|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$36.08
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$36.08 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.53
|
| Rate for Payer: ASR ASR |
$35.00
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$29.75
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$32.47
|
| Rate for Payer: Mclaren Medicaid |
$5.22
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$29.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.61
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$25.29
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$36.08
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$36.08 |
| Rate for Payer: Aetna Commercial |
$32.47
|
| Rate for Payer: ASR ASR |
$35.00
|
| Rate for Payer: BCBS Trust/PPO |
$29.63
|
| Rate for Payer: BCN Commercial |
$29.63
|
| Rate for Payer: Cash Price |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$33.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$35.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.08
|
| Rate for Payer: Mclaren Commercial |
$32.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.67
|
| Rate for Payer: Nomi Health Commercial |
$29.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.75
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$704.42
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$260.64 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: Aetna Medicare |
$260.64
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Complete |
$281.77
|
| Rate for Payer: BCBS Trust/PPO |
$580.79
|
| Rate for Payer: BCN Commercial |
$580.79
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$563.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$617.21
|
| Rate for Payer: Priority Health Narrow Network |
$493.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$704.42
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$528.32 |
| Max. Negotiated Rate |
$704.42 |
| Rate for Payer: Aetna Commercial |
$633.98
|
| Rate for Payer: ASR ASR |
$683.29
|
| Rate for Payer: BCBS Trust/PPO |
$578.47
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$563.54
|
| Rate for Payer: Cofinity Commercial |
$662.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$563.54
|
| Rate for Payer: Healthscope Commercial |
$683.29
|
| Rate for Payer: Healthscope Whirlpool |
$704.42
|
| Rate for Payer: Mclaren Commercial |
$633.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.76
|
| Rate for Payer: Nomi Health Commercial |
$577.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$619.89
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,147.86 |
| Max. Negotiated Rate |
$3,102.33 |
| Rate for Payer: Aetna Commercial |
$2,792.10
|
| Rate for Payer: Aetna Medicare |
$1,147.86
|
| Rate for Payer: ASR ASR |
$3,009.26
|
| Rate for Payer: BCBS Complete |
$1,240.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,557.87
|
| Rate for Payer: BCN Commercial |
$2,557.87
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Commercial |
$2,916.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$3,009.26
|
| Rate for Payer: Healthscope Whirlpool |
$3,102.33
|
| Rate for Payer: Mclaren Commercial |
$2,792.10
|
| 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: Nomi Health Commercial |
$2,543.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,718.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,174.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,730.05
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,102.33
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,326.75 |
| Max. Negotiated Rate |
$3,102.33 |
| Rate for Payer: Aetna Commercial |
$2,792.10
|
| Rate for Payer: ASR ASR |
$3,009.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,547.63
|
| Rate for Payer: BCN Commercial |
$2,547.63
|
| Rate for Payer: Cash Price |
$2,481.86
|
| Rate for Payer: Cofinity Commercial |
$2,916.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,481.86
|
| Rate for Payer: Healthscope Commercial |
$3,009.26
|
| Rate for Payer: Healthscope Whirlpool |
$3,102.33
|
| Rate for Payer: Mclaren Commercial |
$2,792.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,636.98
|
| Rate for Payer: Nomi Health Commercial |
$2,543.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,326.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,730.05
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$447.37
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$335.53 |
| Max. Negotiated Rate |
$447.37 |
| Rate for Payer: Aetna Commercial |
$402.63
|
| Rate for Payer: ASR ASR |
$433.95
|
| Rate for Payer: BCBS Trust/PPO |
$367.38
|
| Rate for Payer: BCN Commercial |
$367.38
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cofinity Commercial |
$420.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.90
|
| Rate for Payer: Healthscope Commercial |
$433.95
|
| Rate for Payer: Healthscope Whirlpool |
$447.37
|
| Rate for Payer: Mclaren Commercial |
$402.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.26
|
| Rate for Payer: Nomi Health Commercial |
$366.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.69
|
|
|
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 |
$447.37 |
| Rate for Payer: Aetna Commercial |
$402.63
|
| Rate for Payer: Aetna Medicare |
$57.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: ASR ASR |
$433.95
|
| Rate for Payer: BCBS Complete |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$368.86
|
| Rate for Payer: BCN Commercial |
$368.86
|
| 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 Commercial |
$420.53
|
| 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 |
$433.95
|
| Rate for Payer: Healthscope Whirlpool |
$447.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.04
|
| Rate for Payer: Mclaren Commercial |
$402.63
|
| 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 |
$31.33
|
| 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 |
$366.84
|
| 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 |
$62.74
|
| Rate for Payer: PHP Medicaid |
$30.57
|
| 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/Tiered Network |
$102.10
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health Narrow Network |
$81.68
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.04
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicaid |
$29.83
|
| Rate for Payer: UHCCP DNSP |
$57.04
|
| Rate for Payer: UHCCP Medicaid |
$29.83
|
| Rate for Payer: VA VA |
$57.04
|
|
|
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 |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: BCBS Complete |
$24.65
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$216.17
|
| Rate for Payer: BCN Commercial |
$216.17
|
| 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 Commercial |
