|
HC ADALIMUMAB AB, S
|
Facility
|
IP
|
$206.04
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.93 |
| Max. Negotiated Rate |
$185.44 |
| Rate for Payer: Aetna Commercial |
$175.13
|
| Rate for Payer: BCBS Trust/PPO |
$168.19
|
| Rate for Payer: BCN Commercial |
$159.23
|
| Rate for Payer: Cash Price |
$164.83
|
| Rate for Payer: Cofinity Commercial |
$177.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.83
|
| Rate for Payer: Healthscope Commercial |
$185.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.13
|
| Rate for Payer: Nomi Health Commercial |
$168.95
|
| Rate for Payer: PHP Commercial |
$175.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.93
|
| Rate for Payer: Priority Health HMO/PPO |
$179.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.32
|
| Rate for Payer: UHC Core |
$172.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.53
|
|
|
HC ADALIMUMAB AB, S
|
Facility
|
OP
|
$206.04
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100666
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$185.44 |
| Rate for Payer: Aetna Commercial |
$175.13
|
| Rate for Payer: Aetna Medicare |
$53.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.39
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$51.51
|
| Rate for Payer: BCBS Trust/PPO |
$169.39
|
| Rate for Payer: BCN Commercial |
$160.20
|
| Rate for Payer: BCN Medicare Advantage |
$51.51
|
| Rate for Payer: Cash Price |
$164.83
|
| Rate for Payer: Cash Price |
$164.83
|
| Rate for Payer: Cofinity Commercial |
$177.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.51
|
| Rate for Payer: Healthscope Commercial |
$185.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.53
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.09
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.13
|
| Rate for Payer: Nomi Health Commercial |
$168.95
|
| Rate for Payer: PACE Senior Care Partners |
$48.93
|
| Rate for Payer: PACE SWMI |
$51.51
|
| Rate for Payer: PHP Commercial |
$175.13
|
| Rate for Payer: PHP Medicare Advantage |
$51.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.93
|
| Rate for Payer: Priority Health HMO/PPO |
$179.25
|
| Rate for Payer: Priority Health Medicare |
$52.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.05
|
| Rate for Payer: Railroad Medicare Medicare |
$51.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.32
|
| Rate for Payer: UHC Core |
$172.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.51
|
| Rate for Payer: UHC Exchange |
$51.51
|
| Rate for Payer: UHC Medicare Advantage |
$51.51
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$51.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.53
|
|
|
HC ADALIMUMAB, S
|
Facility
|
IP
|
$300.90
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
30100704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$195.59 |
| Max. Negotiated Rate |
$270.81 |
| Rate for Payer: Aetna Commercial |
$255.76
|
| Rate for Payer: BCBS Trust/PPO |
$245.62
|
| Rate for Payer: BCN Commercial |
$232.54
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Healthscope Commercial |
$270.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: PHP Commercial |
$255.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.59
|
| Rate for Payer: Priority Health HMO/PPO |
$261.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.79
|
| Rate for Payer: UHC Core |
$251.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.68
|
|
|
HC ADALIMUMAB, S
|
Facility
|
OP
|
$300.90
|
|
|
Service Code
|
CPT 80145
|
| Hospital Charge Code |
30100704
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.89 |
| Max. Negotiated Rate |
$270.81 |
| Rate for Payer: Aetna Commercial |
$255.76
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.03
|
| Rate for Payer: BCBS Complete |
$29.28
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$247.37
|
| Rate for Payer: BCN Commercial |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Healthscope Commercial |
$270.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.68
|
| Rate for Payer: Mclaren Medicaid |
$27.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.99
|
| Rate for Payer: Meridian Medicaid |
$29.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: PACE Senior Care Partners |
$71.46
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Commercial |
$255.76
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.59
|
| Rate for Payer: Priority Health HMO/PPO |
$261.78
|
| Rate for Payer: Priority Health Medicare |
$75.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.60
|
| Rate for Payer: Railroad Medicare Medicare |
$75.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.79
|
| Rate for Payer: UHC Core |
$251.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Exchange |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
| Rate for Payer: UHCCP Medicaid |
$27.89
|
| Rate for Payer: VA VA |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.68
|
|
|
HC ADAMTS13 ACTIVITY AND INHIBITOR PROFILE, PLASMA
|
Facility
|
OP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: Aetna Medicare |
$41.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.23
|
| Rate for Payer: BCBS Complete |
$23.43
|
| Rate for Payer: BCBS MAPPO |
$40.19
|
| Rate for Payer: BCBS Trust/PPO |
$132.15
|
| Rate for Payer: BCN Commercial |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$40.19
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.19
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Mclaren Medicaid |
$22.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.20
|
| Rate for Payer: Meridian Medicaid |
$23.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: PACE Senior Care Partners |
