|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.83
|
| Rate for Payer: BCBS Complete |
$11.75
|
| Rate for Payer: BCBS MAPPO |
$15.87
|
| Rate for Payer: BCBS Trust/PPO |
$52.17
|
| Rate for Payer: BCN Commercial |
$52.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.87
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.87
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Mclaren Medicaid |
$11.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.66
|
| Rate for Payer: Meridian Medicaid |
$11.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PACE Senior Care Partners |
$15.07
|
| Rate for Payer: PACE SWMI |
$15.87
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.21
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.17
|
| Rate for Payer: Railroad Medicare Medicare |
$15.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.99
|
| Rate for Payer: UHC Exchange |
$15.87
|
| Rate for Payer: UHC Medicaid |
$11.19
|
| Rate for Payer: UHC Medicare Advantage |
$15.87
|
| Rate for Payer: UHCCP Medicaid |
$11.19
|
| Rate for Payer: VA VA |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$63.46
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.94
|
| Rate for Payer: BCBS Trust/PPO |
$52.41
|
| Rate for Payer: BCN Commercial |
$52.41
|
| Rate for Payer: Cash Price |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$54.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.77
|
| Rate for Payer: Healthscope Commercial |
$57.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.94
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: PHP Commercial |
$53.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.92 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: Aetna Medicare |
$17.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.13
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS MAPPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$55.60
|
| Rate for Payer: BCN Commercial |
$55.60
|
| Rate for Payer: BCN Medicare Advantage |
$16.91
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.91
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Mclaren Medicaid |
$11.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.75
|
| Rate for Payer: Meridian Medicaid |
$12.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PACE Senior Care Partners |
$16.06
|
| Rate for Payer: PACE SWMI |
$16.91
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Medicare |
$17.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: UHC Exchange |
$16.91
|
| Rate for Payer: UHC Medicaid |
$11.92
|
| Rate for Payer: UHC Medicare Advantage |
$16.91
|
| Rate for Payer: UHCCP Medicaid |
$11.92
|
| Rate for Payer: VA VA |
$16.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$67.63
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$60.87 |
| Rate for Payer: Aetna Commercial |
$57.49
|
| Rate for Payer: BCBS Trust/PPO |
$55.86
|
| Rate for Payer: BCN Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$54.10
|
| Rate for Payer: Cofinity Commercial |
$58.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.10
|
| Rate for Payer: Healthscope Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.49
|
| Rate for Payer: Nomi Health Commercial |
$55.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.72
|
| Rate for Payer: PHP Commercial |
$57.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.51
|
| Rate for Payer: UHC Core |
$56.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.72
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$358.17 |
| Max. Negotiated Rate |
$1,828.44 |
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: Aetna Medicare |
$528.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.88
|
| Rate for Payer: BCBS Complete |
$376.05
|
| Rate for Payer: BCBS MAPPO |
$507.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.18
|
| Rate for Payer: BCN Commercial |
$1,670.18
|
| Rate for Payer: BCN Medicare Advantage |
$507.90
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.90
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.70
|
| Rate for Payer: Mclaren Medicaid |
$358.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.29
|
| Rate for Payer: Meridian Medicaid |
$376.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$558.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Nomi Health Commercial |
$1,665.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PACE Senior Care Partners |
$482.50
|
| Rate for Payer: PACE SWMI |
$507.90
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: PHP Medicare Advantage |
$507.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,767.49
|
| Rate for Payer: Priority Health Medicare |
$512.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,413.99
|
| Rate for Payer: Railroad Medicare Medicare |
$507.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.81
|
| Rate for Payer: UHC Core |
$1,696.39
|
| Rate for Payer: UHC Exchange |
$507.90
|
| Rate for Payer: UHC Medicaid |
$358.17
|
| Rate for Payer: UHC Medicare Advantage |
$507.90
|
| Rate for Payer: UHCCP Medicaid |
$358.17
|
| Rate for Payer: VA VA |
$507.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.70
