| Rate for Payer: Aetna Commercial |
$1,091.26
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$1,176.13
|
| Rate for Payer: ASR Commercial |
$1,176.13
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$992.92
|
| Rate for Payer: BCN Commercial |
$940.06
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cash Price |
$970.01
|
| Rate for Payer: Cofinity Commercial |
$1,139.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$1,212.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$1,091.26
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.63
|
| Rate for Payer: Nomi Health Commercial |
$994.26
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,319.80
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,055.84
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
OP
|
$23.05
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna Commercial |
$20.74
|
| Rate for Payer: Aetna Medicare |
$3.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.29
|
| Rate for Payer: ASR ASR |
$22.36
|
| Rate for Payer: ASR Commercial |
$22.36
|
| Rate for Payer: BCBS Complete |
$1.93
|
| Rate for Payer: BCBS MAPPO |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$18.88
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: BCN Medicare Advantage |
$3.43
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.43
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Whirlpool |
$22.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.43
|
| Rate for Payer: Mclaren Commercial |
$20.74
|
| Rate for Payer: Mclaren Medicaid |
$1.84
|
| Rate for Payer: Mclaren Medicare |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.60
|
| Rate for Payer: Meridian Medicaid |
$1.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.59
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: PACE Medicare |
$3.26
|
| Rate for Payer: PACE SWMI |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: PHP Medicaid |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.20
|
| Rate for Payer: Priority Health Medicare |
$3.43
|
| Rate for Payer: Priority Health Narrow Network |
$16.16
|
| Rate for Payer: Railroad Medicare Medicare |
$3.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.43
|
| Rate for Payer: UHC Exchange |
$5.32
|
| Rate for Payer: UHC Medicare Advantage |
$3.43
|
| Rate for Payer: UHCCP DNSP |
$3.43
|
| Rate for Payer: UHCCP Medicaid |
$1.84
|
| Rate for Payer: VA VA |
$3.43
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
IP
|
$23.05
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna Commercial |
$20.74
|
| Rate for Payer: ASR ASR |
$22.36
|
| Rate for Payer: ASR Commercial |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.78
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: Cash Price |
$18.44
|
| Rate for Payer: Cofinity Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.44
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Whirlpool |
$22.36
|
| Rate for Payer: Mclaren Commercial |
$20.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.59
|
| Rate for Payer: Nomi Health Commercial |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.28
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.47 |
| Max. Negotiated Rate |
$248.80 |
| Rate for Payer: Aetna Commercial |
$223.92
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$241.34
|
| Rate for Payer: ASR Commercial |
$241.34
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$203.74
|
| Rate for Payer: BCN Commercial |
$192.89
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$233.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$248.80
|
| Rate for Payer: Healthscope Whirlpool |
$241.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.00
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$174.41
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$248.80 |
| Rate for Payer: Aetna Commercial |
$223.92
|
| Rate for Payer: ASR ASR |
$241.34
|
| Rate for Payer: ASR Commercial |
$241.34
|
| Rate for Payer: BCBS Trust/PPO |
$202.75
|
| Rate for Payer: BCN Commercial |
$192.89
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$233.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$248.80
|
| Rate for Payer: Healthscope Whirlpool |
$241.34
|
| Rate for Payer: Mclaren Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$218.94
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
OP
|
$46.43
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: Aetna Commercial |
$41.79
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$45.04
|
| Rate for Payer: ASR Commercial |
$45.04
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$38.02
|
| Rate for Payer: BCN Commercial |
$36.00
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$46.43
|
| Rate for Payer: Healthscope Whirlpool |
$45.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$41.79
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.47
|
| Rate for Payer: Nomi Health Commercial |
$38.07
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.68
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$32.55
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
IP
|
$46.43
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$46.43 |
| Rate for Payer: Aetna Commercial |
$41.79
|
| Rate for Payer: ASR ASR |
$45.04
|
| Rate for Payer: ASR Commercial |
$45.04
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$36.00
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$43.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.14
|
| Rate for Payer: Healthscope Commercial |
$46.43
|
| Rate for Payer: Healthscope Whirlpool |
$45.04
|
| Rate for Payer: Mclaren Commercial |
$41.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.47
|
| Rate for Payer: Nomi Health Commercial |
$38.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.86
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
OP
|
$358.58
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.47 |
| Max. Negotiated Rate |
$358.58 |
| Rate for Payer: Aetna Commercial |
$322.72
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$347.82
|
