|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.94 |
| Max. Negotiated Rate |
$633.98 |
| Rate for Payer: Aetna American Axle |
$457.87
|
| Rate for Payer: Aetna Commercial |
$598.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.87
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Advantage |
$493.09
|
| Rate for Payer: Cofinity Commercial |
$605.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$633.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: PHP Commercial |
$598.76
|
| Rate for Payer: Priority Health SBD |
$443.78
|
| Rate for Payer: UMR Bronson Commercial |
$309.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.32
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$2,792.10 |
| Rate for Payer: Aetna American Axle |
$2,016.51
|
| Rate for Payer: Aetna Commercial |
$2,636.98
|
| Rate for Payer: Aetna Medicare |
$1,551.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.51
|
| Rate for Payer: BCBS Complete |
$1,240.93
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Advantage |
$2,171.63
|
| Rate for Payer: Cofinity Commercial |
$2,668.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$2,792.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,481.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: PHP Commercial |
$2,636.98
|
| Rate for Payer: Priority Health SBD |
$1,954.47
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.75
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,365.03 |
| Max. Negotiated Rate |
$2,792.10 |
| Rate for Payer: Aetna American Axle |
$2,016.51
|
| Rate for Payer: Aetna Commercial |
$2,636.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.51
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Advantage |
$2,171.63
|
| Rate for Payer: Cofinity Commercial |
$2,668.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$2,792.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,171.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,326.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: PHP Commercial |
$2,636.98
|
| Rate for Payer: Priority Health SBD |
$1,954.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,365.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,326.75
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$447.37
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.83 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna American Axle |
$290.79
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: BCBS Complete |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$65.94
|
| Rate for Payer: BCN Commercial |
$65.94
|
| Rate for Payer: BCN Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.04
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.53
|
| Rate for Payer: Mclaren Medicaid |
$57.04
|
| Rate for Payer: Mclaren Medicare |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.89
|
| Rate for Payer: Meridian Medicaid |
$59.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$171.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PACE Medicare |
$54.19
|
| Rate for Payer: PACE SWMI |
$57.04
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: PHP Medicare Advantage |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.04
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: Priority Health Tiered Network |
$45.63
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.56
|
| Rate for Payer: UHC Core |
$85.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.04
|
| Rate for Payer: UHC Exchange |
$85.56
|
| Rate for Payer: UHC Medicaid |
$29.83
|
| Rate for Payer: UHCCP Medicaid |
$29.83
|
| Rate for Payer: UMR Bronson Commercial |
$165.53
|
| Rate for Payer: VA VA |
$57.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.53
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$196.84 |
| Max. Negotiated Rate |
$402.63 |
| Rate for Payer: Aetna American Axle |
$290.79
|
| Rate for Payer: Aetna Commercial |
$380.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.79
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Advantage |
$313.16
|
| Rate for Payer: Cofinity Commercial |
$384.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Healthscope Commercial |
$402.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: PHP Commercial |
$380.26
|
| Rate for Payer: Priority Health SBD |
$281.84
|
| Rate for Payer: UMR Bronson Commercial |
$196.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.53
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$262.18
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna American Axle |
$170.42
|
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: Priority Health SBD |
$165.17
|
| Rate for Payer: UMR Bronson Commercial |
$115.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.63
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$262.18
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$235.96 |
| Rate for Payer: Aetna American Axle |
$170.42
|
| Rate for Payer: Aetna Commercial |
$222.85
|
| Rate for Payer: Aetna Medicare |
$46.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$51.90
|
| Rate for Payer: BCN Commercial |
$51.90
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Advantage |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$235.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.63
|
| Rate for Payer: Mclaren Medicaid |
$44.89
|
| Rate for Payer: Mclaren Medicare |
$44.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$47.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$134.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: PACE Medicare |
$42.65
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$222.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44.89
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health SBD |
$165.17
|
| Rate for Payer: Priority Health Tiered Network |
$35.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.34
|
| Rate for Payer: UHC Core |
$67.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.89
|
| Rate for Payer: UHC Exchange |
$67.34
|
| Rate for Payer: UHC Medicaid |
$23.48
|
| Rate for Payer: UHCCP Medicaid |
$23.48
|
| Rate for Payer: UMR Bronson Commercial |
$97.01
|
| Rate for Payer: VA VA |
$44.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.63
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna American Axle |
$41.25
|
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: UMR Bronson Commercial |
$27.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna American Axle |
$41.25
|
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$21.70
|
| Rate for Payer: BCN Commercial |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Advantage |
$44.42
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Mclaren Medicaid |
$18.77
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$28.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$39.98
|
| Rate for Payer: Priority Health Tiered Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.16
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: UMR Bronson Commercial |
$23.48
|
| Rate for Payer: VA VA |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna American Axle |
$43.96
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$7.31
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$7.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$10.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7.31
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$5.85
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$10.97
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: UMR Bronson Commercial |
$25.02
|
| Rate for Payer: VA VA |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna American Axle |