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$2,031.60
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,413.99 |
| Max. Negotiated Rate |
$1,828.44 |
| Rate for Payer: Aetna Commercial |
$1,726.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.90
|
| Rate for Payer: BCN Commercial |
$1,677.90
|
| Rate for Payer: Cash Price |
$1,625.28
|
| Rate for Payer: Cofinity Commercial |
$1,747.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.28
|
| Rate for Payer: Healthscope Commercial |
$1,828.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.86
|
| Rate for Payer: Nomi Health Commercial |
$1,665.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.70
|
| Rate for Payer: PHP Commercial |
$1,726.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,767.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,413.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.81
|
| Rate for Payer: UHC Core |
$1,696.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.70
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,046.54 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: BCBS Trust/PPO |
$4,801.78
|
| Rate for Payer: BCN Commercial |
$4,801.78
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,360.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Nomi Health Commercial |
$4,767.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,058.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,046.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,116.32
|
| Rate for Payer: UHC Core |
$4,854.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,360.50
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,814.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,025.01 |
| Max. Negotiated Rate |
$5,232.60 |
| Rate for Payer: Aetna Commercial |
$4,941.90
|
| Rate for Payer: Aetna Medicare |
$1,511.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,816.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,816.88
|
| Rate for Payer: BCBS Complete |
$1,076.17
|
| Rate for Payer: BCBS MAPPO |
$1,453.50
|
| Rate for Payer: BCBS Trust/PPO |
$4,779.69
|
| Rate for Payer: BCN Commercial |
$4,779.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,453.50
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cofinity Commercial |
$5,000.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,651.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,453.50
|
| Rate for Payer: Healthscope Commercial |
$5,232.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,360.50
|
| Rate for Payer: Mclaren Medicaid |
$1,025.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,526.17
|
| Rate for Payer: Meridian Medicaid |
$1,076.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,671.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,598.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,941.90
|
| Rate for Payer: Nomi Health Commercial |
$4,767.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,360.50
|
| Rate for Payer: PACE Senior Care Partners |
$1,380.83
|
| Rate for Payer: PACE SWMI |
$1,453.50
|
| Rate for Payer: PHP Commercial |
$4,941.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,453.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,058.18
|
| Rate for Payer: Priority Health Medicare |
$1,468.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,046.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,453.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,116.32
|
| Rate for Payer: UHC Core |
$4,854.69
|
| Rate for Payer: UHC Exchange |
$1,453.50
|
| Rate for Payer: UHC Medicaid |
$1,025.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,453.50
|
| Rate for Payer: UHCCP Medicaid |
$1,025.01
|
| Rate for Payer: VA VA |
$1,453.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,360.50
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$259.16 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: BCBS Trust/PPO |
$307.52
|
| Rate for Payer: BCN Commercial |
$307.52
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$305.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.67
|
| Rate for Payer: UHC Core |
$310.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.26
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$372.35
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$335.12 |
| Rate for Payer: Aetna Commercial |
$316.50
|
| Rate for Payer: Aetna Medicare |
$96.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116.36
|
| Rate for Payer: BCBS Complete |
$68.92
|
| Rate for Payer: BCBS MAPPO |
$93.09
|
| Rate for Payer: BCBS Trust/PPO |
$306.11
|
| Rate for Payer: BCN Commercial |
$306.11
|
| Rate for Payer: BCN Medicare Advantage |
$93.09
|
| Rate for Payer: Cash Price |
$297.88
|
| Rate for Payer: Cofinity Commercial |
$320.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.09
|
| Rate for Payer: Healthscope Commercial |
$335.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.26
|
| Rate for Payer: Mclaren Medicaid |
$65.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.74
|
| Rate for Payer: Meridian Medicaid |
$68.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.50
|
| Rate for Payer: Nomi Health Commercial |
$305.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.26
