|
HC BLOOD PATCH
|
Facility
|
OP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.33 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna Medicare |
$309.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.48
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$297.18
|
| Rate for Payer: BCBS Trust/PPO |
$924.25
|
| Rate for Payer: BCN Commercial |
$924.25
|
| Rate for Payer: BCN Medicare Advantage |
$297.18
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.18
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.56
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PACE Senior Care Partners |
$282.33
|
| Rate for Payer: PACE SWMI |
$297.18
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: PHP Medicare Advantage |
$297.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.20
|
| Rate for Payer: Priority Health Medicare |
$297.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.01
|
| Rate for Payer: Railroad Medicare Medicare |
$297.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.09
|
| Rate for Payer: UHC Core |
$992.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.18
|
| Rate for Payer: UHC Medicare Advantage |
$306.10
|
| Rate for Payer: VA VA |
$297.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.56
|
|
|
HC BLOOD PATCH
|
Facility
|
IP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
45000033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.01 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: BCBS Trust/PPO |
$918.66
|
| Rate for Payer: BCN Commercial |
$918.66
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.99
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.09
|
| Rate for Payer: UHC Core |
$992.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.56
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
IP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.01 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: BCBS Trust/PPO |
$918.66
|
| Rate for Payer: BCN Commercial |
$918.66
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.99
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.09
|
| Rate for Payer: UHC Core |
$992.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.56
|
|
|
HC BLOOD PATCH PROCEDURE
|
Facility
|
OP
|
$1,188.74
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
36100280
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.33 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$1,010.43
|
| Rate for Payer: Aetna Medicare |
$309.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$371.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$371.48
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$297.18
|
| Rate for Payer: BCBS Trust/PPO |
$924.25
|
| Rate for Payer: BCN Commercial |
$924.25
|
| Rate for Payer: BCN Medicare Advantage |
$297.18
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cash Price |
$950.99
|
| Rate for Payer: Cofinity Commercial |
$1,022.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$950.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.18
|
| Rate for Payer: Healthscope Commercial |
$1,069.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$891.56
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$312.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,010.43
|
| Rate for Payer: PACE Senior Care Partners |
$282.33
|
| Rate for Payer: PACE SWMI |
$297.18
|
| Rate for Payer: PHP Commercial |
$1,010.43
|
| Rate for Payer: PHP Medicare Advantage |
$297.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$832.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.20
|
| Rate for Payer: Priority Health Medicare |
$297.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$725.01
|
| Rate for Payer: Railroad Medicare Medicare |
$297.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,046.09
|
| Rate for Payer: UHC Core |
$992.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.18
|
| Rate for Payer: UHC Medicare Advantage |
$306.10
|
| Rate for Payer: VA VA |
$297.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$891.56
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
OP
|
$22.60
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.06
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS MAPPO |
$5.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.57
|
| Rate for Payer: BCN Commercial |
$17.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.65
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.95
|
| Rate for Payer: Mclaren Medicaid |
$2.53
|
| Rate for Payer: Meridian Medicaid |
$2.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.21
|
| Rate for Payer: PACE Senior Care Partners |
$5.37
|
| Rate for Payer: PACE SWMI |
$5.65
|
| Rate for Payer: PHP Commercial |
$19.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.66
|
| Rate for Payer: Priority Health Medicare |
$5.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.89
|
| Rate for Payer: UHC Core |
$18.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.65
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: VA VA |
$5.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.95
|
|
|
HC BLOOD SMEAR EXAM
|
Facility
|
IP
|
$22.60
|
|
|
Service Code
|
CPT 85008
|
| Hospital Charge Code |
30500003
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$20.34 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.47
|
| Rate for Payer: BCN Commercial |
$17.47
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.08
|
| Rate for Payer: Healthscope Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.21
|
| Rate for Payer: PHP Commercial |
$19.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.89
|
| Rate for Payer: UHC Core |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.95
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
OP
|
$243.92
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$219.53 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: Aetna Medicare |
$63.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.22
