|
HC PLACE URETERAL STENT PRE EXISTING NEPHROSTOMY TRACT
|
Facility
|
OP
|
$3,643.30
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
36100508
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,811.27 |
| Max. Negotiated Rate |
$5,237.81 |
| Rate for Payer: Aetna Commercial |
$3,278.97
|
| Rate for Payer: Aetna Medicare |
$3,379.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: ASR ASR |
$3,534.00
|
| Rate for Payer: ASR Commercial |
$3,534.00
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,983.50
|
| Rate for Payer: BCN Commercial |
$2,824.65
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$2,914.64
|
| Rate for Payer: Cash Price |
$2,914.64
|
| Rate for Payer: Cofinity Commercial |
$3,424.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,914.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$3,643.30
|
| Rate for Payer: Healthscope Whirlpool |
$3,534.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,379.23
|
| Rate for Payer: Mclaren Commercial |
$3,278.97
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,096.80
|
| Rate for Payer: Nomi Health Commercial |
$2,987.51
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$3,717.15
|
| Rate for Payer: PHP Medicaid |
$1,811.27
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,368.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,192.26
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$2,553.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,206.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,237.81
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP DNSP |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
HC PLASMA CELL PCPD FISH.
|
Facility
|
IP
|
$268.26
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31100044
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$174.37 |
| Max. Negotiated Rate |
$268.26 |
| Rate for Payer: Aetna Commercial |
$241.43
|
| Rate for Payer: ASR ASR |
$260.21
|
| Rate for Payer: ASR Commercial |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$218.61
|
| Rate for Payer: BCN Commercial |
$207.98
|
| Rate for Payer: Cash Price |
$214.61
|
| Rate for Payer: Cofinity Commercial |
$252.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.61
|
| Rate for Payer: Healthscope Commercial |
$268.26
|
| Rate for Payer: Healthscope Whirlpool |
$260.21
|
| Rate for Payer: Mclaren Commercial |
$241.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.02
|
| Rate for Payer: Nomi Health Commercial |
$219.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.07
|
|
|
HC PLASMA CELL PCPD FISH.
|
Facility
|
OP
|
$268.26
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31100044
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$268.26 |
| Rate for Payer: Aetna Commercial |
$241.43
|
| Rate for Payer: Aetna Medicare |
$21.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$260.21
|
| Rate for Payer: ASR Commercial |
$260.21
|
| Rate for Payer: BCBS Complete |
$12.06
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$219.68
|
| Rate for Payer: BCN Commercial |
$207.98
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$214.61
|
| Rate for Payer: Cash Price |
$214.61
|
| Rate for Payer: Cofinity Commercial |
$252.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$268.26
|
| Rate for Payer: Healthscope Whirlpool |
$260.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.42
|
| Rate for Payer: Mclaren Commercial |
$241.43
|
| Rate for Payer: Mclaren Medicaid |
$11.48
|
| Rate for Payer: Mclaren Medicare |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Meridian Medicaid |
$12.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.02
|
| Rate for Payer: Nomi Health Commercial |
$219.97
|
| Rate for Payer: PACE Medicare |
$20.35
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicaid |
$11.48
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.05
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$188.05
|
| Rate for Payer: Railroad Medicare Medicare |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$33.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UHCCP DNSP |
$21.42
|
| Rate for Payer: UHCCP Medicaid |
$11.48
|
| Rate for Payer: VA VA |
$21.42
|
|
|
HC PLASMA CELL PROLIFERATION, MARROW CMPT 1
|
Facility
|
OP
|
$158.36
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000139
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$546.30 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: Aetna Medicare |
$352.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$440.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$440.56
|
| Rate for Payer: ASR ASR |
$153.61
|
| Rate for Payer: ASR Commercial |
$153.61
|
| Rate for Payer: BCBS Complete |
$198.36
|
| Rate for Payer: BCBS MAPPO |
$352.45
|
| Rate for Payer: BCBS Trust/PPO |