| Rate for Payer: ASR Commercial |
$347.82
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$293.64
|
| Rate for Payer: BCN Commercial |
$278.01
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$286.86
|
| Rate for Payer: Cash Price |
$286.86
|
| Rate for Payer: Cofinity Commercial |
$337.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$358.58
|
| Rate for Payer: Healthscope Whirlpool |
$347.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$322.72
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.79
|
| Rate for Payer: Nomi Health Commercial |
$294.04
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.19
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$251.36
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
IP
|
$358.58
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$233.08 |
| Max. Negotiated Rate |
$358.58 |
| Rate for Payer: Aetna Commercial |
$322.72
|
| Rate for Payer: ASR ASR |
$347.82
|
| Rate for Payer: ASR Commercial |
$347.82
|
| Rate for Payer: BCBS Trust/PPO |
$292.21
|
| Rate for Payer: BCN Commercial |
$278.01
|
| Rate for Payer: Cash Price |
$286.86
|
| Rate for Payer: Cofinity Commercial |
$337.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.86
|
| Rate for Payer: Healthscope Commercial |
$358.58
|
| Rate for Payer: Healthscope Whirlpool |
$347.82
|
| Rate for Payer: Mclaren Commercial |
$322.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.79
|
| Rate for Payer: Nomi Health Commercial |
$294.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.55
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
IP
|
$300.68
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$195.44 |
| Max. Negotiated Rate |
$300.68 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: ASR ASR |
$291.66
|
| Rate for Payer: ASR Commercial |
$291.66
|
| Rate for Payer: BCBS Trust/PPO |
$245.02
|
| Rate for Payer: BCN Commercial |
$233.12
|
| Rate for Payer: Cash Price |
$240.54
|
| Rate for Payer: Cofinity Commercial |
$282.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.54
|
| Rate for Payer: Healthscope Commercial |
$300.68
|
| Rate for Payer: Healthscope Whirlpool |
$291.66
|
| Rate for Payer: Mclaren Commercial |
$270.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.58
|
| Rate for Payer: Nomi Health Commercial |
$246.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.60
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
OP
|
$300.68
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.47 |
| Max. Negotiated Rate |
$300.68 |
| Rate for Payer: Aetna Commercial |
$270.61
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$291.66
|
| Rate for Payer: ASR Commercial |
$291.66
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$246.23
|
| Rate for Payer: BCN Commercial |
$233.12
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$240.54
|
| Rate for Payer: Cash Price |
$240.54
|
| Rate for Payer: Cofinity Commercial |
$282.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$300.68
|
| Rate for Payer: Healthscope Whirlpool |
$291.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$270.61
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.58
|
| Rate for Payer: Nomi Health Commercial |
$246.56
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.46
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$210.78
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
OP
|
$81.68
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: Aetna Commercial |
$73.51
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$79.23
|
| Rate for Payer: ASR Commercial |
$79.23
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$66.89
|
| Rate for Payer: BCN Commercial |
$63.33
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$81.68
|
| Rate for Payer: Healthscope Whirlpool |
$79.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$73.51
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.43
|
| Rate for Payer: Nomi Health Commercial |
$66.98
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.57
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$57.26
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
IP
|
$81.68
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$53.09 |
| Max. Negotiated Rate |
$81.68 |
| Rate for Payer: Aetna Commercial |
$73.51
|
| Rate for Payer: ASR ASR |
$79.23
|
| Rate for Payer: ASR Commercial |
$79.23
|
| Rate for Payer: BCBS Trust/PPO |
$66.56
|
| Rate for Payer: BCN Commercial |
$63.33
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.34
|
| Rate for Payer: Healthscope Commercial |
$81.68
|
| Rate for Payer: Healthscope Whirlpool |
$79.23
|
| Rate for Payer: Mclaren Commercial |
$73.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.43
|
| Rate for Payer: Nomi Health Commercial |
$66.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.88
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
IP
|
$103.65
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$103.65 |
| Rate for Payer: Aetna Commercial |
$93.28
|
| Rate for Payer: ASR ASR |
$100.54
|
| Rate for Payer: ASR Commercial |
$100.54
|
| Rate for Payer: BCBS Trust/PPO |
$84.46
|
| Rate for Payer: BCN Commercial |
$80.36
|
| Rate for Payer: Cash Price |
$82.92
|
| Rate for Payer: Cofinity Commercial |
$97.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.92
|
| Rate for Payer: Healthscope Commercial |
$103.65
|
| Rate for Payer: Healthscope Whirlpool |
$100.54
|
| Rate for Payer: Mclaren Commercial |
$93.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.10
|
| Rate for Payer: Nomi Health Commercial |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.21
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
OP
|
$103.65
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$67.37 |
| Max. Negotiated Rate |
$215.34 |
| Rate for Payer: Aetna Commercial |
$93.28
|
| Rate for Payer: Aetna Medicare |
$138.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$173.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$173.66
|
| Rate for Payer: ASR ASR |
$100.54
|
| Rate for Payer: ASR Commercial |
$100.54
|
