|
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 |
$1,124.59
|
| 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 |
$1,070.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.84
|
| Rate for Payer: Meridian Medicaid |
$1,124.59
|
| 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 |
$1,070.97
|
| 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 |
$1,070.97
|
| 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 |
$1,555.23
|
| 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 |
$1,481.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,496.25
|
| Rate for Payer: Meridian Medicaid |
$1,555.23
|
| 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 |
$1,481.07
|
| 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 |
$1,481.07
|
| 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
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$237.28 |
| Max. Negotiated Rate |
$328.55 |
| 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 |
$328.55
|
| 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
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$328.55 |
| 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 |
$63.99
|
| 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 |
$328.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.79
|
| Rate for Payer: Mclaren Medicaid |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.83
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| Rate for Payer: VA VA |
$91.26
|
| 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 |
$60.94 |
| 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 |
$63.99
|
| 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 |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| 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 |
$60.94 |
| 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 |
$63.99
|
| 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 |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| 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 |
$63.99
|
| 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 |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| 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 |
$63.99
|
| 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 |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| 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
|
|
|
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 |
$63.99
|
| 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 |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.85
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| 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 |
$60.94
|
| 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 |
$60.94
|
| Rate for Payer: VA VA |
$57.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.86
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
IP
|
$96.59
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$86.93 |
| Rate for Payer: Aetna Commercial |
$82.10
|
| Rate for Payer: BCBS Trust/PPO |
$78.85
|
| Rate for Payer: BCN Commercial |
$74.64
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$83.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$86.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: Nomi Health Commercial |
$79.20
|
| Rate for Payer: PHP Commercial |
$82.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: Priority Health HMO/PPO |
$84.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.00
|
| Rate for Payer: UHC Core |
$80.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.44
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$96.59
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$86.93 |
| Rate for Payer: Aetna Commercial |
$82.10
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.18
|
| Rate for Payer: BCBS Complete |
$63.99
|
| Rate for Payer: BCBS MAPPO |
$24.15
|
| Rate for Payer: BCBS Trust/PPO |
$79.41
|
| Rate for Payer: BCN Commercial |
$75.10
|
| Rate for Payer: BCN Medicare Advantage |
$24.15
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$83.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.15
|
| Rate for Payer: Healthscope Commercial |
$86.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.44
|
| Rate for Payer: Mclaren Medicaid |
$60.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$63.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: Nomi Health Commercial |
$79.20
|
| Rate for Payer: PACE Senior Care Partners |
$22.94
|
| Rate for Payer: PACE SWMI |
$24.15
|
| Rate for Payer: PHP Commercial |
$82.10
|
| Rate for Payer: PHP Medicare Advantage |
$24.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: Priority Health HMO/PPO |
$84.03
|
| Rate for Payer: Priority Health Medicare |
$24.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.72
|
| Rate for Payer: Railroad Medicare Medicare |
$24.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.00
|
| Rate for Payer: UHC Core |
$80.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.15
|
| Rate for Payer: UHC Exchange |
$24.15
|
| Rate for Payer: UHC Medicare Advantage |
$24.15
|
| Rate for Payer: UHCCP Medicaid |
$60.94
|
| Rate for Payer: VA VA |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.44
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$127.03
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.17 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$107.98
|
| Rate for Payer: Aetna Medicare |
$33.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.70
|
| Rate for Payer: BCBS Complete |
$130.10
|
| Rate for Payer: BCBS MAPPO |
$31.76
|
| Rate for Payer: BCBS Trust/PPO |
$104.43
|
| Rate for Payer: BCN Commercial |
$98.77
|
| Rate for Payer: BCN Medicare Advantage |
$31.76
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$109.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.76
|
| Rate for Payer: Healthscope Commercial |
$114.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.27
|