|
| Rate for Payer: PACE Senior Care Partners |
$88.43
|
| Rate for Payer: PACE SWMI |
$93.09
|
| Rate for Payer: PHP Commercial |
$316.50
|
| Rate for Payer: PHP Medicare Advantage |
$93.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$323.94
|
| Rate for Payer: Priority Health Medicare |
$94.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.16
|
| Rate for Payer: Railroad Medicare Medicare |
$93.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.67
|
| Rate for Payer: UHC Core |
$310.91
|
| Rate for Payer: UHC Exchange |
$93.09
|
| Rate for Payer: UHC Medicaid |
$65.65
|
| Rate for Payer: UHC Medicare Advantage |
$93.09
|
| Rate for Payer: UHCCP Medicaid |
$65.65
|
| Rate for Payer: VA VA |
$93.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.26
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.34 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: BCBS Trust/PPO |
$225.86
|
| Rate for Payer: BCN Commercial |
$225.86
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.65
|
| Rate for Payer: UHC Core |
$228.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$48.21 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$71.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.46
|
| Rate for Payer: BCBS Complete |
$50.62
|
| Rate for Payer: BCBS MAPPO |
$68.37
|
| Rate for Payer: BCBS Trust/PPO |
$224.82
|
| Rate for Payer: BCN Commercial |
$224.82
|
| Rate for Payer: BCN Medicare Advantage |
$68.37
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.37
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Mclaren Medicaid |
$48.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.79
|
| Rate for Payer: Meridian Medicaid |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Senior Care Partners |
$64.95
|
| Rate for Payer: PACE SWMI |
$68.37
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$68.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.92
|
| Rate for Payer: Priority Health Medicare |
$69.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.34
|
| Rate for Payer: Railroad Medicare Medicare |
$68.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.65
|
| Rate for Payer: UHC Core |
$228.35
|
| Rate for Payer: UHC Exchange |
$68.37
|
| Rate for Payer: UHC Medicaid |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$68.37
|
| Rate for Payer: UHCCP Medicaid |
$48.21
|
| Rate for Payer: VA VA |
$68.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
OP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$48.21 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: Aetna Medicare |
$71.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.46
|
| Rate for Payer: BCBS Complete |
$50.62
|
| Rate for Payer: BCBS MAPPO |
$68.37
|
| Rate for Payer: BCBS Trust/PPO |
$224.82
|
| Rate for Payer: BCN Commercial |
$224.82
|
| Rate for Payer: BCN Medicare Advantage |
$68.37
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.37
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Mclaren Medicaid |
$48.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.79
|
| Rate for Payer: Meridian Medicaid |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PACE Senior Care Partners |
$64.95
|
| Rate for Payer: PACE SWMI |
$68.37
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: PHP Medicare Advantage |
$68.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.92
|
| Rate for Payer: Priority Health Medicare |
$69.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.34
|
| Rate for Payer: Railroad Medicare Medicare |
$68.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.65
|
| Rate for Payer: UHC Core |
$228.35
|
| Rate for Payer: UHC Exchange |
$68.37
|
| Rate for Payer: UHC Medicaid |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$68.37
|
| Rate for Payer: UHCCP Medicaid |
$48.21
|
| Rate for Payer: VA VA |
$68.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$273.47
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$190.34 |
| Max. Negotiated Rate |
$246.12 |
| Rate for Payer: Aetna Commercial |
$232.45
|
| Rate for Payer: BCBS Trust/PPO |
$225.86
|
| Rate for Payer: BCN Commercial |
$225.86
|
| Rate for Payer: Cash Price |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$235.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.78
|
| Rate for Payer: Healthscope Commercial |
$246.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.45
|
| Rate for Payer: Nomi Health Commercial |
$224.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.10
|
| Rate for Payer: PHP Commercial |
$232.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.65
|
| Rate for Payer: UHC Core |
$228.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.10
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$164.57 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: BCBS Trust/PPO |
$195.28
|
| Rate for Payer: BCN Commercial |
$195.28
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000053
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$61.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.89
|
| Rate for Payer: BCBS Complete |
$43.77
|
| Rate for Payer: BCBS MAPPO |
$59.11
|
| Rate for Payer: BCBS Trust/PPO |
$194.39
|
