|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$231.34
|
| Rate for Payer: ASR ASR |
$249.33
|
| Rate for Payer: ASR Commercial |
$249.33
|
| Rate for Payer: BCBS Trust/PPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$199.28
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$241.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Healthscope Whirlpool |
$249.33
|
| Rate for Payer: Mclaren Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.20
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$50.70
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| 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 |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.77
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| 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 |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| 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 |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.52
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$43.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Exchange |
$29.09
|
| Rate for Payer: UHC Medicare Advantage |
$18.77
|
| Rate for Payer: UHCCP DNSP |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$10.06
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| 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 |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| 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 |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| 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 |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.09
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Exchange |
$11.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UHCCP DNSP |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$3.92
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
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 |
$1,991.76 |
| Rate for Payer: Aetna Commercial |
$1,792.58
|
| Rate for Payer: ASR ASR |
$1,932.01
|
| Rate for Payer: ASR Commercial |
$1,932.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.09
|
| Rate for Payer: BCN Commercial |
$1,544.21
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,872.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Healthscope Commercial |
$1,991.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.01
|
| Rate for Payer: Mclaren Commercial |
$1,792.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,752.75
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$2,239.22 |
| Rate for Payer: Aetna Commercial |
$1,792.58
|
| Rate for Payer: Aetna Medicare |
$1,444.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: ASR ASR |
$1,932.01
|
| Rate for Payer: ASR Commercial |
$1,932.01
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.05
|
| Rate for Payer: BCN Commercial |
$1,544.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,872.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Healthscope Commercial |
$1,991.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,444.66
|
| Rate for Payer: Mclaren Commercial |
$1,792.58
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Commercial |
$1,589.13
|
| Rate for Payer: PHP Medicaid |
$774.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,745.18
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,396.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,752.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,239.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP DNSP |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,070.86 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare |
$1,997.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,497.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,497.34
|
| Rate for Payer: ASR ASR |
$5,529.00
|
| Rate for Payer: ASR Commercial |
$5,529.00
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,997.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,667.73
|
| Rate for Payer: BCN Commercial |
$4,419.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,997.87
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,358.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,997.87
|
| Rate for Payer: Healthscope Commercial |
$5,700.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,529.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,997.87
|
| Rate for Payer: Mclaren Commercial |
$5,130.00
|
| Rate for Payer: Mclaren Medicaid |
$1,070.86
|
| Rate for Payer: Mclaren Medicare |
$1,997.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,097.76
|
| Rate for Payer: Meridian Medicaid |
$1,124.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,297.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: PACE Medicare |
$1,897.98
|
| Rate for Payer: PACE SWMI |
$1,997.87
|
| Rate for Payer: PHP Commercial |
$2,197.66
|
| Rate for Payer: PHP Medicaid |
$1,070.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,997.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,070.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,994.34
|
| Rate for Payer: Priority Health Medicare |
$1,997.87
|
| Rate for Payer: Priority Health Narrow Network |
$3,995.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,997.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,016.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,997.87
|
| Rate for Payer: UHC Exchange |
$3,096.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,997.87
|
| Rate for Payer: UHCCP DNSP |
$1,997.87
|
| Rate for Payer: UHCCP Medicaid |
$1,070.86
|
| Rate for Payer: VA VA |
$1,997.87
|
|
|
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 |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: ASR ASR |
$5,529.00
|
| Rate for Payer: ASR Commercial |
$5,529.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,644.93
|
| Rate for Payer: BCN Commercial |
$4,419.21
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,358.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Healthscope Commercial |
$5,700.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,529.00
|
| Rate for Payer: Mclaren Commercial |
$5,130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,016.00
|
|
|
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 |
$365.05 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: ASR ASR |
$354.10
|
| Rate for Payer: ASR Commercial |
$354.10
|
| Rate for Payer: BCBS Trust/PPO |
$297.48
|
| Rate for Payer: BCN Commercial |
$283.02
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$343.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$365.05
|
| Rate for Payer: Healthscope Whirlpool |
$354.10
|
| Rate for Payer: Mclaren Commercial |
$328.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.24
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$365.05 |
| Rate for Payer: Aetna Commercial |
$328.55
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$354.10
|
| Rate for Payer: ASR Commercial |
$354.10
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$298.94
|
| Rate for Payer: BCN Commercial |
$283.02
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$343.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$365.05
|
| Rate for Payer: Healthscope Whirlpool |
$354.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$328.55
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.86
