|
HC PLASMA CRYO REDUCED
|
Facility
|
OP
|
$160.12
|
|
|
Service Code
|
HCPCS P9044
|
| Hospital Charge Code |
39000063
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$222.67 |
| Rate for Payer: Aetna Commercial |
$144.11
|
| Rate for Payer: Aetna Medicare |
$143.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.57
|
| Rate for Payer: ASR ASR |
$155.32
|
| Rate for Payer: ASR Commercial |
$155.32
|
| Rate for Payer: BCBS Complete |
$80.85
|
| Rate for Payer: BCBS MAPPO |
$143.66
|
| Rate for Payer: BCBS Trust/PPO |
$131.12
|
| Rate for Payer: BCN Commercial |
$124.14
|
| Rate for Payer: BCN Medicare Advantage |
$143.66
|
| 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 |
$143.66
|
| Rate for Payer: Healthscope Commercial |
$160.12
|
| Rate for Payer: Healthscope Whirlpool |
$155.32
|
| Rate for Payer: Humana Choice PPO Medicare |
$143.66
|
| Rate for Payer: Mclaren Commercial |
$144.11
|
| Rate for Payer: Mclaren Medicaid |
$77.00
|
| Rate for Payer: Mclaren Medicare |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.84
|
| Rate for Payer: Meridian Medicaid |
$80.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.10
|
| Rate for Payer: Nomi Health Commercial |
$131.30
|
| Rate for Payer: PACE Medicare |
$136.48
|
| Rate for Payer: PACE SWMI |
$143.66
|
| Rate for Payer: PHP Commercial |
$158.03
|
| Rate for Payer: PHP Medicaid |
$77.00
|
| Rate for Payer: PHP Medicare Advantage |
$143.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.00
|
| 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 |
$143.66
|
| Rate for Payer: Priority Health Narrow Network |
$112.24
|
| Rate for Payer: Railroad Medicare Medicare |
$143.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.66
|
| Rate for Payer: UHC Exchange |
$222.67
|
| Rate for Payer: UHC Medicare Advantage |
$143.66
|
| Rate for Payer: UHCCP DNSP |
$143.66
|
| Rate for Payer: UHCCP Medicaid |
$77.00
|
| Rate for Payer: VA VA |
$143.66
|
|
|
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 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 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
|
OP
|
$99.88
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$99.88 |
| 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 |
$87.51
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: Priority Health Narrow Network |
$70.02
|
| 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 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 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 |
$65.75 |
| Max. Negotiated Rate |
$279.14 |
| Rate for Payer: Aetna Commercial |
$251.23
|
| Rate for Payer: Aetna Medicare |
$122.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.32
|
| Rate for Payer: ASR ASR |
$270.77
|
| Rate for Payer: ASR Commercial |
$270.77
|
| Rate for Payer: BCBS Complete |
$69.03
|
| Rate for Payer: BCBS MAPPO |
$122.66
|
| Rate for Payer: BCBS Trust/PPO |
$228.59
|
| Rate for Payer: BCN Commercial |
$216.42
|
| Rate for Payer: BCN Medicare Advantage |
$122.66
|
| 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 |
$122.66
|
| Rate for Payer: Healthscope Commercial |
$279.14
|
| Rate for Payer: Healthscope Whirlpool |
$270.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$122.66
|
| Rate for Payer: Mclaren Commercial |
$251.23
|
| Rate for Payer: Mclaren Medicaid |
$65.75
|
| Rate for Payer: Mclaren Medicare |
$122.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.79
|
| Rate for Payer: Meridian Medicaid |
$69.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.27
|
| Rate for Payer: Nomi Health Commercial |
$228.89
|
| Rate for Payer: PACE Medicare |
$116.53
|
| Rate for Payer: PACE SWMI |
$122.66
|
| Rate for Payer: PHP Commercial |
$134.93
|
| Rate for Payer: PHP Medicaid |
$65.75
|
| Rate for Payer: PHP Medicare Advantage |
$122.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.58
|
| Rate for Payer: Priority Health Medicare |
$122.66
|
| Rate for Payer: Priority Health Narrow Network |
$195.68
|
| Rate for Payer: Railroad Medicare Medicare |
$122.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.66
|
| Rate for Payer: UHC Exchange |
$190.12
|
| Rate for Payer: UHC Medicare Advantage |
$122.66
|
| Rate for Payer: UHCCP DNSP |
$122.66
|
| Rate for Payer: UHCCP Medicaid |
$65.75
|
| Rate for Payer: VA VA |
$122.66
|
|
|
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 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 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 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 LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$107.37 |
| Max. Negotiated Rate |
$402.53 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: Aetna Medicare |
$200.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$250.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$250.39
|
| Rate for Payer: ASR ASR |
$390.45
|
| Rate for Payer: ASR Commercial |
$390.45
|
| Rate for Payer: BCBS Complete |
$112.73
|
| Rate for Payer: BCBS MAPPO |
$200.31
|
| Rate for Payer: BCBS Trust/PPO |
$329.63
|
| Rate for Payer: BCN Commercial |
$312.08
|
| Rate for Payer: BCN Medicare Advantage |
$200.31
|
| 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 |
$200.31
|
| Rate for Payer: Healthscope Commercial |
$402.53
|
| Rate for Payer: Healthscope Whirlpool |
$390.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$200.31
|
