|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.36 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: Aetna Medicare |
$790.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$950.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$950.47
|
| Rate for Payer: BCBS Complete |
$1,216.60
|
| Rate for Payer: BCBS MAPPO |
$760.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,500.42
|
| Rate for Payer: BCN Commercial |
$2,364.77
|
| Rate for Payer: BCN Medicare Advantage |
$760.38
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.38
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$874.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: Nomi Health Commercial |
$2,494.03
|
| Rate for Payer: PACE Senior Care Partners |
$722.36
|
| Rate for Payer: PACE SWMI |
$760.38
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: PHP Medicare Advantage |
$760.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.98
|
| Rate for Payer: Priority Health HMO/PPO |
$2,646.10
|
| Rate for Payer: Priority Health Medicare |
$767.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,037.80
|
| Rate for Payer: Railroad Medicare Medicare |
$760.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,676.52
|
| Rate for Payer: UHC Core |
$2,539.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.38
|
| Rate for Payer: UHC Exchange |
$760.38
|
| Rate for Payer: UHC Medicare Advantage |
$760.38
|
| Rate for Payer: VA VA |
$760.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.12
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$285.09 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: BCBS Trust/PPO |
$358.03
|
| Rate for Payer: BCN Commercial |
$338.95
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO |
$381.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.97
|
| Rate for Payer: UHC Core |
$366.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$394.74 |
| Rate for Payer: Aetna Commercial |
$372.81
|
| Rate for Payer: Aetna Medicare |
$114.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.06
|
| Rate for Payer: BCBS Complete |
$43.30
|
| Rate for Payer: BCBS MAPPO |
$109.65
|
| Rate for Payer: BCBS Trust/PPO |
$360.57
|
| Rate for Payer: BCN Commercial |
$341.01
|
| Rate for Payer: BCN Medicare Advantage |
$109.65
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.65
|
| Rate for Payer: Healthscope Commercial |
$394.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$328.95
|
| Rate for Payer: Mclaren Medicaid |
$41.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.13
|
| Rate for Payer: Meridian Medicaid |
$43.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: PACE Senior Care Partners |
$104.17
|
| Rate for Payer: PACE SWMI |
$109.65
|
| Rate for Payer: PHP Commercial |
$372.81
|
| Rate for Payer: PHP Medicare Advantage |
$109.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO |
$381.58
|
| Rate for Payer: Priority Health Medicare |
$110.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$293.86
|
| Rate for Payer: Railroad Medicare Medicare |
$109.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.97
|
| Rate for Payer: UHC Core |
$366.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.65
|
| Rate for Payer: UHC Exchange |
$109.65
|
| Rate for Payer: UHC Medicare Advantage |
$109.65
|
| Rate for Payer: UHCCP Medicaid |
$41.24
|
| Rate for Payer: VA VA |
$109.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$328.95
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: BCBS Trust/PPO |
$209.82
|
| Rate for Payer: BCN Commercial |
$198.64
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO |
$223.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$214.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$66.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.32
|
| Rate for Payer: BCBS Complete |
$34.08
|
| Rate for Payer: BCBS MAPPO |
$64.26
|
| Rate for Payer: BCBS Trust/PPO |
$211.31
|
| Rate for Payer: BCN Commercial |
$199.85
|
| Rate for Payer: BCN Medicare Advantage |
$64.26
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Mclaren Medicaid |
$32.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.47
|
| Rate for Payer: Meridian Medicaid |
$34.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: PACE Senior Care Partners |
$61.05
|
| Rate for Payer: PACE SWMI |
$64.26
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: PHP Medicare Advantage |
$64.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO |
$223.62
|
| Rate for Payer: Priority Health Medicare |
$64.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.22
|
| Rate for Payer: Railroad Medicare Medicare |
$64.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$214.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.26
|
| Rate for Payer: UHC Exchange |
$64.26
|
| Rate for Payer: UHC Medicare Advantage |
$64.26
|
| Rate for Payer: UHCCP Medicaid |
$32.46
|
| Rate for Payer: VA VA |
$64.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.44
|
| Rate for Payer: BCBS Complete |
$14.25
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.15
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.33
|
| Rate for Payer: Meridian Medicaid |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.78
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO |
$54.13
|
| Rate for Payer: Priority Health Medicare |
$15.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Core |
$51.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.56
|
| Rate for Payer: UHC Exchange |
$15.56
|
| Rate for Payer: UHC Medicare Advantage |
$15.56
|
| Rate for Payer: UHCCP Medicaid |
$13.57
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: BCBS Trust/PPO |
$50.79
|
| Rate for Payer: BCN Commercial |
$48.08
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO |
$54.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Core |
$51.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$5.55
|
| Rate for Payer: BCBS MAPPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.58
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Mclaren Medicaid |
$5.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: Meridian Medicaid |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.58
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: PHP Medicare Advantage |
$16.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.58
|
| Rate for Payer: UHC Exchange |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$16.58
|
| Rate for Payer: UHCCP Medicaid |
$5.29
|
| Rate for Payer: VA VA |
$16.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.36
|
| Rate for Payer: BCBS Trust/PPO |
$54.12
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$56.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.72
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,792.58 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: Aetna Medicare |
$517.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$622.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$622.42
|
| Rate for Payer: BCBS Complete |
$1,101.85
|
| Rate for Payer: BCBS MAPPO |