$43.96
|
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.96
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Advantage |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$893.90 |
| Max. Negotiated Rate |
$1,828.44 |
| Rate for Payer: Aetna American Axle |
$1,320.54
|
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.54
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Advantage |
$1,422.12
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,422.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: Priority Health SBD |
$1,279.91
|
| Rate for Payer: UMR Bronson Commercial |
$893.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.70
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$751.69 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna American Axle |
$1,320.54
|
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,320.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.62
|
| Rate for Payer: BCN Commercial |
$1,193.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Advantage |
$1,422.12
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,422.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.70
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health SBD |
$1,279.91
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.54
|
| Rate for Payer: UHC Core |
$1,058.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$798.42
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: UMR Bronson Commercial |
$751.69
|
| Rate for Payer: VA VA |
$1,546.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.70
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,558.16 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Aetna American Axle |
$3,779.10
|
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Advantage |
$4,069.80
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,069.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,360.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
| Rate for Payer: UMR Bronson Commercial |
$2,558.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,360.50
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna American Axle |
$3,779.10
|
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,779.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,801.50
|
| Rate for Payer: BCN Commercial |
$1,801.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Advantage |
$4,069.80
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,069.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,360.50
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health SBD |
$3,662.82
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,779.10
|
| Rate for Payer: UHC Core |
$3,029.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$2,284.90
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: UMR Bronson Commercial |
$2,151.18
|
| Rate for Payer: VA VA |
$2,082.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,360.50
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna American Axle |
$242.03
|
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.97
|
| Rate for Payer: BCN Commercial |
$222.97
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.26
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$234.58
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.03
|
| Rate for Payer: UHC Core |
$193.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$146.33
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$137.77
|
| Rate for Payer: VA VA |
$83.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.26
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$163.83 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna American Axle |
$242.03
|
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.03
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Advantage |
$260.64
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: Priority Health SBD |
$234.58
|
| Rate for Payer: UMR Bronson Commercial |
$163.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.26
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna American Axle |
$177.76
|
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: UMR Bronson Commercial |
$120.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna American Axle |
$177.76
|
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.97
|
| Rate for Payer: BCN Commercial |
$222.97
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.76
|
| Rate for Payer: UHC Core |
$142.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$107.47
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$101.18
|
| Rate for Payer: VA VA |
$83.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna American Axle |
$177.76
|
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: UMR Bronson Commercial |
$120.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna American Axle |
$177.76
|
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.97
|
| Rate for Payer: BCN Commercial |
$222.97
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Advantage |
$191.43
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$172.29
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.76
|
| Rate for Payer: UHC Core |
$142.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$107.47
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$101.18
|
| Rate for Payer: VA VA |
$83.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna American Axle |
$153.69
|
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: UMR Bronson Commercial |
$104.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna American Axle |
$153.69
|
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.97
|
| Rate for Payer: BCN Commercial |
$222.97
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.69
|
| Rate for Payer: UHC Core |
$123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$92.92
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$87.49
|
| Rate for Payer: VA VA |
$83.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$104.04 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna American Axle |
$153.69
|
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: UMR Bronson Commercial |
$104.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$43.85 |
| Max. Negotiated Rate |
$271.16 |
| Rate for Payer: Aetna American Axle |
$153.69
|
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$87.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$222.97
|
| Rate for Payer: BCN Commercial |
$222.97
|
| Rate for Payer: BCN Medicare Advantage |
$83.85
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Advantage |
$165.51
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.85
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Mclaren Medicaid |
$83.85
|
| Rate for Payer: Mclaren Medicare |
$83.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.04
|
| Rate for Payer: Meridian Medicaid |
$88.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$251.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Medicare |
$79.66
|
| Rate for Payer: PACE SWMI |
$83.85
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$83.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$271.16
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health SBD |
$148.96
|
| Rate for Payer: Priority Health Tiered Network |
$216.93
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.69
|
| Rate for Payer: UHC Core |
$123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$92.92
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$87.49
|
| Rate for Payer: VA VA |
$83.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