| Rate for Payer: Mclaren Commercial |
$362.28
|
| Rate for Payer: Mclaren Medicaid |
$107.37
|
| Rate for Payer: Mclaren Medicare |
$200.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.33
|
| Rate for Payer: Meridian Medicaid |
$112.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$230.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: Nomi Health Commercial |
$330.07
|
| Rate for Payer: PACE Medicare |
$190.29
|
| Rate for Payer: PACE SWMI |
$200.31
|
| Rate for Payer: PHP Commercial |
$220.34
|
| Rate for Payer: PHP Medicaid |
$107.37
|
| Rate for Payer: PHP Medicare Advantage |
$200.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.37
|
| 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 |
$200.31
|
| Rate for Payer: Priority Health Narrow Network |
$282.17
|
| Rate for Payer: Railroad Medicare Medicare |
$200.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.31
|
| Rate for Payer: UHC Exchange |
$310.48
|
| Rate for Payer: UHC Medicare Advantage |
$200.31
|
| Rate for Payer: UHCCP DNSP |
$200.31
|
| Rate for Payer: UHCCP Medicaid |
$107.37
|
| Rate for Payer: VA VA |
$200.31
|
|
|
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 RESISTANCE TEST CMPT
|
Facility
|
IP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
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 RESISTANCE TEST CMPT
|
Facility
|
OP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
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 PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| 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 |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Complete |
$14.02
|
| Rate for Payer: BCBS MAPPO |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$75.83
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: BCN Medicare Advantage |
$24.91
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.91
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$24.91
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| 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 |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| 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 |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.14
|
| Rate for Payer: Priority Health Medicare |
$24.91
|
| Rate for Payer: Priority Health Narrow Network |
$64.91
|
| Rate for Payer: Railroad Medicare Medicare |
$24.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
| 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 PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$92.60 |
| Rate for Payer: Aetna Commercial |
$83.34
|
| Rate for Payer: ASR ASR |
$89.82
|
| Rate for Payer: ASR Commercial |
$89.82
|
| Rate for Payer: BCBS Trust/PPO |
$75.46
|
| Rate for Payer: BCN Commercial |
$71.79
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$87.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$92.60
|
| Rate for Payer: Healthscope Whirlpool |
$89.82
|
| Rate for Payer: Mclaren Commercial |
$83.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.49
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.26 |
| Max. Negotiated Rate |
$2,068.38 |
| Rate for Payer: Aetna Commercial |
$1,748.19
|
| Rate for Payer: Aetna Medicare |
$1,334.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,668.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,668.05
|
| Rate for Payer: ASR ASR |
$1,884.16
|
| Rate for Payer: ASR Commercial |
$1,884.16
|
| Rate for Payer: BCBS Complete |
$751.02
|
| Rate for Payer: BCBS MAPPO |
$1,334.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,590.66
|
| Rate for Payer: BCN Commercial |
$1,505.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,334.44
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,825.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,334.44
|
| Rate for Payer: Healthscope Commercial |
$1,942.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,334.44
|
| Rate for Payer: Mclaren Commercial |
$1,748.19
|
| Rate for Payer: Mclaren Medicaid |
$715.26
|
| Rate for Payer: Mclaren Medicare |
$1,334.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,401.16
|
| Rate for Payer: Meridian Medicaid |
$751.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,534.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: PACE Medicare |
$1,267.72
|
| Rate for Payer: PACE SWMI |
$1,334.44
|
| Rate for Payer: PHP Commercial |
$1,467.88
|
| Rate for Payer: PHP Medicaid |
$715.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,334.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.96
|
| Rate for Payer: Priority Health Medicare |
$1,334.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,361.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,334.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,334.44
|
| Rate for Payer: UHC Exchange |
$2,068.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,334.44
|
| Rate for Payer: UHCCP DNSP |
$1,334.44
|
| Rate for Payer: UHCCP Medicaid |
$715.26
|
| Rate for Payer: VA VA |
$1,334.44
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,262.58 |
| Max. Negotiated Rate |
$1,942.43 |
| Rate for Payer: Aetna Commercial |
$1,748.19
|
| Rate for Payer: ASR ASR |
$1,884.16
|
| Rate for Payer: ASR Commercial |
$1,884.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.89
|
| Rate for Payer: BCN Commercial |
$1,505.97
