|
HC CRYOABLATION SUPPLIES
|
Facility
|
IP
|
$12,272.17
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27200284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,976.91 |
| Max. Negotiated Rate |
$11,044.95 |
| Rate for Payer: Aetna Commercial |
$10,431.34
|
| Rate for Payer: BCBS Trust/PPO |
$10,017.77
|
| Rate for Payer: BCN Commercial |
$9,483.93
|
| Rate for Payer: Cash Price |
$9,817.74
|
| Rate for Payer: Cofinity Commercial |
$10,554.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,817.74
|
| Rate for Payer: Healthscope Commercial |
$11,044.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,204.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,431.34
|
| Rate for Payer: Nomi Health Commercial |
$10,063.18
|
| Rate for Payer: PHP Commercial |
$10,431.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,976.91
|
| Rate for Payer: Priority Health HMO/PPO |
$10,676.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,222.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,799.51
|
| Rate for Payer: UHC Core |
$10,247.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,204.13
|
|
|
HC CRYOGLOBULINS
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.18
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS MAPPO |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.25
|
| Rate for Payer: BCN Commercial |
$15.37
|
| Rate for Payer: BCN Medicare Advantage |
$4.94
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.83
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.19
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.21
|
| Rate for Payer: PACE Senior Care Partners |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.94
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO |
$17.20
|
| Rate for Payer: Priority Health Medicare |
$4.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.40
|
| Rate for Payer: UHC Core |
$16.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.94
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UHC Medicare Advantage |
$4.94
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$4.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.83
|
|
|
HC CRYOGLOBULINS
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100184
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$16.14
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$17.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.21
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO |
$17.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.40
|
| Rate for Payer: UHC Core |
$16.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.83
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
HC CRYOGLOBULINS CMPT
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
CPT 82585
|
| Hospital Charge Code |
30100183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$6.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.23
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: BCBS MAPPO |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.78
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Mclaren Medicaid |
$10.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: Meridian Medicaid |
$10.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: PACE Senior Care Partners |
$5.50
|
| Rate for Payer: PACE SWMI |
$5.78
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health Medicare |
$5.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.78
|
| Rate for Payer: UHC Exchange |
$5.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
| Rate for Payer: UHCCP Medicaid |
$10.22
|
| Rate for Payer: VA VA |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC CRYOGLOBULIN, SERUM
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 82595
|
| Hospital Charge Code |
30100600
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$4.91
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$36.06
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Mclaren Medicaid |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.28
|
| Rate for Payer: Nomi Health Commercial |
$35.97
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.51
|
| Rate for Payer: Priority Health HMO/PPO |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$11.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.39
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Exchange |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$10.96
|
| Rate for Payer: UHCCP Medicaid |
$4.68
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
IP
|
$143.16
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$128.84 |
| Rate for Payer: Aetna Commercial |
$121.69
|
| Rate for Payer: BCBS Trust/PPO |
$116.86
|
| Rate for Payer: BCN Commercial |
$110.63
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.53
|
| Rate for Payer: Healthscope Commercial |
$128.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.69
|
| Rate for Payer: Nomi Health Commercial |
$117.39
|
| Rate for Payer: PHP Commercial |
$121.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.05
|
| Rate for Payer: Priority Health HMO/PPO |
$124.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.98
|
| Rate for Payer: UHC Core |
$119.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.37
|
|
|
HC CRYOPRECIPITATE
|
Facility
|
OP
|
$143.16
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000042
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$128.84 |
| Rate for Payer: Aetna Commercial |
$121.69
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.74
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$35.79
|
| Rate for Payer: BCBS Trust/PPO |
$117.69
|
| Rate for Payer: BCN Commercial |
$111.31
|
| Rate for Payer: BCN Medicare Advantage |