| Rate for Payer: BCN Commercial |
$194.39
|
| Rate for Payer: BCN Medicare Advantage |
$59.11
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.11
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Mclaren Medicaid |
$41.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.07
|
| Rate for Payer: Meridian Medicaid |
$43.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Senior Care Partners |
$56.16
|
| Rate for Payer: PACE SWMI |
$59.11
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$59.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Medicare |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$59.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: UHC Exchange |
$59.11
|
| Rate for Payer: UHC Medicaid |
$41.69
|
| Rate for Payer: UHC Medicare Advantage |
$59.11
|
| Rate for Payer: UHCCP Medicaid |
$41.69
|
| Rate for Payer: VA VA |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$164.57 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: BCBS Trust/PPO |
$195.28
|
| Rate for Payer: BCN Commercial |
$195.28
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT1
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000054
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$61.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.89
|
| Rate for Payer: BCBS Complete |
$43.77
|
| Rate for Payer: BCBS MAPPO |
$59.11
|
| Rate for Payer: BCBS Trust/PPO |
$194.39
|
| Rate for Payer: BCN Commercial |
$194.39
|
| Rate for Payer: BCN Medicare Advantage |
$59.11
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.11
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Mclaren Medicaid |
$41.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.07
|
| Rate for Payer: Meridian Medicaid |
$43.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Senior Care Partners |
$56.16
|
| Rate for Payer: PACE SWMI |
$59.11
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$59.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Medicare |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$59.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: UHC Exchange |
$59.11
|
| Rate for Payer: UHC Medicaid |
$41.69
|
| Rate for Payer: UHC Medicare Advantage |
$59.11
|
| Rate for Payer: UHCCP Medicaid |
$41.69
|
| Rate for Payer: VA VA |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
OP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$41.69 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: Aetna Medicare |
$61.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.89
|
| Rate for Payer: BCBS Complete |
$43.77
|
| Rate for Payer: BCBS MAPPO |
$59.11
|
| Rate for Payer: BCBS Trust/PPO |
$194.39
|
| Rate for Payer: BCN Commercial |
$194.39
|
| Rate for Payer: BCN Medicare Advantage |
$59.11
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.11
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Mclaren Medicaid |
$41.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.07
|
| Rate for Payer: Meridian Medicaid |
$43.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PACE Senior Care Partners |
$56.16
|
| Rate for Payer: PACE SWMI |
$59.11
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: PHP Medicare Advantage |
$59.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Medicare |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$59.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: UHC Exchange |
$59.11
|
| Rate for Payer: UHC Medicaid |
$41.69
|
| Rate for Payer: UHC Medicare Advantage |
$59.11
|
| Rate for Payer: UHCCP Medicaid |
$41.69
|
| Rate for Payer: VA VA |
$59.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA 3X CMPT2
|
Facility
|
IP
|
$236.45
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000055
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$164.57 |
| Max. Negotiated Rate |
$212.81 |
| Rate for Payer: Aetna Commercial |
$200.98
|
| Rate for Payer: BCBS Trust/PPO |
$195.28
|
| Rate for Payer: BCN Commercial |
$195.28
|
| Rate for Payer: Cash Price |
$189.16
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.16
|
| Rate for Payer: Healthscope Commercial |
$212.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.98
|
| Rate for Payer: Nomi Health Commercial |
$193.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.34
|
| Rate for Payer: PHP Commercial |
$200.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$205.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.08
|
| Rate for Payer: UHC Core |
$197.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.34
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
OP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: Aetna Medicare |
$25.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.79
|
| Rate for Payer: BCBS Complete |
$18.24
|
| Rate for Payer: BCBS MAPPO |
$24.63
|
| Rate for Payer: BCBS Trust/PPO |
$80.99
|
| Rate for Payer: BCN Commercial |
$80.99
|
| Rate for Payer: BCN Medicare Advantage |
$24.63
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.63
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.89
|
| Rate for Payer: Mclaren Medicaid |
$17.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.86
|
| Rate for Payer: Meridian Medicaid |