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$255.90
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$219.56
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.92
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$187.95
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
|
|
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 |
$44.06 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$219.56
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.92
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$187.95
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
|
|
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 |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Trust/PPO |
$188.90
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$231.81
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$189.83
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.11
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$162.50
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Trust/PPO |
$188.90
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
|
|
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 |
$44.06 |
| Max. Negotiated Rate |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$189.83
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.11
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$162.50
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$44.06 |
| Max. Negotiated Rate |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$189.83
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.11
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$162.50
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$231.81 |
| Rate for Payer: Aetna Commercial |
$208.63
|
| Rate for Payer: ASR ASR |
$224.86
|
| Rate for Payer: ASR Commercial |
$224.86
|
| Rate for Payer: BCBS Trust/PPO |
$188.90
|
| Rate for Payer: BCN Commercial |
$179.72
|
| Rate for Payer: Cash Price |
$185.45
|
| Rate for Payer: Cofinity Commercial |
$217.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.45
|
| Rate for Payer: Healthscope Commercial |
$231.81
|
| Rate for Payer: Healthscope Whirlpool |
$224.86
|
| Rate for Payer: Mclaren Commercial |
$208.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.04
|
| Rate for Payer: Nomi Health Commercial |
$190.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.99
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$96.59
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.06 |
| Max. Negotiated Rate |
$127.43 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: Aetna Medicare |
$82.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.76
|
| Rate for Payer: ASR ASR |
$93.69
|
| Rate for Payer: ASR Commercial |
$93.69
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: BCBS MAPPO |
$82.21
|
| Rate for Payer: BCBS Trust/PPO |
$79.10
|
| Rate for Payer: BCN Commercial |
$74.89
|
| Rate for Payer: BCN Medicare Advantage |
$82.21
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$90.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.21
|
| Rate for Payer: Healthscope Commercial |
$96.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.21
|
| Rate for Payer: Mclaren Commercial |
$86.93
|
| Rate for Payer: Mclaren Medicaid |
$44.06
|
| Rate for Payer: Mclaren Medicare |
$82.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.32
|
| Rate for Payer: Meridian Medicaid |
$46.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: Nomi Health Commercial |
$79.20
|
| Rate for Payer: PACE Medicare |
$78.10
|
| Rate for Payer: PACE SWMI |
$82.21
|
| Rate for Payer: PHP Commercial |
$90.43
|
| Rate for Payer: PHP Medicaid |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$82.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.63
|
| Rate for Payer: Priority Health Medicare |
$82.21
|
| Rate for Payer: Priority Health Narrow Network |
$67.71
|
| Rate for Payer: Railroad Medicare Medicare |
$82.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.21
|
| Rate for Payer: UHC Exchange |
$127.43
|
| Rate for Payer: UHC Medicare Advantage |
$82.21
|
| Rate for Payer: UHCCP DNSP |
$82.21
|
| Rate for Payer: UHCCP Medicaid |
$44.06
|
| Rate for Payer: VA VA |
$82.21
|
|
|
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 |
$96.59 |
| Rate for Payer: Aetna Commercial |
$86.93
|
| Rate for Payer: ASR ASR |
$93.69
|
| Rate for Payer: ASR Commercial |
$93.69
|
| Rate for Payer: BCBS Trust/PPO |
$78.71
|
| Rate for Payer: BCN Commercial |
$74.89
|
| Rate for Payer: Cash Price |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$90.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$96.59
|
| Rate for Payer: Healthscope Whirlpool |
$93.69
|
| Rate for Payer: Mclaren Commercial |
$86.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.10
|
| Rate for Payer: Nomi Health Commercial |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.00
|
|
|
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 |
$127.03 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: ASR ASR |
$123.22
|
| Rate for Payer: ASR Commercial |
$123.22
|
| Rate for Payer: BCBS Trust/PPO |
$103.52
|
| Rate for Payer: BCN Commercial |
$98.49
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Healthscope Commercial |
$127.03
|
| Rate for Payer: Healthscope Whirlpool |
$123.22
|
| Rate for Payer: Mclaren Commercial |
$114.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.79
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$127.03
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$82.57 |
| Max. Negotiated Rate |
$259.04 |
| Rate for Payer: Aetna Commercial |
$114.33
|
| Rate for Payer: Aetna Medicare |
$167.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.90
|
| Rate for Payer: ASR ASR |
$123.22
|
| Rate for Payer: ASR Commercial |
$123.22
|
| Rate for Payer: BCBS Complete |
$94.06
|
| Rate for Payer: BCBS MAPPO |
$167.12
|
| Rate for Payer: BCBS Trust/PPO |
$104.02
|
| Rate for Payer: BCN Commercial |
$98.49
|
| Rate for Payer: BCN Medicare Advantage |
$167.12
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cash Price |
$101.62
|
| Rate for Payer: Cofinity Commercial |
$119.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.12
|
| Rate for Payer: Healthscope Commercial |
$127.03
|
| Rate for Payer: Healthscope Whirlpool |
$123.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$167.12
|
| Rate for Payer: Mclaren Commercial |
$114.33
|
| Rate for Payer: Mclaren Medicaid |
$89.58
|
| Rate for Payer: Mclaren Medicare |
$167.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.48
|
| Rate for Payer: Meridian Medicaid |
$94.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$104.16
|
| Rate for Payer: PACE Medicare |
$158.76
|
| Rate for Payer: PACE SWMI |
$167.12
|
| Rate for Payer: PHP Commercial |
$183.83
|
| Rate for Payer: PHP Medicaid |
$89.58
|
| Rate for Payer: PHP Medicare Advantage |
$167.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.30
|
| Rate for Payer: Priority Health Medicare |
$167.12
|
| Rate for Payer: Priority Health Narrow Network |
$89.05
|
| Rate for Payer: Railroad Medicare Medicare |
$167.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$167.12
|
| Rate for Payer: UHC Exchange |
$259.04
|
| Rate for Payer: UHC Medicare Advantage |
$167.12
|
| Rate for Payer: UHCCP DNSP |
$167.12
|
| Rate for Payer: UHCCP Medicaid |
$89.58
|
| Rate for Payer: VA VA |
$167.12
|
|