$129.68
|
| Rate for Payer: BCN Commercial |
$122.78
|
| Rate for Payer: BCN Medicare Advantage |
$352.45
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.45
|
| Rate for Payer: Healthscope Commercial |
$158.36
|
| Rate for Payer: Healthscope Whirlpool |
$153.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$352.45
|
| Rate for Payer: Mclaren Commercial |
$142.52
|
| Rate for Payer: Mclaren Medicaid |
$188.91
|
| Rate for Payer: Mclaren Medicare |
$352.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.07
|
| Rate for Payer: Meridian Medicaid |
$198.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$405.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.61
|
| Rate for Payer: Nomi Health Commercial |
$129.86
|
| Rate for Payer: PACE Medicare |
$334.83
|
| Rate for Payer: PACE SWMI |
$352.45
|
| Rate for Payer: PHP Commercial |
$387.70
|
| Rate for Payer: PHP Medicaid |
$188.91
|
| Rate for Payer: PHP Medicare Advantage |
$352.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Medicare |
$352.45
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: Railroad Medicare Medicare |
$352.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.45
|
| Rate for Payer: UHC Exchange |
$546.30
|
| Rate for Payer: UHC Medicare Advantage |
$352.45
|
| Rate for Payer: UHCCP DNSP |
$352.45
|
| Rate for Payer: UHCCP Medicaid |
$188.91
|
| Rate for Payer: VA VA |
$352.45
|
|
|
HC PLASMA CELL PROLIFERATION, MARROW CMPT 1
|
Facility
|
IP
|
$158.36
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000139
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$102.93 |
| Max. Negotiated Rate |
$158.36 |
| Rate for Payer: Aetna Commercial |
$142.52
|
| Rate for Payer: ASR ASR |
$153.61
|
| Rate for Payer: ASR Commercial |
$153.61
|
| Rate for Payer: BCBS Trust/PPO |
$129.05
|
| Rate for Payer: BCN Commercial |
$122.78
|
| Rate for Payer: Cash Price |
$126.69
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.69
|
| Rate for Payer: Healthscope Commercial |
$158.36
|
| Rate for Payer: Healthscope Whirlpool |
$153.61
|
| Rate for Payer: Mclaren Commercial |
$142.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.61
|
| Rate for Payer: Nomi Health Commercial |
$129.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.36
|
|
|
HC PLASMA CELL PROLIFERATION, MARROW CMPT 2
|
Facility
|
IP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000140
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$52.24 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Trust/PPO |
$42.57
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC PLASMA CELL PROLIFERATION, MARROW CMPT 2
|
Facility
|
OP
|
$52.24
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000140
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$26.12
|
| Rate for Payer: ASR ASR |
$50.67
|
| Rate for Payer: ASR Commercial |
$50.67
|
| Rate for Payer: BCBS Complete |
$20.90
|
| Rate for Payer: BCBS Trust/PPO |
$42.78
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cash Price |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$49.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$52.24
|
| Rate for Payer: Healthscope Whirlpool |
$50.67
|
| Rate for Payer: Mclaren Commercial |
$47.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.40
|
| Rate for Payer: Nomi Health Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.30
|
| Rate for Payer: Priority Health Narrow Network |
$47.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.97
|
|
|
HC PLASMA CELL PROLIF MARROW
|
Facility
|
IP
|
$115.57
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100042
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$115.57 |
| Rate for Payer: Aetna Commercial |
$104.01
|
| Rate for Payer: ASR ASR |
$112.10
|
| Rate for Payer: ASR Commercial |
$112.10
|
| Rate for Payer: BCBS Trust/PPO |
$94.18
|
| Rate for Payer: BCN Commercial |
$89.60
|
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$108.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.46
|
| Rate for Payer: Healthscope Commercial |
$115.57
|
| Rate for Payer: Healthscope Whirlpool |
$112.10
|
| Rate for Payer: Mclaren Commercial |
$104.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.23
|
| Rate for Payer: Nomi Health Commercial |
$94.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.70
|
|
|
HC PLASMA CELL PROLIF MARROW
|
Facility
|
OP
|
$115.57
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
31100042
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$115.57 |
| Rate for Payer: Aetna Commercial |
$104.01
|
| Rate for Payer: Aetna Medicare |
$52.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.44
|
| Rate for Payer: ASR ASR |
$112.10
|
| Rate for Payer: ASR Commercial |
$112.10
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$52.35
|