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$60.98
|
| Rate for Payer: BCBS Trust/PPO |
$189.65
|
| Rate for Payer: BCN Commercial |
$189.65
|
| Rate for Payer: BCN Medicare Advantage |
$60.98
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.94
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PACE Senior Care Partners |
$57.93
|
| Rate for Payer: PACE SWMI |
$60.98
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$60.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.21
|
| Rate for Payer: Priority Health Medicare |
$60.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: Railroad Medicare Medicare |
$60.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.65
|
| Rate for Payer: UHC Core |
$203.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.98
|
| Rate for Payer: UHC Medicare Advantage |
$62.81
|
| Rate for Payer: VA VA |
$60.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.94
|
|
|
HC BLOOD SPLIT CRYOPRECIPITATE UNIT
|
Facility
|
IP
|
$243.92
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000094
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$148.77 |
| Max. Negotiated Rate |
$219.53 |
| Rate for Payer: Aetna Commercial |
$207.33
|
| Rate for Payer: BCBS Trust/PPO |
$188.50
|
| Rate for Payer: BCN Commercial |
$188.50
|
| Rate for Payer: Cash Price |
$195.14
|
| Rate for Payer: Cofinity Commercial |
$209.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.14
|
| Rate for Payer: Healthscope Commercial |
$219.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.33
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.65
|
| Rate for Payer: UHC Core |
$203.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.94
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
IP
|
$45.52
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$40.97 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: BCBS Trust/PPO |
$35.18
|
| Rate for Payer: BCN Commercial |
$35.18
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$39.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.69
|
| Rate for Payer: PHP Commercial |
$38.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.06
|
| Rate for Payer: UHC Core |
$38.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.14
|
|
|
HC BLOOD SPLIT FFP UNIT
|
Facility
|
OP
|
$45.52
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000091
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$107.77 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: Aetna Medicare |
$11.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.22
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$35.39
|
| Rate for Payer: BCN Commercial |
$35.39
|
| Rate for Payer: BCN Medicare Advantage |
$11.38
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$39.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.38
|
| Rate for Payer: Healthscope Commercial |
$40.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.14
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.69
|
| Rate for Payer: PACE Senior Care Partners |
$10.81
|
| Rate for Payer: PACE SWMI |
$11.38
|
| Rate for Payer: PHP Commercial |
$38.69
|
| Rate for Payer: PHP Medicare Advantage |
$11.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.60
|
| Rate for Payer: Priority Health Medicare |
$11.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.06
|
| Rate for Payer: UHC Core |
$38.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.38
|
| Rate for Payer: UHC Medicare Advantage |
$11.72
|
| Rate for Payer: VA VA |
$11.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.14
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
IP
|
$351.55
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$214.41 |
| Max. Negotiated Rate |
$316.40 |
| Rate for Payer: Aetna Commercial |
$298.82
|
| Rate for Payer: BCBS Trust/PPO |
$271.68
|
| Rate for Payer: BCN Commercial |
$271.68
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.24
|
| Rate for Payer: Healthscope Commercial |
$316.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.82
|
| Rate for Payer: PHP Commercial |
$298.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.36
|
| Rate for Payer: UHC Core |
$293.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.66
|
|
|
HC BLOOD SPLIT LVDS PLT UNIT
|
Facility
|
OP
|
$351.55
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000092
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$316.40 |
| Rate for Payer: Aetna Commercial |
$298.82
|
| Rate for Payer: Aetna Medicare |
$91.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.86
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$273.33
|
| Rate for Payer: BCN Commercial |
$273.33
|
| Rate for Payer: BCN Medicare Advantage |
$87.89
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cash Price |
$281.24
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.89
|
| Rate for Payer: Healthscope Commercial |
$316.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.66
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.82
|
| Rate for Payer: PACE Senior Care Partners |
$83.49
|
| Rate for Payer: PACE SWMI |
$87.89
|
| Rate for Payer: PHP Commercial |
$298.82
|
| Rate for Payer: PHP Medicare Advantage |
$87.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.85
|
| Rate for Payer: Priority Health Medicare |
$87.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.41
|
| Rate for Payer: Railroad Medicare Medicare |
$87.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.36
|
| Rate for Payer: UHC Core |
$293.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.89
|
| Rate for Payer: UHC Medicare Advantage |
$90.52
|
| Rate for Payer: VA VA |
$87.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.66
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
IP
|
$294.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$179.79 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$250.56
|
| Rate for Payer: BCBS Trust/PPO |
$227.81
|
| Rate for Payer: BCN Commercial |
$227.81
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.82