$497.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,637.43
|
| Rate for Payer: BCN Commercial |
$1,548.59
|
| Rate for Payer: BCN Medicare Advantage |
$497.94
|
| 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: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.94
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,493.82
|
| Rate for Payer: Mclaren Medicaid |
$1,049.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.84
|
| Rate for Payer: Meridian Medicaid |
$1,101.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$572.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: PACE Senior Care Partners |
$473.04
|
| Rate for Payer: PACE SWMI |
$497.94
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: PHP Medicare Advantage |
$497.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,049.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,732.83
|
| Rate for Payer: Priority Health Medicare |
$502.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,334.48
|
| Rate for Payer: Railroad Medicare Medicare |
$497.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,752.75
|
| Rate for Payer: UHC Core |
$1,663.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$497.94
|
| Rate for Payer: UHC Exchange |
$497.94
|
| Rate for Payer: UHC Medicare Advantage |
$497.94
|
| Rate for Payer: UHCCP Medicaid |
$1,049.31
|
| Rate for Payer: VA VA |
$497.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,493.82
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,294.64 |
| Max. Negotiated Rate |
$1,792.58 |
| Rate for Payer: Aetna Commercial |
$1,693.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,625.87
|
| Rate for Payer: BCN Commercial |
$1,539.23
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,712.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Healthscope Commercial |
$1,792.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,493.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: PHP Commercial |
$1,693.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,732.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,334.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,752.75
|
| Rate for Payer: UHC Core |
$1,663.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,493.82
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,705.00 |
| Max. Negotiated Rate |
$5,130.00 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,652.91
|
| Rate for Payer: BCN Commercial |
$4,404.96
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$4,902.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4,959.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,819.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,016.00
|
| Rate for Payer: UHC Core |
$4,759.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,275.00
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,353.75 |
| Max. Negotiated Rate |
$5,130.00 |
| Rate for Payer: Aetna Commercial |
$4,845.00
|
| Rate for Payer: Aetna Medicare |
$1,482.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.25
|
| Rate for Payer: BCBS Complete |
$1,523.78
|
| Rate for Payer: BCBS MAPPO |
$1,425.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,685.97
|
| Rate for Payer: BCN Commercial |
$4,431.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.00
|
| 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: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.00
|
| Rate for Payer: Healthscope Commercial |
$5,130.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,275.00
|
| Rate for Payer: Mclaren Medicaid |
$1,451.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.25
|
| Rate for Payer: Meridian Medicaid |
$1,523.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,353.75
|
| Rate for Payer: PACE SWMI |
$1,425.00
|
| Rate for Payer: PHP Commercial |
$4,845.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,451.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health HMO/PPO |
$4,959.00
|
| Rate for Payer: Priority Health Medicare |
$1,439.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,819.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,016.00
|
| Rate for Payer: UHC Core |
$4,759.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.00
|
| Rate for Payer: UHC Exchange |
$1,425.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,425.00
|
| Rate for Payer: UHCCP Medicaid |
$1,451.13
|
| Rate for Payer: VA VA |
$1,425.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,275.00
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$328.54 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: Aetna Medicare |
$94.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.08
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$91.26
|
| Rate for Payer: BCBS Trust/PPO |
$300.11
|
| Rate for Payer: BCN Commercial |
$283.83
|
| Rate for Payer: BCN Medicare Advantage |
$91.26
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.26
|
| Rate for Payer: Healthscope Commercial |
$328.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.79
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.83
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: PACE Senior Care Partners |
$86.70
|
| Rate for Payer: PACE SWMI |
$91.26
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: PHP Medicare Advantage |
$91.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health HMO/PPO |
$317.59
|
| Rate for Payer: Priority Health Medicare |
$92.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.58
|
| Rate for Payer: Railroad Medicare Medicare |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.24
|
| Rate for Payer: UHC Core |
$304.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.26
|
| Rate for Payer: UHC Exchange |
$91.26
|
| Rate for Payer: UHC Medicare Advantage |
$91.26
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$91.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.79
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$237.28 |
| Max. Negotiated Rate |
$328.54 |
| Rate for Payer: Aetna Commercial |
$310.29
|
| Rate for Payer: BCBS Trust/PPO |
$297.99
|
| Rate for Payer: BCN Commercial |
$282.11
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$313.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$328.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: PHP Commercial |
$310.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health HMO/PPO |
$317.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.24
|
| Rate for Payer: UHC Core |
$304.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.79
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.27 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: BCBS Trust/PPO |
$218.86
|
| Rate for Payer: BCN Commercial |
$207.20
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO |
$233.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.94
|
| Rate for Payer: UHC Core |
$223.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.08
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$59.71 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna Medicare |