| Rate for Payer: BCBS Trust/PPO |
$94.64
|
| Rate for Payer: BCN Commercial |
$89.60
|
| Rate for Payer: BCN Medicare Advantage |
$52.35
|
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Cash Price |
$92.46
|
| Rate for Payer: Cofinity Commercial |
$108.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.35
|
| Rate for Payer: Healthscope Commercial |
$115.57
|
| Rate for Payer: Healthscope Whirlpool |
$112.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$52.35
|
| Rate for Payer: Mclaren Commercial |
$104.01
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Mclaren Medicare |
$52.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.97
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.23
|
| Rate for Payer: Nomi Health Commercial |
$94.77
|
| Rate for Payer: PACE Medicare |
$49.73
|
| Rate for Payer: PACE SWMI |
$52.35
|
| Rate for Payer: PHP Commercial |
$57.58
|
| Rate for Payer: PHP Medicaid |
$28.06
|
| Rate for Payer: PHP Medicare Advantage |
$52.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.26
|
| Rate for Payer: Priority Health Medicare |
$52.35
|
| Rate for Payer: Priority Health Narrow Network |
$81.01
|
| Rate for Payer: Railroad Medicare Medicare |
$52.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.35
|
| Rate for Payer: UHC Exchange |
$81.14
|
| Rate for Payer: UHC Medicare Advantage |
$52.35
|
| Rate for Payer: UHCCP DNSP |
$52.35
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$52.35
|
|
|
HC PLASMA CRYO REDUCED
|
Facility
|
OP
|
$160.12
|
|
|
Service Code
|
HCPCS P9044
|
| Hospital Charge Code |
39000063
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$223.70 |
| Rate for Payer: Aetna Commercial |
$144.11
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.40
|
| Rate for Payer: ASR ASR |
$155.32
|
| Rate for Payer: ASR Commercial |
$155.32
|
| Rate for Payer: BCBS Complete |
$81.22
|
| Rate for Payer: BCBS MAPPO |
$144.32
|
| Rate for Payer: BCBS Trust/PPO |
$131.12
|
| Rate for Payer: BCN Commercial |
$124.14
|
| Rate for Payer: BCN Medicare Advantage |
$144.32
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$150.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.32
|
| Rate for Payer: Healthscope Commercial |
$160.12
|
| Rate for Payer: Healthscope Whirlpool |
$155.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$144.32
|
| Rate for Payer: Mclaren Commercial |
$144.11
|
| Rate for Payer: Mclaren Medicaid |
$77.36
|
| Rate for Payer: Mclaren Medicare |
$144.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.54
|
| Rate for Payer: Meridian Medicaid |
$81.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.10
|
| Rate for Payer: Nomi Health Commercial |
$131.30
|
| Rate for Payer: PACE Medicare |
$137.10
|
| Rate for Payer: PACE SWMI |
$144.32
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: PHP Medicaid |
$77.36
|
| Rate for Payer: PHP Medicare Advantage |
$144.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.30
|
| Rate for Payer: Priority Health Medicare |
$144.32
|
| Rate for Payer: Priority Health Narrow Network |
$112.24
|
| Rate for Payer: Railroad Medicare Medicare |
$144.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.32
|
| Rate for Payer: UHC Exchange |
$223.70
|
| Rate for Payer: UHC Medicare Advantage |
$144.32
|
| Rate for Payer: UHCCP DNSP |
$144.32
|
| Rate for Payer: UHCCP Medicaid |
$77.36
|
| Rate for Payer: VA VA |
$144.32
|
|
|
HC PLASMA CRYO REDUCED
|
Facility
|
IP
|
$160.12
|
|
|
Service Code
|
HCPCS P9044
|
| Hospital Charge Code |
39000063
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$160.12 |
| Rate for Payer: Aetna Commercial |
$144.11
|
| Rate for Payer: ASR ASR |
$155.32
|
| Rate for Payer: ASR Commercial |
$155.32
|
| Rate for Payer: BCBS Trust/PPO |
$130.48
|
| Rate for Payer: BCN Commercial |
$124.14
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cofinity Commercial |
$150.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.10
|
| Rate for Payer: Healthscope Commercial |
$160.12
|
| Rate for Payer: Healthscope Whirlpool |
$155.32
|
| Rate for Payer: Mclaren Commercial |
$144.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.10
|
| Rate for Payer: Nomi Health Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.91
|
|
|
HC PLASMINOGEN
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
30500068
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: ASR ASR |
$83.76
|
| Rate for Payer: ASR Commercial |
$83.76
|
| Rate for Payer: BCBS Trust/PPO |
$70.37
|
| Rate for Payer: BCN Commercial |
$66.95
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$86.35
|
| Rate for Payer: Healthscope Whirlpool |
$83.76
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
|
|
HC PLASMINOGEN
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 85420
|
| Hospital Charge Code |