$18.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Nomi Health Commercial |
$80.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PACE Senior Care Partners |
$23.40
|
| Rate for Payer: PACE SWMI |
$24.63
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: PHP Medicare Advantage |
$24.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.71
|
| Rate for Payer: Priority Health Medicare |
$24.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.57
|
| Rate for Payer: Railroad Medicare Medicare |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.70
|
| Rate for Payer: UHC Core |
$82.26
|
| Rate for Payer: UHC Exchange |
$24.63
|
| Rate for Payer: UHC Medicaid |
$17.37
|
| Rate for Payer: UHC Medicare Advantage |
$24.63
|
| Rate for Payer: UHCCP Medicaid |
$17.37
|
| Rate for Payer: VA VA |
$24.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.89
|
|
|
HC FRESH FROZEN PLASMA SPLIT
|
Facility
|
IP
|
$98.52
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000056
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$68.57 |
| Max. Negotiated Rate |
$88.67 |
| Rate for Payer: Aetna Commercial |
$83.74
|
| Rate for Payer: BCBS Trust/PPO |
$81.37
|
| Rate for Payer: BCN Commercial |
$81.37
|
| Rate for Payer: Cash Price |
$78.82
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.82
|
| Rate for Payer: Healthscope Commercial |
$88.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.74
|
| Rate for Payer: Nomi Health Commercial |
$80.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.89
|
| Rate for Payer: PHP Commercial |
$83.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$85.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.70
|
| Rate for Payer: UHC Core |
$82.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.89
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.18 |
| Max. Negotiated Rate |
$116.61 |
| Rate for Payer: Aetna Commercial |
$110.13
|
| Rate for Payer: BCBS Trust/PPO |
$107.01
|
| Rate for Payer: BCN Commercial |
$107.01
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Commercial |
$111.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Healthscope Commercial |
$116.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Nomi Health Commercial |
$106.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: PHP Commercial |
$110.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.02
|
| Rate for Payer: UHC Core |
$108.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.18
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$129.57
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
31000056
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$116.61 |
| Rate for Payer: Aetna Commercial |
$110.13
|
| Rate for Payer: Aetna Medicare |
$33.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.49
|
| Rate for Payer: BCBS Complete |
$23.98
|
| Rate for Payer: BCBS MAPPO |
$32.39
|
| Rate for Payer: BCBS Trust/PPO |
$106.52
|
| Rate for Payer: BCCCP Commercial |
$94.70
|
| Rate for Payer: BCN Commercial |
$106.52
|
| Rate for Payer: BCN Medicare Advantage |
$32.39
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cash Price |
$103.66
|
| Rate for Payer: Cofinity Commercial |
$111.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.39
|
| Rate for Payer: Healthscope Commercial |
$116.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.18
|
| Rate for Payer: Mclaren Medicaid |
$22.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.01
|
| Rate for Payer: Meridian Medicaid |
$23.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.13
|
| Rate for Payer: Nomi Health Commercial |
$106.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.18
|
| Rate for Payer: PACE Senior Care Partners |
$30.77
|
| Rate for Payer: PACE SWMI |
$32.39
|
| Rate for Payer: PHP Commercial |
$110.13
|
| Rate for Payer: PHP Medicare Advantage |
$32.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$112.73
|
| Rate for Payer: Priority Health Medicare |
$32.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.18
|
| Rate for Payer: Railroad Medicare Medicare |
$32.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.02
|
| Rate for Payer: UHC Core |
$108.19
|
| Rate for Payer: UHC Exchange |
$32.39
|
| Rate for Payer: UHC Medicaid |
$22.84
|
| Rate for Payer: UHC Medicare Advantage |
$32.39
|
| Rate for Payer: UHCCP Medicaid |
$22.84
|
| Rate for Payer: VA VA |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.18
|
|
|
HC FRUCTOSAMINE
|
Facility
|
IP
|
$53.06
|
|
|
Service Code
|
CPT 82985
|
| Hospital Charge Code |
30100627
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$47.75 |
| Rate for Payer: Aetna Commercial |
$45.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.82
|
| Rate for Payer: BCN Commercial |
$43.82
|
| Rate for Payer: Cash Price |
$42.45
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$47.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.10
|
| Rate for Payer: Nomi Health Commercial |
$43.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.80
|
| Rate for Payer: PHP Commercial |
$45.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.69
|
| Rate for Payer: UHC Core |
$44.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.80
|
|