$38.18
|
| Rate for Payer: PACE SWMI |
$40.19
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: PHP Medicare Advantage |
$40.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health HMO/PPO |
$139.85
|
| Rate for Payer: Priority Health Medicare |
$40.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.70
|
| Rate for Payer: Railroad Medicare Medicare |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.46
|
| Rate for Payer: UHC Core |
$134.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.19
|
| Rate for Payer: UHC Exchange |
$40.19
|
| Rate for Payer: UHC Medicare Advantage |
$40.19
|
| Rate for Payer: UHCCP Medicaid |
$22.31
|
| Rate for Payer: VA VA |
$40.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
HC ADAMTS13 ACTIVITY AND INHIBITOR PROFILE, PLASMA
|
Facility
|
IP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500106
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.49 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: BCBS Trust/PPO |
$131.22
|
| Rate for Payer: BCN Commercial |
$124.23
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health HMO/PPO |
$139.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.46
|
| Rate for Payer: UHC Core |
$134.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
HC ADAMTS 13 ANTIBODY
|
Facility
|
IP
|
$180.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.35 |
| Max. Negotiated Rate |
$162.49 |
| Rate for Payer: Aetna Commercial |
$153.46
|
| Rate for Payer: BCBS Trust/PPO |
$147.37
|
| Rate for Payer: BCN Commercial |
$139.52
|
| Rate for Payer: Cash Price |
$144.43
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.43
|
| Rate for Payer: Healthscope Commercial |
$162.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.46
|
| Rate for Payer: Nomi Health Commercial |
$148.04
|
| Rate for Payer: PHP Commercial |
$153.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.35
|
| Rate for Payer: Priority Health HMO/PPO |
$157.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.88
|
| Rate for Payer: UHC Core |
$150.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.41
|
|
|
HC ADAMTS 13 ANTIBODY
|
Facility
|
OP
|
$180.54
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30000056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$162.49 |
| Rate for Payer: Aetna Commercial |
$153.46
|
| Rate for Payer: Aetna Medicare |
$46.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.42
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$45.13
|
| Rate for Payer: BCBS Trust/PPO |
$148.42
|
| Rate for Payer: BCN Commercial |
$140.37
|
| Rate for Payer: BCN Medicare Advantage |
$45.13
|
| Rate for Payer: Cash Price |
$144.43
|
| Rate for Payer: Cash Price |
$144.43
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.13
|
| Rate for Payer: Healthscope Commercial |
$162.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.41
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.39
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.46
|
| Rate for Payer: Nomi Health Commercial |
$148.04
|
| Rate for Payer: PACE Senior Care Partners |
$42.88
|
| Rate for Payer: PACE SWMI |
$45.13
|
| Rate for Payer: PHP Commercial |
$153.46
|
| Rate for Payer: PHP Medicare Advantage |
$45.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.35
|
| Rate for Payer: Priority Health HMO/PPO |
$157.07
|
| Rate for Payer: Priority Health Medicare |
$45.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.96
|
| Rate for Payer: Railroad Medicare Medicare |
$45.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.88
|
| Rate for Payer: UHC Core |
$150.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.13
|
| Rate for Payer: UHC Exchange |
$45.13
|
| Rate for Payer: UHC Medicare Advantage |
$45.13
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$45.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.41
|
|
|
HC ADAMTS 13 INHIBITOR
|
Facility
|
OP
|
$151.90
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30000055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: Aetna Medicare |
$39.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.47
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$37.98
|
| Rate for Payer: BCBS Trust/PPO |
$124.88
|
| Rate for Payer: BCN Commercial |
$118.10
|
| Rate for Payer: BCN Medicare Advantage |
$37.98
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.98
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.92
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.87
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: PACE Senior Care Partners |
$36.08
|
| Rate for Payer: PACE SWMI |
$37.98
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: PHP Medicare Advantage |
$37.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.73
|
| Rate for Payer: Priority Health HMO/PPO |
$132.15
|
| Rate for Payer: Priority Health Medicare |
$38.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.77
|
| Rate for Payer: Railroad Medicare Medicare |
$37.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.67
|
| Rate for Payer: UHC Core |
$126.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.98
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Medicare Advantage |
$37.98
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$37.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.92
|
|
|
HC ADAMTS 13 INHIBITOR
|
Facility
|
IP
|
$151.90
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
30000055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.73 |
| Max. Negotiated Rate |
$136.71 |
| Rate for Payer: Aetna Commercial |
$129.12
|
| Rate for Payer: BCBS Trust/PPO |
$124.00
|