30500068
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$86.35 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.16
|
| Rate for Payer: ASR ASR |
$83.76
|
| Rate for Payer: ASR Commercial |
$83.76
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS MAPPO |
$6.53
|
| Rate for Payer: BCBS Trust/PPO |
$70.71
|
| Rate for Payer: BCN Commercial |
$66.95
|
| Rate for Payer: BCN Medicare Advantage |
$6.53
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$81.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.53
|
| Rate for Payer: Healthscope Commercial |
$86.35
|
| Rate for Payer: Healthscope Whirlpool |
$83.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.53
|
| Rate for Payer: Mclaren Commercial |
$77.72
|
| Rate for Payer: Mclaren Medicaid |
$3.50
|
| Rate for Payer: Mclaren Medicare |
$6.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.86
|
| Rate for Payer: Meridian Medicaid |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: PACE Medicare |
$6.20
|
| Rate for Payer: PACE SWMI |
$6.53
|
| Rate for Payer: PHP Commercial |
$7.18
|
| Rate for Payer: PHP Medicaid |
$3.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.66
|
| Rate for Payer: Priority Health Medicare |
$6.53
|
| Rate for Payer: Priority Health Narrow Network |
$60.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.53
|
| Rate for Payer: UHC Exchange |
$10.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.53
|
| Rate for Payer: UHCCP DNSP |
$6.53
|
| Rate for Payer: UHCCP Medicaid |
$3.50
|
| Rate for Payer: VA VA |
$6.53
|
|
|
HC PLATELET AGGREGATION EA AGENT
|
Facility
|
IP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.23 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: ASR ASR |
$94.36
|
| Rate for Payer: ASR Commercial |
$94.36
|
| Rate for Payer: BCBS Trust/PPO |
$79.27
|
| Rate for Payer: BCN Commercial |
$75.42
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$91.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Healthscope Commercial |
$97.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.36
|
| Rate for Payer: Mclaren Commercial |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.61
|
|
|
HC PLATELET AGGREGATION EA AGENT
|
Facility
|
OP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500055
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Aetna Commercial |
$87.55
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$94.36
|
| Rate for Payer: ASR Commercial |
$94.36
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$75.42
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$91.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$97.28
|
| Rate for Payer: Healthscope Whirlpool |
$94.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$87.55
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| 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 |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.24
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$68.19
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET ANTIBODY
|
Facility
|
IP
|
$99.88
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$99.88 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: ASR Commercial |
$96.88
|
| Rate for Payer: BCBS Trust/PPO |
$81.39
|
| Rate for Payer: BCN Commercial |
$77.44
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$99.88
|
| Rate for Payer: Healthscope Whirlpool |
$96.88
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
|
|
HC PLATELET ANTIBODY
|
Facility
|
OP
|
$99.88
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$250.89 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$18.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.96
|
| Rate for Payer: ASR ASR |
$96.88
|
| Rate for Payer: ASR Commercial |
$96.88
|
| Rate for Payer: BCBS Complete |
$10.34
|
| Rate for Payer: BCBS MAPPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$81.79
|
| Rate for Payer: BCN Commercial |
$77.44
|
| Rate for Payer: BCN Medicare Advantage |
$18.37
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$93.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$99.88
|
| Rate for Payer: Healthscope Whirlpool |
$96.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.37
|
| Rate for Payer: Mclaren Commercial |
$89.89
|
| Rate for Payer: Mclaren Medicaid |
$9.85
|
| Rate for Payer: Mclaren Medicare |
$18.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.29
|
| Rate for Payer: Meridian Medicaid |
$10.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: PACE Medicare |
$17.45
|
| Rate for Payer: PACE SWMI |
$18.37
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Medicaid |
$9.85
|
| Rate for Payer: PHP Medicare Advantage |
$18.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.89