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.56
|
| Rate for Payer: PHP Commercial |
$250.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.41
|
| Rate for Payer: UHC Core |
$246.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.08
|
|
|
HC BLOOD SPLIT PSORALEN PLT UNIT
|
Facility
|
OP
|
$294.78
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000093
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$70.01 |
| Max. Negotiated Rate |
$265.30 |
| Rate for Payer: Aetna Commercial |
$250.56
|
| Rate for Payer: Aetna Medicare |
$76.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.12
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$73.70
|
| Rate for Payer: BCBS Trust/PPO |
$229.19
|
| Rate for Payer: BCN Commercial |
$229.19
|
| Rate for Payer: BCN Medicare Advantage |
$73.70
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cash Price |
$235.82
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.70
|
| Rate for Payer: Healthscope Commercial |
$265.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.08
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.56
|
| Rate for Payer: PACE Senior Care Partners |
$70.01
|
| Rate for Payer: PACE SWMI |
$73.70
|
| Rate for Payer: PHP Commercial |
$250.56
|
| Rate for Payer: PHP Medicare Advantage |
$73.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.46
|
| Rate for Payer: Priority Health Medicare |
$73.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.79
|
| Rate for Payer: Railroad Medicare Medicare |
$73.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.41
|
| Rate for Payer: UHC Core |
$246.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.70
|
| Rate for Payer: UHC Medicare Advantage |
$75.91
|
| Rate for Payer: VA VA |
$73.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.08
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
IP
|
$80.08
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$48.84 |
| Max. Negotiated Rate |
$72.07 |
| Rate for Payer: Aetna Commercial |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$61.89
|
| Rate for Payer: BCN Commercial |
$61.89
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$68.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.06
|
| Rate for Payer: Healthscope Commercial |
$72.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.07
|
| Rate for Payer: PHP Commercial |
$68.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.47
|
| Rate for Payer: UHC Core |
$66.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.06
|
|
|
HC BLOOD SPLIT RBC UNIT
|
Facility
|
OP
|
$80.08
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000090
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$107.77 |
| Rate for Payer: Aetna Commercial |
$68.07
|
| Rate for Payer: Aetna Medicare |
$20.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.02
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$20.02
|
| Rate for Payer: BCBS Trust/PPO |
$62.26
|
| Rate for Payer: BCN Commercial |
$62.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.02
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Cofinity Commercial |
$68.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$72.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.06
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.07
|
| Rate for Payer: PACE Senior Care Partners |
$19.02
|
| Rate for Payer: PACE SWMI |
$20.02
|
| Rate for Payer: PHP Commercial |
$68.07
|
| Rate for Payer: PHP Medicare Advantage |
$20.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.67
|
| Rate for Payer: Priority Health Medicare |
$20.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.84
|
| Rate for Payer: Railroad Medicare Medicare |
$20.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.47
|
| Rate for Payer: UHC Core |
$66.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.02
|
| Rate for Payer: UHC Medicare Advantage |
$20.62
|
| Rate for Payer: VA VA |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.06
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
OP
|
$101.62
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$107.77 |
| Rate for Payer: Aetna Commercial |
$86.38
|
| Rate for Payer: Aetna Medicare |
$26.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.76
|
| Rate for Payer: BCBS Complete |
$107.77
|
| Rate for Payer: BCBS MAPPO |
$25.40
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: BCN Commercial |
$79.01
|
| Rate for Payer: BCN Medicare Advantage |
$25.40
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$87.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$91.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.22
|
| Rate for Payer: Mclaren Medicaid |
$102.63
|
| Rate for Payer: Meridian Medicaid |
$107.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.38
|
| Rate for Payer: PACE Senior Care Partners |
$24.13
|
| Rate for Payer: PACE SWMI |
$25.40
|
| Rate for Payer: PHP Commercial |
$86.38
|
| Rate for Payer: PHP Medicare Advantage |
$25.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.41
|
| Rate for Payer: Priority Health Medicare |
$25.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.98
|
| Rate for Payer: Railroad Medicare Medicare |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.43
|
| Rate for Payer: UHC Core |
$84.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.40
|
| Rate for Payer: UHC Medicare Advantage |
$26.17
|
| Rate for Payer: VA VA |
$25.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.22
|
|
|
HC BLOOD SPLIT WASHED RBC UNIT
|
Facility
|
IP
|
$101.62
|
|
|
Service Code
|
HCPCS P9011
|
| Hospital Charge Code |
39000095
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$91.46 |
| Rate for Payer: Aetna Commercial |
$86.38
|
| Rate for Payer: BCBS Trust/PPO |
$78.53
|
| Rate for Payer: BCN Commercial |
$78.53
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cofinity Commercial |
$87.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.30
|
| Rate for Payer: Healthscope Commercial |