| Rate for Payer: BCN Commercial |
$117.39
|
| Rate for Payer: Cash Price |
$121.52
|
| Rate for Payer: Cofinity Commercial |
$130.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.52
|
| Rate for Payer: Healthscope Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.12
|
| Rate for Payer: Nomi Health Commercial |
$124.56
|
| Rate for Payer: PHP Commercial |
$129.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.73
|
| Rate for Payer: Priority Health HMO/PPO |
$132.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.67
|
| Rate for Payer: UHC Core |
$126.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.92
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
IP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$104.49 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: BCBS Trust/PPO |
$131.22
|
| Rate for Payer: BCN Commercial |
$124.23
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health HMO/PPO |
$139.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.46
|
| Rate for Payer: UHC Core |
$134.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
HC ADAMTS ACTIVITY AND INHIB PROFILE
|
Facility
|
OP
|
$160.75
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500103
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$144.68 |
| Rate for Payer: Aetna Commercial |
$136.64
|
| Rate for Payer: Aetna Medicare |
$41.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.23
|
| Rate for Payer: BCBS Complete |
$23.43
|
| Rate for Payer: BCBS MAPPO |
$40.19
|
| Rate for Payer: BCBS Trust/PPO |
$132.15
|
| Rate for Payer: BCN Commercial |
$124.98
|
| Rate for Payer: BCN Medicare Advantage |
$40.19
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cash Price |
$128.60
|
| Rate for Payer: Cofinity Commercial |
$138.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.19
|
| Rate for Payer: Healthscope Commercial |
$144.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.56
|
| Rate for Payer: Mclaren Medicaid |
$22.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.20
|
| Rate for Payer: Meridian Medicaid |
$23.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.64
|
| Rate for Payer: Nomi Health Commercial |
$131.81
|
| Rate for Payer: PACE Senior Care Partners |
$38.18
|
| Rate for Payer: PACE SWMI |
$40.19
|
| Rate for Payer: PHP Commercial |
$136.64
|
| Rate for Payer: PHP Medicare Advantage |
$40.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.49
|
| Rate for Payer: Priority Health HMO/PPO |
$139.85
|
| Rate for Payer: Priority Health Medicare |
$40.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.70
|
| Rate for Payer: Railroad Medicare Medicare |
$40.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.46
|
| Rate for Payer: UHC Core |
$134.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.19
|
| Rate for Payer: UHC Exchange |
$40.19
|
| Rate for Payer: UHC Medicare Advantage |
$40.19
|
| Rate for Payer: UHCCP Medicaid |
$22.31
|
| Rate for Payer: VA VA |
$40.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.56
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
OP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.77
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$6.89
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.10
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health HMO/PPO |
$7.71
|
| Rate for Payer: Priority Health Medicare |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.80
|
| Rate for Payer: UHC Core |
$7.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
| Rate for Payer: VA VA |
$2.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
HC ADAPT BARRIER RING
|
Facility
|
IP
|
$8.86
|
|
| Hospital Charge Code |
27100020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$7.53
|
| Rate for Payer: BCBS Trust/PPO |
$7.23
|
| Rate for Payer: BCN Commercial |
$6.85
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$7.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.09
|
| Rate for Payer: Healthscope Commercial |
$7.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.53
|
| Rate for Payer: Nomi Health Commercial |
$7.27
|
| Rate for Payer: PHP Commercial |
$7.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health HMO/PPO |
$7.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.80
|
| Rate for Payer: UHC Core |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
OP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC ADAPTER PERFUSION STERILE
|
Facility
|
IP
|
$91.80
|
|
| Hospital Charge Code |
27000677
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
OP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.06
|
| Rate for Payer: BCN Commercial |
$9.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.06
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE SWMI |
$3.06
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Medicare |
$3.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.06
|
| Rate for Payer: UHC Exchange |
$3.06
|
| Rate for Payer: UHC Medicare Advantage |
$3.06
|
| Rate for Payer: VA VA |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC ADAPTOR PERFUSION
|
Facility
|
IP
|
$12.24
|
|
| Hospital Charge Code |
27000264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$11.02 |
| Rate for Payer: Aetna Commercial |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$11.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$10.04
|
| Rate for Payer: PHP Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.96
|
| Rate for Payer: Priority Health HMO/PPO |
$10.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.77
|
| Rate for Payer: UHC Core |
$10.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.18
|
|
|