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$200.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.37
|
| Rate for Payer: UHC Exchange |
$28.47
|
| Rate for Payer: UHC Medicare Advantage |
$18.37
|
| Rate for Payer: UHCCP DNSP |
$18.37
|
| Rate for Payer: UHCCP Medicaid |
$9.85
|
| Rate for Payer: VA VA |
$18.37
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
IP
|
$279.14
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.44 |
| Max. Negotiated Rate |
$279.14 |
| Rate for Payer: Aetna Commercial |
$251.23
|
| Rate for Payer: ASR ASR |
$270.77
|
| Rate for Payer: ASR Commercial |
$270.77
|
| Rate for Payer: BCBS Trust/PPO |
$227.47
|
| Rate for Payer: BCN Commercial |
$216.42
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cofinity Commercial |
$262.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.31
|
| Rate for Payer: Healthscope Commercial |
$279.14
|
| Rate for Payer: Healthscope Whirlpool |
$270.77
|
| Rate for Payer: Mclaren Commercial |
$251.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.27
|
| Rate for Payer: Nomi Health Commercial |
$228.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.64
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
OP
|
$279.14
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.05 |
| Max. Negotiated Rate |
$279.14 |
| Rate for Payer: Aetna Commercial |
$251.23
|
| Rate for Payer: Aetna Medicare |
$123.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.04
|
| Rate for Payer: ASR ASR |
$270.77
|
| Rate for Payer: ASR Commercial |
$270.77
|
| Rate for Payer: BCBS Complete |
$69.35
|
| Rate for Payer: BCBS MAPPO |
$123.23
|
| Rate for Payer: BCBS Trust/PPO |
$228.59
|
| Rate for Payer: BCN Commercial |
$216.42
|
| Rate for Payer: BCN Medicare Advantage |
$123.23
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cofinity Commercial |
$262.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.23
|
| Rate for Payer: Healthscope Commercial |
$279.14
|
| Rate for Payer: Healthscope Whirlpool |
$270.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$123.23
|
| Rate for Payer: Mclaren Commercial |
$251.23
|
| Rate for Payer: Mclaren Medicaid |
$66.05
|
| Rate for Payer: Mclaren Medicare |
$123.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.39
|
| Rate for Payer: Meridian Medicaid |
$69.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.27
|
| Rate for Payer: Nomi Health Commercial |
$228.89
|
| Rate for Payer: PACE Medicare |
$117.07
|
| Rate for Payer: PACE SWMI |
$123.23
|
| Rate for Payer: PHP Commercial |
$135.55
|
| Rate for Payer: PHP Medicaid |
$66.05
|
| Rate for Payer: PHP Medicare Advantage |
$123.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.22
|
| Rate for Payer: Priority Health Medicare |
$123.23
|
| Rate for Payer: Priority Health Narrow Network |
$196.18
|
| Rate for Payer: Railroad Medicare Medicare |
$123.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.23
|
| Rate for Payer: UHC Exchange |
$191.01
|
| Rate for Payer: UHC Medicare Advantage |
$123.23
|
| Rate for Payer: UHCCP DNSP |
$123.23
|
| Rate for Payer: UHCCP Medicaid |
$66.05
|
| Rate for Payer: VA VA |
$123.23
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.60
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Complete |
$2.52
|
| Rate for Payer: BCBS MAPPO |
$4.48
|
| Rate for Payer: BCBS Trust/PPO |
$31.66
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: BCN Medicare Advantage |
$4.48
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.48
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$4.48
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Mclaren Medicaid |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Medicare |
$4.26
|
| Rate for Payer: PACE SWMI |
$4.48
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: PHP Medicaid |
$2.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.87
|
| Rate for Payer: Priority Health Medicare |
$4.48
|
| Rate for Payer: Priority Health Narrow Network |
$27.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.48
|
| Rate for Payer: UHC Exchange |
$6.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.48
|
| Rate for Payer: UHCCP DNSP |
$4.48
|
| Rate for Payer: UHCCP Medicaid |
$2.40
|
| Rate for Payer: VA VA |
$4.48
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$38.66 |
| Rate for Payer: Aetna Commercial |
$34.79
|
| Rate for Payer: ASR ASR |
$37.50
|
| Rate for Payer: ASR Commercial |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.50
|
| Rate for Payer: BCN Commercial |
$29.97
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$36.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$38.66
|
| Rate for Payer: Healthscope Whirlpool |
$37.50
|
| Rate for Payer: Mclaren Commercial |
$34.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.02
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