$91.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.38
|
| Rate for Payer: PHP Commercial |
$86.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.43
|
| Rate for Payer: UHC Core |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.22
|
|
|
HC BLOOD TYPING RH
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.82
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.18
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
HC BLOOD TYPING RH
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
30200348
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$914.85 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.20
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,305.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.00
|
| Rate for Payer: UHC Core |
$1,252.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
HC BLOOD (WHOLE) FOR TRANSFUSION PER UNIT
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS P9010
|
| Hospital Charge Code |
39000089
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$139.84 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: Aetna Commercial |
$1,275.00
|
| Rate for Payer: Aetna Medicare |
$390.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$468.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$468.75
|
| Rate for Payer: BCBS Complete |
$146.83
|
| Rate for Payer: BCBS MAPPO |
$375.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.25
|
| Rate for Payer: BCN Commercial |
$1,166.25
|
| Rate for Payer: BCN Medicare Advantage |
$375.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,290.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.00
|
| Rate for Payer: Healthscope Commercial |
$1,350.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,125.00
|
| Rate for Payer: Mclaren Medicaid |
$139.84
|
| Rate for Payer: Meridian Medicaid |
$146.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$393.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$431.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,275.00
|
| Rate for Payer: PACE Senior Care Partners |
$356.25
|
| Rate for Payer: PACE SWMI |
$375.00
|
| Rate for Payer: PHP Commercial |
$1,275.00
|
| Rate for Payer: PHP Medicare Advantage |
$375.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,305.00
|
| Rate for Payer: Priority Health Medicare |
$375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$914.85
|
| Rate for Payer: Railroad Medicare Medicare |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.00
|
| Rate for Payer: UHC Core |
$1,252.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.00
|
| Rate for Payer: UHC Medicare Advantage |
$386.25
|
| Rate for Payer: VA VA |
$375.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,125.00
|
|
|
HC B.NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30100562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$92.22 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: BCBS Trust/PPO |
$116.85
|
| Rate for Payer: BCN Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.06
|
| Rate for Payer: UHC Core |
$126.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
HC B.NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30100562
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$39.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.25
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS MAPPO |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$117.56
|
| Rate for Payer: BCN Commercial |
$117.56
|
| Rate for Payer: BCN Medicare Advantage |
$37.80
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.80
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Mclaren Medicaid |
$28.97
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PACE Senior Care Partners |
$35.91
|
| Rate for Payer: PACE SWMI |
$37.80
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: PHP Medicare Advantage |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.54
|
| Rate for Payer: Priority Health Medicare |
$37.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: Railroad Medicare Medicare |
$37.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.06
|
| Rate for Payer: UHC Core |
$126.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.80
|
| Rate for Payer: UHC Medicare Advantage |
$38.93
|
| Rate for Payer: VA VA |
$37.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
HC BONE CEMENT
|
Facility
|
OP
|
$1,995.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27800095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.94 |
| Max. Negotiated Rate |
$1,795.97 |
| Rate for Payer: Aetna Commercial |
$1,696.19
|
| Rate for Payer: Aetna Medicare |
$518.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.60
|
| Rate for Payer: BCBS Complete |
$798.21
|
| Rate for Payer: BCBS MAPPO |
$498.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.52
|
| Rate for Payer: BCN Commercial |
$1,551.52
|
| Rate for Payer: BCN Medicare Advantage |
$498.88
|
| Rate for Payer: Cash Price |
$1,596.42
|
| Rate for Payer: Cofinity Commercial |
$1,716.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,596.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.88
|
| Rate for Payer: Healthscope Commercial |
$1,795.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,496.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,696.19
|
| Rate for Payer: PACE Senior Care Partners |
$473.94
|
| Rate for Payer: PACE SWMI |
$498.88
|
| Rate for Payer: PHP Commercial |
$1,696.19
|
| Rate for Payer: PHP Medicare Advantage |
$498.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,736.10
|
| Rate for Payer: Priority Health Medicare |
$498.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,217.07
|
| Rate for Payer: Railroad Medicare Medicare |
$498.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,756.06
|
| Rate for Payer: UHC Core |
$1,666.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.85
|
| Rate for Payer: VA VA |
$498.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,496.64
|
|
