|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
IP
|
$359.40
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: BCBS Trust/PPO |
$277.74
|
| Rate for Payer: BCN Commercial |
$277.74
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.27
|
| Rate for Payer: UHC Core |
$300.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.55
|
|
|
HC FORESKIN MANIP W LYSIS ADH AND STRETCH
|
Facility
|
OP
|
$359.40
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
76100269
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Aetna Commercial |
$305.49
|
| Rate for Payer: Aetna Medicare |
$93.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.31
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$89.85
|
| Rate for Payer: BCBS Trust/PPO |
$279.43
|
| Rate for Payer: BCN Commercial |
$279.43
|
| Rate for Payer: BCN Medicare Advantage |
$89.85
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cash Price |
$287.52
|
| Rate for Payer: Cofinity Commercial |
$309.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.85
|
| Rate for Payer: Healthscope Commercial |
$323.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.55
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.49
|
| Rate for Payer: PACE Senior Care Partners |
$85.36
|
| Rate for Payer: PACE SWMI |
$89.85
|
| Rate for Payer: PHP Commercial |
$305.49
|
| Rate for Payer: PHP Medicare Advantage |
$89.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.68
|
| Rate for Payer: Priority Health Medicare |
$89.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.20
|
| Rate for Payer: Railroad Medicare Medicare |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.27
|
| Rate for Payer: UHC Core |
$300.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.85
|
| Rate for Payer: UHC Medicare Advantage |
$92.55
|
| Rate for Payer: VA VA |
$89.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.55
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
OP
|
$23.66
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$6.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.39
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: Cash Price |
$18.93
|
| Rate for Payer: Cash Price |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$21.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.74
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.11
|
| Rate for Payer: PACE Senior Care Partners |
$5.62
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PHP Commercial |
$20.11
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.58
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.43
|
| Rate for Payer: Railroad Medicare Medicare |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.82
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.09
|
| Rate for Payer: VA VA |
$5.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.74
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
IP
|
$23.66
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCN Commercial |
$18.28
|
| Rate for Payer: Cash Price |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$20.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.93
|
| Rate for Payer: Healthscope Commercial |
$21.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.11
|
| Rate for Payer: PHP Commercial |
$20.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.82
|
| Rate for Payer: UHC Core |
$19.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.74
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$34.68
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$8.67
|
| Rate for Payer: BCBS Trust/PPO |
$26.96
|
| Rate for Payer: BCN Commercial |
$26.96
|
| Rate for Payer: BCN Medicare Advantage |
$8.67
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.67
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PACE Senior Care Partners |
$8.24
|
| Rate for Payer: PACE SWMI |
$8.67
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: PHP Medicare Advantage |
$8.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Medicare |
$8.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.67
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: VA VA |
$8.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$34.68
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.15 |
| Max. Negotiated Rate |
$31.21 |
| Rate for Payer: Aetna Commercial |
$29.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.80
|
| Rate for Payer: BCN Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$27.74
|
| Rate for Payer: Cofinity Commercial |
$29.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.74
|
| Rate for Payer: Healthscope Commercial |
$31.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.48
|
| Rate for Payer: PHP Commercial |
$29.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.52
|
| Rate for Payer: UHC Core |
$28.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.01
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.02 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: Aetna Medicare |
$179.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.82
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS MAPPO |
$172.65
|
| Rate for Payer: BCBS Trust/PPO |
$536.95
|
| Rate for Payer: BCN Commercial |
$536.95
|
| Rate for Payer: BCN Medicare Advantage |
$172.65
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.65
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$181.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PACE Senior Care Partners |
$164.02
|
| Rate for Payer: PACE SWMI |
$172.65
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: PHP Medicare Advantage |
$172.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Medicare |
$172.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: Railroad Medicare Medicare |
$172.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.65
|
| Rate for Payer: UHC Medicare Advantage |
$177.83
|
| Rate for Payer: VA VA |
$172.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$421.20 |
| Max. Negotiated Rate |
$621.55 |
| Rate for Payer: Aetna Commercial |
$587.02
|
| Rate for Payer: BCBS Trust/PPO |
$533.70
|
| Rate for Payer: BCN Commercial |
$533.70
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$593.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$621.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$517.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$587.02
|
| Rate for Payer: PHP Commercial |
$587.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.74
|
| Rate for Payer: UHC Core |
$576.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$517.96
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.36 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: Aetna Medicare |
$790.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$950.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$950.47
|
| Rate for Payer: BCBS Complete |
$1,216.60
|
| Rate for Payer: BCBS MAPPO |