OP
|
$124.01
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$124.01 |
| Rate for Payer: Aetna Commercial |
$111.61
|
| Rate for Payer: Aetna Medicare |
$24.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.14
|
| Rate for Payer: ASR ASR |
$120.29
|
| Rate for Payer: ASR Commercial |
$120.29
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$101.55
|
| Rate for Payer: BCN Commercial |
$96.14
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cofinity Commercial |
$116.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$124.01
|
| Rate for Payer: Healthscope Whirlpool |
$120.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$111.61
|
| Rate for Payer: Mclaren Medicaid |
$13.35
|
| 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 |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.41
|
| Rate for Payer: Nomi Health Commercial |
$101.69
|
| Rate for Payer: PACE Medicare |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.91
|
| Rate for Payer: PHP Commercial |
$27.40
|
| Rate for Payer: PHP Medicaid |
$13.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.66
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$86.93
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.91
|
| Rate for Payer: UHC Exchange |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$24.91
|
| Rate for Payer: UHCCP DNSP |
$24.91
|
| Rate for Payer: UHCCP Medicaid |
$13.35
|
| Rate for Payer: VA VA |
$24.91
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
IP
|
$124.01
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$124.01 |
| Rate for Payer: Aetna Commercial |
$111.61
|
| Rate for Payer: ASR ASR |
$120.29
|
| Rate for Payer: ASR Commercial |
$120.29
|
| Rate for Payer: BCBS Trust/PPO |
$101.06
|
| Rate for Payer: BCN Commercial |
$96.14
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cofinity Commercial |
$116.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.21
|
| Rate for Payer: Healthscope Commercial |
$124.01
|
| Rate for Payer: Healthscope Whirlpool |
$120.29
|
| Rate for Payer: Mclaren Commercial |
$111.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.41
|
| Rate for Payer: Nomi Health Commercial |
$101.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.13
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$261.64 |
| Max. Negotiated Rate |
$402.53 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: ASR ASR |
$390.45
|
| Rate for Payer: ASR Commercial |
$390.45
|
| Rate for Payer: BCBS Trust/PPO |
$328.02
|
| Rate for Payer: BCN Commercial |
$312.08
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cofinity Commercial |
$378.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.02
|
| Rate for Payer: Healthscope Commercial |
$402.53
|
| Rate for Payer: Healthscope Whirlpool |
$390.45
|
| Rate for Payer: Mclaren Commercial |
$362.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: Nomi Health Commercial |
$330.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.23
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$402.53 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: Aetna Medicare |
$201.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.55
|
| Rate for Payer: ASR ASR |
$390.45
|
| Rate for Payer: ASR Commercial |
$390.45
|
| Rate for Payer: BCBS Complete |
$113.26
|
| Rate for Payer: BCBS MAPPO |
$201.24
|
| Rate for Payer: BCBS Trust/PPO |
$329.63
|
| Rate for Payer: BCN Commercial |
$312.08
|
| Rate for Payer: BCN Medicare Advantage |
$201.24
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cofinity Commercial |
$378.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.24
|
| Rate for Payer: Healthscope Commercial |
$402.53
|
| Rate for Payer: Healthscope Whirlpool |
$390.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$201.24
|
| Rate for Payer: Mclaren Commercial |
$362.28
|
| Rate for Payer: Mclaren Medicaid |
$107.86
|
| Rate for Payer: Mclaren Medicare |
$201.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.30
|
| Rate for Payer: Meridian Medicaid |
$113.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: Nomi Health Commercial |
$330.07
|
| Rate for Payer: PACE Medicare |
$191.18
|
| Rate for Payer: PACE SWMI |
$201.24
|
| Rate for Payer: PHP Commercial |
$221.36
|
| Rate for Payer: PHP Medicaid |
$107.86
|
| Rate for Payer: PHP Medicare Advantage |
$201.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.70
|
| Rate for Payer: Priority Health Medicare |
$201.24
|
| Rate for Payer: Priority Health Narrow Network |
$282.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.24
|
| Rate for Payer: UHC Exchange |
$311.92
|
| Rate for Payer: UHC Medicare Advantage |
$201.24
|
| Rate for Payer: UHCCP DNSP |
$201.24
|
| Rate for Payer: UHCCP Medicaid |
$107.86
|
| Rate for Payer: VA VA |
$201.24
|
|