$35.79
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cash Price |
$114.53
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.79
|
| Rate for Payer: Healthscope Commercial |
$128.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.37
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.58
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.69
|
| Rate for Payer: Nomi Health Commercial |
$117.39
|
| Rate for Payer: PACE Senior Care Partners |
$34.00
|
| Rate for Payer: PACE SWMI |
$35.79
|
| Rate for Payer: PHP Commercial |
$121.69
|
| Rate for Payer: PHP Medicare Advantage |
$35.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.05
|
| Rate for Payer: Priority Health HMO/PPO |
$124.55
|
| Rate for Payer: Priority Health Medicare |
$36.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.92
|
| Rate for Payer: Railroad Medicare Medicare |
$35.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.98
|
| Rate for Payer: UHC Core |
$119.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.79
|
| Rate for Payer: UHC Exchange |
$35.79
|
| Rate for Payer: UHC Medicare Advantage |
$35.79
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$35.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.37
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
IP
|
$340.78
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$221.51 |
| Max. Negotiated Rate |
$306.70 |
| Rate for Payer: Aetna Commercial |
$289.66
|
| Rate for Payer: BCBS Trust/PPO |
$278.18
|
| Rate for Payer: BCN Commercial |
$263.35
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cofinity Commercial |
$293.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.62
|
| Rate for Payer: Healthscope Commercial |
$306.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.66
|
| Rate for Payer: Nomi Health Commercial |
$279.44
|
| Rate for Payer: PHP Commercial |
$289.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.51
|
| Rate for Payer: Priority Health HMO/PPO |
$296.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.89
|
| Rate for Payer: UHC Core |
$284.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.58
|
|
|
HC CRYOPRECIPITATE DIRECT
|
Facility
|
OP
|
$340.78
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000043
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$306.70 |
| Rate for Payer: Aetna Commercial |
$289.66
|
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.49
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$85.20
|
| Rate for Payer: BCBS Trust/PPO |
$280.16
|
| Rate for Payer: BCN Commercial |
$264.96
|
| Rate for Payer: BCN Medicare Advantage |
$85.20
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cash Price |
$272.62
|
| Rate for Payer: Cofinity Commercial |
$293.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.20
|
| Rate for Payer: Healthscope Commercial |
$306.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.58
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.45
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.66
|
| Rate for Payer: Nomi Health Commercial |
$279.44
|
| Rate for Payer: PACE Senior Care Partners |
$80.94
|
| Rate for Payer: PACE SWMI |
$85.20
|
| Rate for Payer: PHP Commercial |
$289.66
|
| Rate for Payer: PHP Medicare Advantage |
$85.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.51
|
| Rate for Payer: Priority Health HMO/PPO |
$296.48
|
| Rate for Payer: Priority Health Medicare |
$86.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.32
|
| Rate for Payer: Railroad Medicare Medicare |
$85.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.89
|
| Rate for Payer: UHC Core |
$284.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.20
|
| Rate for Payer: UHC Exchange |
$85.20
|
| Rate for Payer: UHC Medicare Advantage |
$85.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$85.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.58
|
|
|
HC CRYOPRECIPITATE POOL
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: BCBS Trust/PPO |
$203.10
|
| Rate for Payer: BCN Commercial |
$192.27
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000044
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.75
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$193.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Senior Care Partners |
$59.09
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: Railroad Medicare Medicare |
$62.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT1
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: BCBS Trust/PPO |
$203.10
|
| Rate for Payer: BCN Commercial |
$192.27
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT1
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000045
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.75
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$193.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Senior Care Partners |
$59.09
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: Railroad Medicare Medicare |
$62.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT2
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.75
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$193.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Senior Care Partners |
$59.09
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: Railroad Medicare Medicare |
$62.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT2
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000046
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: BCBS Trust/PPO |
$203.10
|
| Rate for Payer: BCN Commercial |
$192.27
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: BCBS Trust/PPO |
$203.10
|
| Rate for Payer: BCN Commercial |
$192.27