$69.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.78
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$67.03
|
| Rate for Payer: BCBS Trust/PPO |
$220.41
|
| Rate for Payer: BCN Commercial |
$208.46
|
| Rate for Payer: BCN Medicare Advantage |
$67.03
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.03
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.08
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Senior Care Partners |
$63.68
|
| Rate for Payer: PACE SWMI |
$67.03
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: PHP Medicare Advantage |
$67.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO |
$233.26
|
| Rate for Payer: Priority Health Medicare |
$67.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: Railroad Medicare Medicare |
$67.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.94
|
| Rate for Payer: UHC Core |
$223.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.03
|
| Rate for Payer: UHC Exchange |
$67.03
|
| Rate for Payer: UHC Medicare Advantage |
$67.03
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$67.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.08
|
|
|
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 |
$59.71 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: Aetna Medicare |
$69.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.78
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$67.03
|
| Rate for Payer: BCBS Trust/PPO |
$220.41
|
| Rate for Payer: BCN Commercial |
$208.46
|
| Rate for Payer: BCN Medicare Advantage |
$67.03
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.03
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.08
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Senior Care Partners |
$63.68
|
| Rate for Payer: PACE SWMI |
$67.03
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: PHP Medicare Advantage |
$67.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO |
$233.26
|
| Rate for Payer: Priority Health Medicare |
$67.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: Railroad Medicare Medicare |
$67.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.94
|
| Rate for Payer: UHC Core |
$223.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.03
|
| Rate for Payer: UHC Exchange |
$67.03
|
| Rate for Payer: UHC Medicare Advantage |
$67.03
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$67.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.08
|
|
|
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 |
$174.27 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$227.89
|
| Rate for Payer: BCBS Trust/PPO |
$218.86
|
| Rate for Payer: BCN Commercial |
$207.20
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$230.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$241.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PHP Commercial |
$227.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO |
$233.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.94
|
| Rate for Payer: UHC Core |
$223.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.08
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
IP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$150.68 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: BCBS Trust/PPO |
$189.23
|
| Rate for Payer: BCN Commercial |
$179.14
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$60.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.44
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$57.95
|
| Rate for Payer: BCBS Trust/PPO |
$190.57
|
| Rate for Payer: BCN Commercial |
$180.23
|
| Rate for Payer: BCN Medicare Advantage |
$57.95
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.95
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Senior Care Partners |
$55.05
|
| Rate for Payer: PACE SWMI |
$57.95
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$57.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Medicare |
$58.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.95
|
| Rate for Payer: UHC Exchange |
$57.95
|
| Rate for Payer: UHC Medicare Advantage |
$57.95
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$57.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
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 |
$150.68 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: BCBS Trust/PPO |
$189.23
|
| Rate for Payer: BCN Commercial |
$179.14
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
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 |
$55.05 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$60.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.44
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$57.95
|
| Rate for Payer: BCBS Trust/PPO |
$190.57
|
| Rate for Payer: BCN Commercial |
$180.23
|
| Rate for Payer: BCN Medicare Advantage |
$57.95
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.95
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Senior Care Partners |
$55.05
|
| Rate for Payer: PACE SWMI |
$57.95
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$57.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Medicare |
$58.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.95
|
| Rate for Payer: UHC Exchange |
$57.95
|
| Rate for Payer: UHC Medicare Advantage |
$57.95
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$57.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
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 |
$55.05 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: Aetna Medicare |
$60.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.44
|
| Rate for Payer: BCBS Complete |
$62.70
|
| Rate for Payer: BCBS MAPPO |
$57.95
|
| Rate for Payer: BCBS Trust/PPO |
$190.57
|
| Rate for Payer: BCN Commercial |
$180.23
|
| Rate for Payer: BCN Medicare Advantage |
$57.95
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.95
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Mclaren Medicaid |
$59.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$62.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Senior Care Partners |
$55.05
|
| Rate for Payer: PACE SWMI |
$57.95
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: PHP Medicare Advantage |
$57.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Medicare |
$58.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.95
|
| Rate for Payer: UHC Exchange |
$57.95
|
| Rate for Payer: UHC Medicare Advantage |
$57.95
|
| Rate for Payer: UHCCP Medicaid |
$59.71
|
| Rate for Payer: VA VA |
$57.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
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 |
$150.68 |
| Max. Negotiated Rate |
$208.63 |
| Rate for Payer: Aetna Commercial |
$197.04
|
| Rate for Payer: BCBS Trust/PPO |
$189.23
|
| Rate for Payer: BCN Commercial |
$179.14
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$208.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PHP Commercial |
$197.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO |
$201.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.99
|
| Rate for Payer: UHC Core |
$193.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