$760.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.77
|
| Rate for Payer: BCN Commercial |
$2,364.77
|
| Rate for Payer: BCN Medicare Advantage |
$760.38
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.38
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$798.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$874.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.28
|
| Rate for Payer: PACE Senior Care Partners |
$722.36
|
| Rate for Payer: PACE SWMI |
$760.38
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: PHP Medicare Advantage |
$760.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,646.10
|
| Rate for Payer: Priority Health Medicare |
$760.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,855.01
|
| Rate for Payer: Railroad Medicare Medicare |
$760.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,676.52
|
| Rate for Payer: UHC Core |
$2,539.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.38
|
| Rate for Payer: UHC Medicare Advantage |
$783.19
|
| Rate for Payer: VA VA |
$760.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.12
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,855.01 |
| Max. Negotiated Rate |
$2,737.35 |
| Rate for Payer: Aetna Commercial |
$2,585.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.47
|
| Rate for Payer: BCN Commercial |
$2,350.47
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,615.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$2,737.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,281.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,585.28
|
| Rate for Payer: PHP Commercial |
$2,585.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,129.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,646.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,855.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,676.52
|
| Rate for Payer: UHC Core |
$2,539.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,281.12
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$262.26 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$332.30
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.40
|
| Rate for Payer: UHC Core |
$359.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.50
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$365.50
|
| Rate for Payer: Aetna Medicare |
$111.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.38
|
| Rate for Payer: BCBS Complete |
$44.20
|
| Rate for Payer: BCBS MAPPO |
$107.50
|
| Rate for Payer: BCBS Trust/PPO |
$334.32
|
| Rate for Payer: BCN Commercial |
$334.32
|
| Rate for Payer: BCN Medicare Advantage |
$107.50
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$369.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.50
|
| Rate for Payer: Healthscope Commercial |
$387.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.50
|
| Rate for Payer: Mclaren Medicaid |
$42.10
|
| Rate for Payer: Meridian Medicaid |
$44.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$365.50
|
| Rate for Payer: PACE Senior Care Partners |
$102.12
|
| Rate for Payer: PACE SWMI |
$107.50
|
| Rate for Payer: PHP Commercial |
$365.50
|
| Rate for Payer: PHP Medicare Advantage |
$107.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.10
|
| Rate for Payer: Priority Health Medicare |
$107.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.26
|
| Rate for Payer: Railroad Medicare Medicare |
$107.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.40
|
| Rate for Payer: UHC Core |
$359.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.50
|
| Rate for Payer: UHC Medicare Advantage |
$110.72
|
| Rate for Payer: VA VA |
$107.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.50
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.13 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$34.79
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$195.93
|
| Rate for Payer: BCN Commercial |
$195.93
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Mclaren Medicaid |
$33.13
|
| Rate for Payer: Meridian Medicaid |
$34.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.00
|
| Rate for Payer: UHC Medicare Advantage |
$64.89
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$194.75
|
| Rate for Payer: BCN Commercial |
$194.75
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: BCBS Trust/PPO |
$47.14
|
| Rate for Payer: BCN Commercial |
$47.14
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Aetna Medicare |
$15.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.06
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS MAPPO |
$15.25
|
| Rate for Payer: BCBS Trust/PPO |
$47.43
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: BCN Medicare Advantage |
$15.25
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$54.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.75
|
| Rate for Payer: Mclaren Medicaid |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.85
|
| Rate for Payer: PACE Senior Care Partners |
$14.49
|
| Rate for Payer: PACE SWMI |
$15.25
|
| Rate for Payer: PHP Commercial |
$51.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Medicare |
$15.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.20
|
| Rate for Payer: Railroad Medicare Medicare |
$15.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.68
|
| Rate for Payer: UHC Core |
$50.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$15.71
|
| Rate for Payer: VA VA |
$15.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.75
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$50.23
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$55.25
|
| Rate for Payer: Aetna Medicare |
$16.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.31
|
| Rate for Payer: BCBS Complete |
$5.66
|
| Rate for Payer: BCBS MAPPO |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$50.54
|
| Rate for Payer: BCN Commercial |
$50.54
|
| Rate for Payer: BCN Medicare Advantage |
$16.25
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$55.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$58.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.75
|
| Rate for Payer: Mclaren Medicaid |
$5.39
|
| Rate for Payer: Meridian Medicaid |
$5.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.25
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.25
|
| Rate for Payer: PHP Commercial |
$55.25
|
| Rate for Payer: PHP Medicare Advantage |
$16.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.55
|
| Rate for Payer: Priority Health Medicare |
$16.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.64
|
| Rate for Payer: Railroad Medicare Medicare |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.20
|
| Rate for Payer: UHC Core |
$54.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.74
|
| Rate for Payer: VA VA |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.75
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$1,952.71
