|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$20.02
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Mclaren Medicaid |
$9.82
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$28.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: Priority Health Tiered Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.16
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$7.79
|
| Rate for Payer: BCN Commercial |
$7.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$10.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.31
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$5.85
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$10.97
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,279.91 |
| Max. Negotiated Rate |
$1,828.44 |
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.54
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Advantage |
$1,422.12
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: Priority Health SBD |
$1,279.91
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$726.30 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$726.30
|
| Rate for Payer: BCN Commercial |
$726.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Advantage |
$1,422.12
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health SBD |
$1,279.91
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.54
|
| Rate for Payer: UHC Core |
$1,058.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$798.42
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.19
|
| Rate for Payer: BCN Commercial |
$1,096.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Advantage |
$4,069.80
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,779.10
|
| Rate for Payer: UHC Core |
$3,029.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$2,284.90
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,662.82 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Advantage |
$4,069.80
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$234.58 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: Priority Health SBD |
$234.58
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$234.58
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.03
|
| Rate for Payer: UHC Core |
$193.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$146.33
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health SBD |
$172.29
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.76
|
| Rate for Payer: UHC Core |
$142.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$107.47
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$172.29 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health SBD |
$172.29
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.76
|
| Rate for Payer: UHC Core |
$142.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$107.47
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health SBD |
$148.96
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.69
|
| Rate for Payer: UHC Core |
$123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$92.92
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health SBD |
$148.96
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.69
|
| Rate for Payer: UHC Core |
$123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$92.92
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.69
|
| Rate for Payer: UHC Core |
$123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$92.92
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.96 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health SBD |
$148.96
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
IP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.07 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.04
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Advantage |
$68.96
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: Priority Health SBD |
$62.07
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$234.30
|
| Rate for Payer: BCN Commercial |
$234.30
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Advantage |
$68.96
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Mclaren Medicaid |
$43.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$62.07
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.04
|
| Rate for Payer: UHC Core |
$51.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$38.72
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$548.99 |
| Rate for Payer: Aetna Commercial |
$110.13
|
| Rate for Payer: Aetna Medicare |
$176.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.20
|
| Rate for Payer: BCBS Complete |
$93.23
|
| Rate for Payer: BCBS MAPPO |
$169.76
|
| Rate for Payer: BCBS Trust/PPO |
$69.29
|
| Rate for Payer: BCCCP Commercial |
$94.70
|
| Rate for Payer: BCN Commercial |
$69.29
|
| Rate for Payer: BCN Medicare Advantage |
$169.76
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Advantage |
$90.70
|
| Rate for Payer: Cofinity Commercial |
$111.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.76
|
| Rate for Payer: Healthscope Commercial |
$116.61
|
| Rate for Payer: Mclaren Medicaid |
$88.78
|
| Rate for Payer: Mclaren Medicare |
$169.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.25
|
| Rate for Payer: Meridian Medicaid |
$178.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Nomi Health Commercial |
$509.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: PACE Medicare |
$161.27
|
| Rate for Payer: PACE SWMI |
$169.76
|
| Rate for Payer: PHP Commercial |
$110.13
|
| Rate for Payer: PHP Medicare Advantage |
$169.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$548.99
|
| Rate for Payer: Priority Health Medicare |
$169.76
|
| Rate for Payer: Priority Health SBD |
$81.63
|
| Rate for Payer: Priority Health Tiered Network |
$439.19
|
| Rate for Payer: Railroad Medicare Medicare |
$169.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.04
|
| Rate for Payer: UHC Core |
$257.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.76
|
| Rate for Payer: UHC Exchange |
$257.04
|
| Rate for Payer: UHC Medicaid |
$88.78
|
| Rate for Payer: UHCCP Medicaid |
$88.78
|
| Rate for Payer: VA VA |
$169.76
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.63 |
| Max. Negotiated Rate |
$116.61 |
| Rate for Payer: Aetna Commercial |
$110.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.22
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Advantage |
$90.70
|
| Rate for Payer: Cofinity Commercial |
$111.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Healthscope Commercial |
$116.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: PHP Commercial |
$110.13
|
| Rate for Payer: Priority Health SBD |
$81.63
|
|
|
HC FRUCTOSAMINE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health SBD |
$33.43
|
|
|
HC FRUCTOSAMINE
|
Facility
|
OP
|
$53.06
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: Aetna Medicare |
$17.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.95
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$16.76
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$17.87
|
| Rate for Payer: BCN Medicare Advantage |
$16.76
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Advantage |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$8.77
|
| Rate for Payer: Mclaren Medicare |
$16.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.60
|
| Rate for Payer: Meridian Medicaid |
$17.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$25.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PACE Medicare |
$15.92
|
| Rate for Payer: PACE SWMI |
$16.76
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: PHP Medicare Advantage |
$16.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.76
|
| Rate for Payer: Priority Health Medicare |
$16.76
|
| Rate for Payer: Priority Health SBD |
$33.43
|
| Rate for Payer: Priority Health Tiered Network |
$13.41
|
| Rate for Payer: Railroad Medicare Medicare |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.14
|
| Rate for Payer: UHC Core |
$25.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.76
|
| Rate for Payer: UHC Exchange |
$25.14
|
| Rate for Payer: UHC Medicaid |
$8.77
|
| Rate for Payer: UHCCP Medicaid |
$8.77
|
| Rate for Payer: VA VA |
$16.76
|
|