$246.45
|
| 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 |
$254.31
|
| Rate for Payer: Healthscope Whirlpool |
$262.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$44.89
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| 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 |
$24.65
|
| 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 |
$214.99
|
| 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 |
$49.38
|
| Rate for Payer: PHP Medicaid |
$24.06
|
| 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/Tiered Network |
$32.62
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health Narrow Network |
$26.10
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.89
|
| Rate for Payer: UHC Exchange |
$69.58
|
| Rate for Payer: UHC Medicaid |
$23.48
|
| Rate for Payer: UHCCP DNSP |
$44.89
|
| Rate for Payer: UHCCP Medicaid |
$23.48
|
| Rate for Payer: VA VA |
$44.89
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$262.18
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.63 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: BCBS Trust/PPO |
$215.30
|
| Rate for Payer: BCN Commercial |
$215.30
|
| Rate for Payer: Cash Price |
$209.74
|
| Rate for Payer: Cofinity Commercial |
$246.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$254.31
|
| Rate for Payer: Healthscope Whirlpool |
$262.18
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$214.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
|
|
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 |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$52.32
|
| Rate for Payer: BCN Commercial |
$52.32
|
| 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 Commercial |
$59.65
|
| 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 |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.77
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| 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 |
$10.31
|
| 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 |
$52.04
|
| 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 |
$20.65
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| 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/Tiered Network |
$55.60
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$44.49
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$29.09
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP DNSP |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.46 |
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: ASR ASR |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$61.56
|
| Rate for Payer: Healthscope Whirlpool |
$63.46
|
| Rate for Payer: Mclaren Commercial |
$57.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
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 |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCN Commercial |
$55.76
|
| 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 Commercial |
$63.57
|
| 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 |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| 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 |
$4.01
|
| 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 |
$55.46
|
| 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 |
$8.04
|
| Rate for Payer: PHP Medicaid |
$3.92
|
| 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/Tiered Network |
$59.26
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$11.33
|
| Rate for Payer: UHC Medicaid |
$3.82
|
| Rate for Payer: UHCCP DNSP |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$3.82
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$67.63 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: ASR ASR |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.54
|
| Rate for Payer: BCN Commercial |
$55.54
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$67.63
|
| Rate for Payer: Mclaren Commercial |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.51
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$2,396.30 |
| Rate for Payer: Aetna Commercial |
$1,828.44
|
| Rate for Payer: Aetna Medicare |
$1,546.00
|
| 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: ASR ASR |
$1,970.65
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,675.05
|
| Rate for Payer: BCN Commercial |
$1,675.05
|
| 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: Cofinity Commercial |
$1,909.70
|
| 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 |
$1,970.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,031.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,546.00
|
| Rate for Payer: Mclaren Commercial |
$1,828.44
|
| 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 |
$849.06
|
| 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 |
$1,665.91
|
| 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 |
$1,700.60
|
| Rate for Payer: PHP Medicaid |
$828.66
|
| 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/Tiered Network |
$1,780.09
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Exchange |
$2,396.30
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP DNSP |
$1,546.00
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,523.70 |
| Max. Negotiated Rate |
$2,031.60 |
| Rate for Payer: Aetna Commercial |
$1,828.44
|
| Rate for Payer: ASR ASR |
$1,970.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.35
|
| Rate for Payer: BCN Commercial |
$1,668.35
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Commercial |
$1,909.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Healthscope Commercial |
$1,970.65
|
| Rate for Payer: Healthscope Whirlpool |
$2,031.60
|
| Rate for Payer: Mclaren Commercial |
$1,828.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Nomi Health Commercial |
$1,665.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.81
|
|
|
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 |
$5,814.00 |
| Rate for Payer: Aetna Commercial |
$5,232.60
|
| Rate for Payer: Aetna Medicare |
$2,082.87
|
| 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: ASR ASR |
$5,639.58
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,793.64
|
| Rate for Payer: BCN Commercial |
$4,793.64
|
| 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: Cofinity Commercial |
$5,465.16
|
| 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 |
$5,639.58
|
| Rate for Payer: Healthscope Whirlpool |
$5,814.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,082.87
|
| Rate for Payer: Mclaren Commercial |
$5,232.60
|
| 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 |
$1,143.91
|
| 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 |
$4,767.48
|
| 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 |
$2,291.16
|
| Rate for Payer: PHP Medicaid |
$1,116.42
|
| 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/Tiered Network |