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,825.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Healthscope Commercial |
$1,942.43
|
| Rate for Payer: Healthscope Whirlpool |
$1,884.16
|
| Rate for Payer: Mclaren Commercial |
$1,748.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,709.34
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,432.80 |
| Max. Negotiated Rate |
$2,204.30 |
| Rate for Payer: Aetna Commercial |
$1,983.87
|
| Rate for Payer: ASR ASR |
$2,138.17
|
| Rate for Payer: ASR Commercial |
$2,138.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.28
|
| Rate for Payer: BCN Commercial |
$1,708.99
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$2,072.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Healthscope Commercial |
$2,204.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.17
|
| Rate for Payer: Mclaren Commercial |
$1,983.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.78
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$254.63 |
| Max. Negotiated Rate |
$2,204.30 |
| Rate for Payer: Aetna Commercial |
$1,983.87
|
| Rate for Payer: Aetna Medicare |
$475.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.83
|
| Rate for Payer: ASR ASR |
$2,138.17
|
| Rate for Payer: ASR Commercial |
$2,138.17
|
| Rate for Payer: BCBS Complete |
$267.36
|
| Rate for Payer: BCBS MAPPO |
$475.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,805.10
|
| Rate for Payer: BCN Commercial |
$1,708.99
|
| Rate for Payer: BCN Medicare Advantage |
$475.06
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$2,072.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.06
|
| Rate for Payer: Healthscope Commercial |
$2,204.30
|
| Rate for Payer: Healthscope Whirlpool |
$2,138.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$475.06
|
| Rate for Payer: Mclaren Commercial |
$1,983.87
|
| Rate for Payer: Mclaren Medicaid |
$254.63
|
| Rate for Payer: Mclaren Medicare |
$475.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.81
|
| Rate for Payer: Meridian Medicaid |
$267.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$546.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PACE Medicare |
$451.31
|
| Rate for Payer: PACE SWMI |
$475.06
|
| Rate for Payer: PHP Commercial |
$522.57
|
| Rate for Payer: PHP Medicaid |
$254.63
|
| Rate for Payer: PHP Medicare Advantage |
$475.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,931.41
|
| Rate for Payer: Priority Health Medicare |
$475.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.21
|
| Rate for Payer: Railroad Medicare Medicare |
$475.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,939.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.06
|
| Rate for Payer: UHC Exchange |
$736.34
|
| Rate for Payer: UHC Medicare Advantage |
$475.06
|
| Rate for Payer: UHCCP DNSP |
$475.06
|
| Rate for Payer: UHCCP Medicaid |
$254.63
|
| Rate for Payer: VA VA |
$475.06
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$353.20 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,598.00
|
| Rate for Payer: Aetna Medicare |
$658.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.70
|
| Rate for Payer: ASR ASR |
$2,800.07
|
| Rate for Payer: ASR Commercial |
$2,800.07
|
| Rate for Payer: BCBS Complete |
$370.86
|
| Rate for Payer: BCBS MAPPO |
$658.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,363.89
|
| Rate for Payer: BCN Commercial |
$2,238.04
|
| Rate for Payer: BCN Medicare Advantage |
$658.96
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,713.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.96
|
| Rate for Payer: Healthscope Commercial |
$2,886.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,800.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$658.96
|
| Rate for Payer: Mclaren Commercial |
$2,598.00
|
| Rate for Payer: Mclaren Medicaid |
$353.20
|
| Rate for Payer: Mclaren Medicare |
$658.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.91
|
| Rate for Payer: Meridian Medicaid |
$370.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PACE Medicare |
$626.01
|
| Rate for Payer: PACE SWMI |
$658.96
|
| Rate for Payer: PHP Commercial |
$724.86
|
| Rate for Payer: PHP Medicaid |
$353.20
|
| Rate for Payer: PHP Medicare Advantage |
$658.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,529.30
|
| Rate for Payer: Priority Health Medicare |
$658.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,023.56
|
| Rate for Payer: Railroad Medicare Medicare |
$658.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,540.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.96
|
| Rate for Payer: UHC Exchange |
$1,021.39
|
| Rate for Payer: UHC Medicare Advantage |
$658.96
|
| Rate for Payer: UHCCP DNSP |
$658.96
|
| Rate for Payer: UHCCP Medicaid |
$353.20
|
| Rate for Payer: VA VA |
$658.96
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,876.34 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,598.00
|
| Rate for Payer: ASR ASR |
$2,800.07
|
| Rate for Payer: ASR Commercial |
$2,800.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,352.35
|
| Rate for Payer: BCN Commercial |
$2,238.04
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,713.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Healthscope Commercial |
$2,886.67
|
| Rate for Payer: Healthscope Whirlpool |
$2,800.07
|
| Rate for Payer: Mclaren Commercial |
$2,598.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,540.27
|
|