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,190.96 |
| Max. Negotiated Rate |
$1,757.44 |
| Rate for Payer: Aetna Commercial |
$1,659.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,509.05
|
| Rate for Payer: BCN Commercial |
$1,509.05
|
| Rate for Payer: Cash Price |
$1,562.17
|
| Rate for Payer: Cofinity Commercial |
$1,679.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.17
|
| Rate for Payer: Healthscope Commercial |
$1,757.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,464.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,659.80
|
| Rate for Payer: PHP Commercial |
$1,659.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,190.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,718.38
|
| Rate for Payer: UHC Core |
$1,630.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,464.53
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,952.71
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.77 |
| Max. Negotiated Rate |
$1,757.44 |
| Rate for Payer: Aetna Commercial |
$1,659.80
|
| Rate for Payer: Aetna Medicare |
$507.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$610.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$610.22
|
| Rate for Payer: BCBS Complete |
$1,050.44
|
| Rate for Payer: BCBS MAPPO |
$488.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.23
|
| Rate for Payer: BCN Commercial |
$1,518.23
|
| Rate for Payer: BCN Medicare Advantage |
$488.18
|
| Rate for Payer: Cash Price |
$1,562.17
|
| Rate for Payer: Cash Price |
$1,562.17
|
| Rate for Payer: Cofinity Commercial |
$1,679.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.18
|
| Rate for Payer: Healthscope Commercial |
$1,757.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,464.53
|
| Rate for Payer: Mclaren Medicaid |
$1,000.42
|
| Rate for Payer: Meridian Medicaid |
$1,050.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$512.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,659.80
|
| Rate for Payer: PACE Senior Care Partners |
$463.77
|
| Rate for Payer: PACE SWMI |
$488.18
|
| Rate for Payer: PHP Commercial |
$1,659.80
|
| Rate for Payer: PHP Medicare Advantage |
$488.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,698.86
|
| Rate for Payer: Priority Health Medicare |
$488.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,190.96
|
| Rate for Payer: Railroad Medicare Medicare |
$488.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,718.38
|
| Rate for Payer: UHC Core |
$1,630.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.18
|
| Rate for Payer: UHC Medicare Advantage |
$502.82
|
| Rate for Payer: VA VA |
$488.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,464.53
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: BCBS Trust/PPO |
$276.58
|
| Rate for Payer: BCN Commercial |
$276.58
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.94
|
| Rate for Payer: UHC Core |
$298.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.42
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.84
|
| Rate for Payer: BCBS Complete |
$57.81
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCBS Trust/PPO |
$278.26
|
| Rate for Payer: BCN Commercial |
$278.26
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.42
|
| Rate for Payer: Mclaren Medicaid |
$55.05
|
| Rate for Payer: Meridian Medicaid |
$57.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PACE Senior Care Partners |
$85.00
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.36
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.28
|
| Rate for Payer: Railroad Medicare Medicare |
$89.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.94
|
| Rate for Payer: UHC Core |
$298.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Medicare Advantage |
$92.16
|
| Rate for Payer: VA VA |
$89.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.42
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$262.85
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$236.56 |
| Rate for Payer: Aetna Commercial |
$223.42
|
| Rate for Payer: Aetna Medicare |
$68.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.14
|
| Rate for Payer: BCBS Complete |
$57.81
|
| Rate for Payer: BCBS MAPPO |
$65.71
|
| Rate for Payer: BCBS Trust/PPO |
$204.37
|
| Rate for Payer: BCN Commercial |
$204.37
|
| Rate for Payer: BCN Medicare Advantage |
$65.71
|
| Rate for Payer: Cash Price |
$210.28
|
| Rate for Payer: Cash Price |
$210.28
|
| Rate for Payer: Cofinity Commercial |
$226.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.71
|
| Rate for Payer: Healthscope Commercial |
$236.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.14
|
| Rate for Payer: Mclaren Medicaid |
$55.05
|
| Rate for Payer: Meridian Medicaid |
$57.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.42
|
| Rate for Payer: PACE Senior Care Partners |
$62.43
|
| Rate for Payer: PACE SWMI |
$65.71
|
| Rate for Payer: PHP Commercial |
$223.42
|
| Rate for Payer: PHP Medicare Advantage |
$65.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.68
|
| Rate for Payer: Priority Health Medicare |
$65.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.31
|
| Rate for Payer: Railroad Medicare Medicare |
$65.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.31
|
| Rate for Payer: UHC Core |
$219.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.71
|
| Rate for Payer: UHC Medicare Advantage |
$67.68
|
| Rate for Payer: VA VA |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.14
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$262.85
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$236.56 |
| Rate for Payer: Aetna Commercial |
$223.42
|
| Rate for Payer: BCBS Trust/PPO |
$203.13
|
| Rate for Payer: BCN Commercial |
$203.13
|
| Rate for Payer: Cash Price |
$210.28
|
| Rate for Payer: Cofinity Commercial |
$226.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.28
|
| Rate for Payer: Healthscope Commercial |
$236.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.42
|
| Rate for Payer: PHP Commercial |
$223.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.31
|
| Rate for Payer: UHC Core |
$219.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.14
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$262.85
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$160.31 |
| Max. Negotiated Rate |
$236.56 |
| Rate for Payer: Aetna Commercial |
$223.42
|
| Rate for Payer: BCBS Trust/PPO |
$203.13
|
| Rate for Payer: BCN Commercial |
$203.13
|
| Rate for Payer: Cash Price |
$210.28
|
| Rate for Payer: Cofinity Commercial |
$226.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.28
|
| Rate for Payer: Healthscope Commercial |
$236.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.42
|
| Rate for Payer: PHP Commercial |
$223.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.31
|
| Rate for Payer: UHC Core |
$219.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.14
|
|