| Rate for Payer: Mclaren Medicaid |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.35
|
| Rate for Payer: Meridian Medicaid |
$130.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: PACE Senior Care Partners |
$30.17
|
| Rate for Payer: PACE SWMI |
$31.76
|
| Rate for Payer: PHP Commercial |
$107.98
|
| Rate for Payer: PHP Medicare Advantage |
$31.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.57
|
| Rate for Payer: Priority Health HMO/PPO |
$110.52
|
| Rate for Payer: Priority Health Medicare |
$32.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.11
|
| Rate for Payer: Railroad Medicare Medicare |
$31.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.79
|
| Rate for Payer: UHC Core |
$106.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.76
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$31.76
|
| Rate for Payer: UHCCP Medicaid |
$123.89
|
| Rate for Payer: VA VA |
$31.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.27
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$127.03
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.57 |
| Max. Negotiated Rate |
$114.33 |
| Rate for Payer: Aetna Commercial |
$107.98
|
| Rate for Payer: BCBS Trust/PPO |
$103.69
|
| Rate for Payer: BCN Commercial |
$98.17
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$109.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Healthscope Commercial |
$114.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: PHP Commercial |
$107.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.57
|
| Rate for Payer: Priority Health HMO/PPO |
$110.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.79
|
| Rate for Payer: UHC Core |
$106.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.27
|
|
|
HC FRUCTOSAMINE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC FRUCTOSAMINE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$12.72
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$12.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$12.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$12.12
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC FRUCTOSE SEMEN
|
Facility
|
OP
|
$96.80
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
30100206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.54 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Aetna Commercial |
$82.28
|
| Rate for Payer: Aetna Medicare |
$25.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.25
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS MAPPO |
$24.20
|
| Rate for Payer: BCBS Trust/PPO |
$79.58
|
| Rate for Payer: BCN Commercial |
$75.26
|
| Rate for Payer: BCN Medicare Advantage |
$24.20
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cofinity Commercial |
$83.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.20
|
| Rate for Payer: Healthscope Commercial |
$87.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.60
|
| Rate for Payer: Mclaren Medicaid |
$12.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.41
|
| Rate for Payer: Meridian Medicaid |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.28
|
| Rate for Payer: Nomi Health Commercial |
$79.38
|
| Rate for Payer: PACE Senior Care Partners |
$22.99
|
| Rate for Payer: PACE SWMI |
$24.20
|
| Rate for Payer: PHP Commercial |
$82.28
|
| Rate for Payer: PHP Medicare Advantage |
$24.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.92
|
| Rate for Payer: Priority Health HMO/PPO |
$84.22
|
| Rate for Payer: Priority Health Medicare |
$24.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.86
|
| Rate for Payer: Railroad Medicare Medicare |
$24.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.18
|
| Rate for Payer: UHC Core |
$80.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.20
|
| Rate for Payer: UHC Exchange |
$24.20
|
| Rate for Payer: UHC Medicare Advantage |
$24.20
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: VA VA |
$24.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.60
|
|
|
HC FRUCTOSE SEMEN
|
Facility
|
IP
|
$96.80
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
30100206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$87.12 |
| Rate for Payer: Aetna Commercial |
$82.28
|
| Rate for Payer: BCBS Trust/PPO |
$79.02
|
| Rate for Payer: BCN Commercial |
$74.81
|
| Rate for Payer: Cash Price |
$77.44
|
| Rate for Payer: Cofinity Commercial |
$83.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.44
|
| Rate for Payer: Healthscope Commercial |
$87.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.28
|
| Rate for Payer: Nomi Health Commercial |
$79.38
|
| Rate for Payer: PHP Commercial |
$82.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.92
|
| Rate for Payer: Priority Health HMO/PPO |
$84.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.18
|
| Rate for Payer: UHC Core |
$80.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.60
|
|
|
HC F/U EP STUDY
|
Facility
|
IP
|
$5,613.56
|
|
|
Service Code
|
CPT 93624
|
| Hospital Charge Code |
48100040
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,648.81 |
| Max. Negotiated Rate |
$5,052.20 |
| Rate for Payer: Aetna Commercial |
$4,771.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,582.35
|
| Rate for Payer: BCN Commercial |
$4,338.16
|
| Rate for Payer: Cash Price |
$4,490.85
|
| Rate for Payer: Cofinity Commercial |
$4,827.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,490.85
|
| Rate for Payer: Healthscope Commercial |
$5,052.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,210.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,771.53
|
| Rate for Payer: Nomi Health Commercial |
$4,603.12
|
| Rate for Payer: PHP Commercial |
$4,771.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,648.81
|
| Rate for Payer: Priority Health HMO/PPO |
$4,883.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,761.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,939.93
|
| Rate for Payer: UHC Core |
$4,687.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,210.17
|
|