| Rate for Payer: BCBS Complete |
$78.19
|
| Rate for Payer: BCBS MAPPO |
$138.93
|
| Rate for Payer: BCBS Trust/PPO |
$84.88
|
| Rate for Payer: BCN Commercial |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$138.93
|
| Rate for Payer: Cash Price |
$82.92
|
| Rate for Payer: Cash Price |
$82.92
|
| Rate for Payer: Cofinity Commercial |
$97.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.93
|
| Rate for Payer: Healthscope Commercial |
$103.65
|
| Rate for Payer: Healthscope Whirlpool |
$100.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$138.93
|
| Rate for Payer: Mclaren Commercial |
$93.28
|
| Rate for Payer: Mclaren Medicaid |
$74.47
|
| Rate for Payer: Mclaren Medicare |
$138.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.88
|
| Rate for Payer: Meridian Medicaid |
$78.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.10
|
| Rate for Payer: Nomi Health Commercial |
$84.99
|
| Rate for Payer: PACE Medicare |
$131.98
|
| Rate for Payer: PACE SWMI |
$138.93
|
| Rate for Payer: PHP Commercial |
$152.82
|
| Rate for Payer: PHP Medicaid |
$74.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.82
|
| Rate for Payer: Priority Health Medicare |
$138.93
|
| Rate for Payer: Priority Health Narrow Network |
$72.66
|
| Rate for Payer: Railroad Medicare Medicare |
$138.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.93
|
| Rate for Payer: UHC Exchange |
$215.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.93
|
| Rate for Payer: UHCCP DNSP |
$138.93
|
| Rate for Payer: UHCCP Medicaid |
$74.47
|
| Rate for Payer: VA VA |
$138.93
|
|
|
HC BLOOD TYPING RH
|
Facility
|
IP
|
$22.27
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$22.27 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
|
|
HC BLOOD TYPING RH
|
Facility
|
OP
|
$22.27
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$59.61 |
| Rate for Payer: Aetna Commercial |
$20.04
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.08
|
| Rate for Payer: ASR ASR |
$21.60
|
| Rate for Payer: ASR Commercial |
$21.60
|
| Rate for Payer: BCBS Complete |
$21.65
|
| Rate for Payer: BCBS MAPPO |
$38.46
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: BCN Medicare Advantage |
$38.46
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$22.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$20.04
|
| Rate for Payer: Mclaren Medicaid |
$20.61
|
| Rate for Payer: Mclaren Medicare |
$38.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.38
|
| Rate for Payer: Meridian Medicaid |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Nomi Health Commercial |
$18.26
|
| Rate for Payer: PACE Medicare |
$36.54
|
| Rate for Payer: PACE SWMI |
$38.46
|
| Rate for Payer: PHP Commercial |
$42.31
|
| Rate for Payer: PHP Medicaid |
$20.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$38.46
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$38.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.46
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicare Advantage |
$38.46
|
| Rate for Payer: UHCCP DNSP |
$38.46
|
| Rate for Payer: UHCCP Medicaid |
$20.61
|
| Rate for Payer: VA VA |
$38.46
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$994.50 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,377.00
|
| Rate for Payer: ASR ASR |
$1,484.10
|
| Rate for Payer: ASR Commercial |
$1,484.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.80
|
| Rate for Payer: BCN Commercial |
$1,186.21
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.10
|
| Rate for Payer: Mclaren Commercial |
$1,377.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$1,254.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.40
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna Commercial |
$1,377.00
|
| Rate for Payer: Aetna Medicare |
$220.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.71
|
| Rate for Payer: ASR ASR |
$1,484.10
|
| Rate for Payer: ASR Commercial |
$1,484.10
|
| Rate for Payer: BCBS Complete |
$124.14
|
| Rate for Payer: BCBS MAPPO |
$220.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,252.92
|
| Rate for Payer: BCN Commercial |
$1,186.21
|
| Rate for Payer: BCN Medicare Advantage |
$220.57
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$1,530.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$220.57
|
| Rate for Payer: Mclaren Commercial |
$1,377.00
|
| Rate for Payer: Mclaren Medicaid |
$118.23
|
| Rate for Payer: Mclaren Medicare |
$220.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.60
|
| Rate for Payer: Meridian Medicaid |
$124.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$1,254.60
|
| Rate for Payer: PACE Medicare |
$209.54
|
| Rate for Payer: PACE SWMI |
$220.57
|
| Rate for Payer: PHP Commercial |
$242.63
|
| Rate for Payer: PHP Medicaid |
$118.23
|
| Rate for Payer: PHP Medicare Advantage |
$220.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.79
|
| Rate for Payer: Priority Health Medicare |
$220.57
|
| Rate for Payer: Priority Health Narrow Network |
$356.63
|
| Rate for Payer: Railroad Medicare Medicare |
$220.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.57
|
| Rate for Payer: UHC Exchange |
$341.88
|
| Rate for Payer: UHC Medicare Advantage |
$220.57
|
| Rate for Payer: UHCCP DNSP |
$220.57
|
| Rate for Payer: UHCCP Medicaid |
$118.23
|
| Rate for Payer: VA VA |
$220.57
|
|
|
HC B.NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$154.22
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30100562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Commercial |
$138.80
|
| Rate for Payer: ASR ASR |
$149.59
|
| Rate for Payer: ASR Commercial |
$149.59
|
| Rate for Payer: BCBS Trust/PPO |
$125.67
|
| Rate for Payer: BCN Commercial |
$119.57
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.38
|
| Rate for Payer: Healthscope Commercial |
$154.22
|
| Rate for Payer: Healthscope Whirlpool |
$149.59
|
| Rate for Payer: Mclaren Commercial |
$138.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.09
|
| Rate for Payer: Nomi Health Commercial |
$126.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.71
|
|
