|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: BCBS Complete |
$32.10
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$50.49
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$307.02
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.04
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Mclaren Medicaid |
$30.57
|
| Rate for Payer: Mclaren Medicare |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.89
|
| Rate for Payer: Meridian Medicaid |
$32.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$171.12
|
| Rate for Payer: PACE Medicare |
$54.19
|
| Rate for Payer: PACE SWMI |
$57.04
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: PHP Medicare Advantage |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health Narrow Network |
$45.63
|
| Rate for Payer: Priority Health SBD |
$276.32
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.45
|
| Rate for Payer: UHC Core |
$181.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.04
|
| Rate for Payer: UHC Exchange |
$181.07
|
| Rate for Payer: UHC Medicare Advantage |
$57.04
|
| Rate for Payer: UHCCP Medicaid |
$32.11
|
| Rate for Payer: VA VA |
$57.04
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$46.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: BCBS Complete |
$25.26
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$39.74
|
| Rate for Payer: BCN Commercial |
$39.74
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Mclaren Medicaid |
$24.06
|
| Rate for Payer: Mclaren Medicare |
$44.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$25.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$134.67
|
| Rate for Payer: PACE Medicare |
$42.65
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.07
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health Narrow Network |
$60.06
|
| Rate for Payer: Priority Health SBD |
$161.94
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.87
|
| Rate for Payer: UHC Core |
$181.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.89
|
| Rate for Payer: UHC Exchange |
$181.07
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UHCCP Medicaid |
$25.27
|
| Rate for Payer: VA VA |
$44.89
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.08
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$179.93
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health SBD |
$161.94
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health SBD |
$39.20
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| 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 |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$16.62
|
| Rate for Payer: BCN Commercial |
$16.62
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| 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 |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$28.16
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$15.02
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Medicare Advantage |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$10.57
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| 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 |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.47
|
| Rate for Payer: BCN Commercial |
$6.47
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| 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 |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$10.96
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.31
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$5.85
|
| Rate for Payer: Priority Health SBD |
$41.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$4.12
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.10
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health SBD |
$41.77
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$114.33 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$567.04
|
| Rate for Payer: BCN Commercial |
$567.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,712.91
|
| Rate for Payer: Cofinity Commercial |
$1,394.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,394.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Priority Health SBD |
$1,254.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.33
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$817.10
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,254.81 |
| Max. Negotiated Rate |
$1,792.58 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.64
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,394.23
|
| Rate for Payer: Cofinity Commercial |
$1,712.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,394.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health SBD |
$1,254.81
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.95 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,705.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$855.81
|
| Rate for Payer: BCN Commercial |
$855.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$4,902.00
|
| Rate for Payer: Cofinity Commercial |
$3,990.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,990.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$3,591.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.95
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,129.99
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,591.00 |
| Max. Negotiated Rate |
$5,130.00 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,705.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$3,990.00
|
| Rate for Payer: Cofinity Commercial |
$4,902.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,990.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health SBD |
$3,591.00
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$328.54 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$328.54
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$229.98
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$270.14
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$229.98 |
| Max. Negotiated Rate |
$328.54 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.28
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$255.54
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$328.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health SBD |
$229.98
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$168.91
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$198.40
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health SBD |
$168.91
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$168.91
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$198.40
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.27
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$187.68
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health SBD |
$168.91
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
IP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.04 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health SBD |
$146.04
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$146.04
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$171.54
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
IP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.04 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health SBD |
$146.04
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
OP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$146.04
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$171.54
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
OP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$146.04
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$171.54
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
IP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$146.04 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.68
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$162.27
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health SBD |
$146.04
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
IP
|
$96.59
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$60.85 |
| Max. Negotiated Rate |
$86.93 |
| Rate for Payer: Aetna Commercial |
$82.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.78
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$67.61
|
| Rate for Payer: Cofinity Commercial |
$83.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$86.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: PHP Commercial |
$82.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: Priority Health SBD |
$60.85
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$96.59
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$259.57 |
| Rate for Payer: Aetna Commercial |
$82.10
|
| Rate for Payer: Aetna Medicare |
$85.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$221.69
|
| Rate for Payer: BCN Commercial |
$221.69
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$83.07
|
| Rate for Payer: Cofinity Commercial |
$67.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$86.93
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: Nomi Health Commercial |
$247.77
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$82.10
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.57
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$207.66
|
| Rate for Payer: Priority Health SBD |
$60.85
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$71.48
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$46.50
|
| Rate for Payer: VA VA |
$82.59
|
|