$5,094.23
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Narrow Network |
$4,075.61
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,116.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Exchange |
$3,228.45
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP DNSP |
$2,082.87
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,360.50 |
| Max. Negotiated Rate |
$5,814.00 |
| Rate for Payer: Aetna Commercial |
$5,232.60
|
| Rate for Payer: ASR ASR |
$5,639.58
|
| Rate for Payer: BCBS Trust/PPO |
$4,774.46
|
| Rate for Payer: BCN Commercial |
$4,774.46
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Commercial |
$5,465.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Healthscope Commercial |
$5,639.58
|
| Rate for Payer: Healthscope Whirlpool |
$5,814.00
|
| Rate for Payer: Mclaren Commercial |
$5,232.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Nomi Health Commercial |
$4,767.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,116.32
|
|
|
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 |
$372.35 |
| Rate for Payer: Aetna Commercial |
$335.12
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$361.18
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$307.00
|
| Rate for Payer: BCN Commercial |
$307.00
|
| 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 Commercial |
$350.01
|
| 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 |
$361.18
|
| Rate for Payer: Healthscope Whirlpool |
$372.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$335.12
|
| 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 |
$46.05
|
| 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 |
$305.33
|
| 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 |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| 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/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$372.35 |
| Rate for Payer: Aetna Commercial |
$335.12
|
| Rate for Payer: ASR ASR |
$361.18
|
| Rate for Payer: BCBS Trust/PPO |
$305.77
|
| Rate for Payer: BCN Commercial |
$305.77
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Commercial |
$350.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Healthscope Commercial |
$361.18
|
| Rate for Payer: Healthscope Whirlpool |
$372.35
|
| Rate for Payer: Mclaren Commercial |
$335.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$305.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.67
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$205.10 |
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: Aetna Commercial |
$246.12
|
| Rate for Payer: ASR ASR |
$265.27
|
| Rate for Payer: BCBS Trust/PPO |
$224.57
|
| Rate for Payer: BCN Commercial |
$224.57
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$257.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$265.27
|
| Rate for Payer: Healthscope Whirlpool |
$273.47
|
| Rate for Payer: Mclaren Commercial |
$246.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.65
|
|
|
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 |
$273.47 |
| Rate for Payer: Aetna Commercial |
$246.12
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$265.27
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$225.48
|
| Rate for Payer: BCN Commercial |
$225.48
|
| 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 Commercial |
$257.06
|
| 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 |
$265.27
|
| Rate for Payer: Healthscope Whirlpool |
$273.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$246.12
|
| 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 |
$46.05
|
| 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 |
$224.25
|
| 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 |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| 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/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
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 |
$205.10 |
| Max. Negotiated Rate |
$273.47 |
| Rate for Payer: Aetna Commercial |
$246.12
|
| Rate for Payer: ASR ASR |
$265.27
|
| Rate for Payer: BCBS Trust/PPO |
$224.57
|
| Rate for Payer: BCN Commercial |
$224.57
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$257.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$265.27
|
| Rate for Payer: Healthscope Whirlpool |
$273.47
|
| Rate for Payer: Mclaren Commercial |
$246.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.65
|
|
|
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 |
$273.47 |
| Rate for Payer: Aetna Commercial |
$246.12
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$265.27
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$225.48
|
| Rate for Payer: BCN Commercial |
$225.48
|
| 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 Commercial |
$257.06
|
| 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 |
$265.27
|
| Rate for Payer: Healthscope Whirlpool |
$273.47
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$246.12
|
| 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 |
$46.05
|
| 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 |
$224.25
|
| 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 |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| 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/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
|
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 |
$236.45 |
| Rate for Payer: Aetna Commercial |
$212.81
|
| Rate for Payer: Aetna Medicare |
$83.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.81
|
| Rate for Payer: ASR ASR |
$229.36
|
| Rate for Payer: BCBS Complete |
$46.05
|
| Rate for Payer: BCBS MAPPO |
$83.85
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| 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 Commercial |
$222.26
|
| 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 |
$229.36
|
| Rate for Payer: Healthscope Whirlpool |
$236.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$83.85
|
| Rate for Payer: Mclaren Commercial |
$212.81
|
| 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 |
$46.05
|
| 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 |
$193.89
|
| 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 |
$92.23
|
| Rate for Payer: PHP Medicaid |
$44.94
|
| 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/Tiered Network |
$130.75
|
| Rate for Payer: Priority Health Medicare |
$83.85
|
| Rate for Payer: Priority Health Narrow Network |
$104.60
|
| Rate for Payer: Railroad Medicare Medicare |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.85
|
| Rate for Payer: UHC Exchange |
$129.97
|
| Rate for Payer: UHC Medicaid |
$43.85
|
| Rate for Payer: UHCCP DNSP |
$83.85
|
| Rate for Payer: UHCCP Medicaid |
$43.85
|
| Rate for Payer: VA VA |
$83.85
|
|