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT3
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000047
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.75
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$193.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Senior Care Partners |
$59.09
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: Railroad Medicare Medicare |
$62.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT4
|
Facility
|
IP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$161.72 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: BCBS Trust/PPO |
$203.10
|
| Rate for Payer: BCN Commercial |
$192.27
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOPRECIPITATE POOL CMPT4
|
Facility
|
OP
|
$248.80
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
39000048
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Aetna Commercial |
$211.48
|
| Rate for Payer: Aetna Medicare |
$64.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.75
|
| Rate for Payer: BCBS Complete |
$47.28
|
| Rate for Payer: BCBS MAPPO |
$62.20
|
| Rate for Payer: BCBS Trust/PPO |
$204.54
|
| Rate for Payer: BCN Commercial |
$193.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.20
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cash Price |
$199.04
|
| Rate for Payer: Cofinity Commercial |
$213.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.20
|
| Rate for Payer: Healthscope Commercial |
$223.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.60
|
| Rate for Payer: Mclaren Medicaid |
$45.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.31
|
| Rate for Payer: Meridian Medicaid |
$47.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.48
|
| Rate for Payer: Nomi Health Commercial |
$204.02
|
| Rate for Payer: PACE Senior Care Partners |
$59.09
|
| Rate for Payer: PACE SWMI |
$62.20
|
| Rate for Payer: PHP Commercial |
$211.48
|
| Rate for Payer: PHP Medicare Advantage |
$62.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.72
|
| Rate for Payer: Priority Health HMO/PPO |
$216.46
|
| Rate for Payer: Priority Health Medicare |
$62.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.70
|
| Rate for Payer: Railroad Medicare Medicare |
$62.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.94
|
| Rate for Payer: UHC Core |
$207.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.20
|
| Rate for Payer: UHC Exchange |
$62.20
|
| Rate for Payer: UHC Medicare Advantage |
$62.20
|
| Rate for Payer: UHCCP Medicaid |
$45.03
|
| Rate for Payer: VA VA |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.60
|
|
|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
OP
|
$553.35
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.42 |
| Max. Negotiated Rate |
$498.02 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: Aetna Medicare |
$143.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.92
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$138.34
|
| Rate for Payer: BCBS Trust/PPO |
$454.91
|
| Rate for Payer: BCN Commercial |
$430.23
|
| Rate for Payer: BCN Medicare Advantage |
$138.34
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cofinity Commercial |
$475.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.34
|
| Rate for Payer: Healthscope Commercial |
$498.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.01
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.25
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.35
|
| Rate for Payer: Nomi Health Commercial |
$453.75
|
| Rate for Payer: PACE Senior Care Partners |
$131.42
|
| Rate for Payer: PACE SWMI |
$138.34
|
| Rate for Payer: PHP Commercial |
$470.35
|
| Rate for Payer: PHP Medicare Advantage |
$138.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.68
|
| Rate for Payer: Priority Health HMO/PPO |
$481.41
|
| Rate for Payer: Priority Health Medicare |
$139.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.74
|
| Rate for Payer: Railroad Medicare Medicare |
$138.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.95
|
| Rate for Payer: UHC Core |
$462.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.34
|
| Rate for Payer: UHC Exchange |
$138.34
|
| Rate for Payer: UHC Medicare Advantage |
$138.34
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$138.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.01
|
|
|
HC CRYOSURGERY ANAL LESION(S)
|
Facility
|
IP
|
$553.35
|
|
|
Service Code
|
CPT 46916
|
| Hospital Charge Code |
76100353
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$359.68 |
| Max. Negotiated Rate |
$498.02 |
| Rate for Payer: Aetna Commercial |
$470.35
|
| Rate for Payer: BCBS Trust/PPO |
$451.70
|
| Rate for Payer: BCN Commercial |
$427.63
|
| Rate for Payer: Cash Price |
$442.68
|
| Rate for Payer: Cofinity Commercial |
$475.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.68
|
| Rate for Payer: Healthscope Commercial |
$498.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.35
|
| Rate for Payer: Nomi Health Commercial |
$453.75
|
| Rate for Payer: PHP Commercial |
$470.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.68
|
| Rate for Payer: Priority Health HMO/PPO |
$481.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.95
|
| Rate for Payer: UHC Core |
$462.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.01
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC CRYPTOCOCCAL ANTIGEN FLUID
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30200210
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$12.20
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$11.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$11.70
|
| Rate for Payer: UHCCP Medicaid |
$11.62
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