HC ADD. ABLATION
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,266.70
|
| Rate for Payer: BCN Commercial |
$6,879.47
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD. ABLATION
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,114.22 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$2,314.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,781.88
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS MAPPO |
$2,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,318.33
|
| Rate for Payer: BCN Commercial |
$6,921.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,225.50
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,225.50
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,336.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,559.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Senior Care Partners |
$2,114.22
|
| Rate for Payer: PACE SWMI |
$2,225.50
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Medicare |
$2,247.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,225.50
|
| Rate for Payer: UHC Exchange |
$2,225.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,225.50
|
| Rate for Payer: VA VA |
$2,225.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
OP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,114.22 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: Aetna Medicare |
$2,314.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,781.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,781.88
|
| Rate for Payer: BCBS Complete |
$3,560.80
|
| Rate for Payer: BCBS MAPPO |
$2,225.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,318.33
|
| Rate for Payer: BCN Commercial |
$6,921.31
|
| Rate for Payer: BCN Medicare Advantage |
$2,225.50
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,225.50
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,336.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,559.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PACE Senior Care Partners |
$2,114.22
|
| Rate for Payer: PACE SWMI |
$2,225.50
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Medicare |
$2,247.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,225.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,225.50
|
| Rate for Payer: UHC Exchange |
$2,225.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,225.50
|
| Rate for Payer: VA VA |
$2,225.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADD.AFIB ABL AFTER PVI
|
Facility
|
IP
|
$8,902.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,786.30 |
| Max. Negotiated Rate |
$8,011.80 |
| Rate for Payer: Aetna Commercial |
$7,566.70
|
| Rate for Payer: BCBS Trust/PPO |
$7,266.70
|
| Rate for Payer: BCN Commercial |
$6,879.47
|
| Rate for Payer: Cash Price |
$7,121.60
|
| Rate for Payer: Cofinity Commercial |
$7,655.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,121.60
|
| Rate for Payer: Healthscope Commercial |
$8,011.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,676.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,566.70
|
| Rate for Payer: Nomi Health Commercial |
$7,299.64
|
| Rate for Payer: PHP Commercial |
$7,566.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.30
|
| Rate for Payer: Priority Health HMO/PPO |
$7,744.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,964.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,833.76
|
| Rate for Payer: UHC Core |
$7,433.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,676.50
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna Medicare |
$14.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.07
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS MAPPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$42.47
|
| Rate for Payer: BCN Medicare Advantage |
$13.65
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.65
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.97
|
| Rate for Payer: Mclaren Medicaid |
$7.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.34
|
| Rate for Payer: Meridian Medicaid |
$7.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| Rate for Payer: PACE Senior Care Partners |
$12.97
|
| Rate for Payer: PACE SWMI |
$13.65
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: PHP Medicare Advantage |
$13.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health HMO/PPO |
$47.52
|
| Rate for Payer: Priority Health Medicare |
$13.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.07
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.65
|
| Rate for Payer: UHC Exchange |
$13.65
|
| Rate for Payer: UHC Medicare Advantage |
$13.65
|
| Rate for Payer: UHCCP Medicaid |
$7.23
|
| Rate for Payer: VA VA |
$13.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.97
|
|
|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
IP
|
$54.62
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$49.16 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.59
|
| Rate for Payer: BCN Commercial |
$42.21
|
| Rate for Payer: Cash Price |
$43.70
|
| Rate for Payer: Cofinity Commercial |
$46.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.70
|
| Rate for Payer: Healthscope Commercial |
$49.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.43
|
| Rate for Payer: Nomi Health Commercial |
$44.79
|
| Rate for Payer: PHP Commercial |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.50
|
| Rate for Payer: Priority Health HMO/PPO |
$47.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.07
|
| Rate for Payer: UHC Core |
$45.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.97
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.93
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
