|
HC F78 CASEIN
|
Facility
|
IP
|
$30.87
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200441
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$27.78 |
| Rate for Payer: Aetna Commercial |
$26.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.86
|
| Rate for Payer: BCN Commercial |
$23.86
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$26.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.70
|
| Rate for Payer: Healthscope Commercial |
$27.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.24
|
| Rate for Payer: PHP Commercial |
$26.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.17
|
| Rate for Payer: UHC Core |
$25.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.15
|
|
|
HC FACTOR II ASSAY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
30500015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.69
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS MAPPO |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: BCN Commercial |
$73.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.75
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Mclaren Medicaid |
$9.58
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PACE Senior Care Partners |
$22.56
|
| Rate for Payer: PACE SWMI |
$23.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Medicare Advantage |
$23.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: Railroad Medicare Medicare |
$23.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$24.46
|
| Rate for Payer: VA VA |
$23.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR II ASSAY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
30500015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR IX
|
Facility
|
IP
|
$153.71
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$93.75 |
| Max. Negotiated Rate |
$138.34 |
| Rate for Payer: Aetna Commercial |
$130.65
|
| Rate for Payer: BCBS Trust/PPO |
$118.79
|
| Rate for Payer: BCN Commercial |
$118.79
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Healthscope Commercial |
$138.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.65
|
| Rate for Payer: PHP Commercial |
$130.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.26
|
| Rate for Payer: UHC Core |
$128.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.28
|
|
|
HC FACTOR IX
|
Facility
|
OP
|
$153.71
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$138.34 |
| Rate for Payer: Aetna Commercial |
$130.65
|
| Rate for Payer: Aetna Medicare |
$39.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.03
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: BCBS MAPPO |
$38.43
|
| Rate for Payer: BCBS Trust/PPO |
$119.51
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$38.43
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.43
|
| Rate for Payer: Healthscope Commercial |
$138.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.28
|
| Rate for Payer: Mclaren Medicaid |
$14.05
|
| Rate for Payer: Meridian Medicaid |
$14.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.65
|
| Rate for Payer: PACE Senior Care Partners |
$36.51
|
| Rate for Payer: PACE SWMI |
$38.43
|
| Rate for Payer: PHP Commercial |
$130.65
|
| Rate for Payer: PHP Medicare Advantage |
$38.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.73
|
| Rate for Payer: Priority Health Medicare |
$38.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.75
|
| Rate for Payer: Railroad Medicare Medicare |
$38.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.26
|
| Rate for Payer: UHC Core |
$128.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.43
|
| Rate for Payer: UHC Medicare Advantage |
$39.58
|
| Rate for Payer: VA VA |
$38.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.28
|
|
|
HC FACTOR IX ASSAY
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.28
|
| Rate for Payer: BCBS Complete |
$14.75
|
| Rate for Payer: BCBS MAPPO |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$75.34
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.22
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Mclaren Medicaid |
$14.05
|
| Rate for Payer: Meridian Medicaid |
$14.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PACE Senior Care Partners |
$23.01
|
| Rate for Payer: PACE SWMI |
$24.22
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Medicare |
$24.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: Railroad Medicare Medicare |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.22
|
| Rate for Payer: UHC Medicare Advantage |
$24.95
|
| Rate for Payer: VA VA |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC FACTOR IX ASSAY
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 85250
|
| Hospital Charge Code |
30500030
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$59.10 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$74.88
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.36
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC FACTOR V ASSAY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR V ASSAY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85220
|
| Hospital Charge Code |
30500016
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.69
|
| Rate for Payer: BCBS Complete |
$13.68
|
| Rate for Payer: BCBS MAPPO |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: BCN Commercial |
$73.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.75
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Mclaren Medicaid |
$13.03
|
| Rate for Payer: Meridian Medicaid |
$13.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PACE Senior Care Partners |
$22.56
|
| Rate for Payer: PACE SWMI |
$23.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Medicare Advantage |
$23.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: Railroad Medicare Medicare |
$23.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$24.46
|
| Rate for Payer: VA VA |
$23.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.42
|
| Rate for Payer: BCN Commercial |
$73.42
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR VII ASSAY
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 85230
|
| Hospital Charge Code |
30500017
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.69
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$23.75
|
| Rate for Payer: BCBS Trust/PPO |
$73.86
|
| Rate for Payer: BCN Commercial |
$73.86
|
| Rate for Payer: BCN Medicare Advantage |
$23.75
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.75
|
| Rate for Payer: Healthscope Commercial |
$85.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.25
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.75
|
| Rate for Payer: PACE Senior Care Partners |
$22.56
|
| Rate for Payer: PACE SWMI |
$23.75
|
| Rate for Payer: PHP Commercial |
$80.75
|
| Rate for Payer: PHP Medicare Advantage |
$23.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.65
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.94
|
| Rate for Payer: Railroad Medicare Medicare |
$23.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.60
|
| Rate for Payer: UHC Core |
$79.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$24.46
|
| Rate for Payer: VA VA |
$23.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.25
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna Medicare |
$43.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.81
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$41.45
|
| Rate for Payer: BCBS Trust/PPO |
$128.91
|
| Rate for Payer: BCN Commercial |
$128.91
|
| Rate for Payer: BCN Medicare Advantage |
$41.45
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.45
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.35
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Senior Care Partners |
$39.38
|
| Rate for Payer: PACE SWMI |
$41.45
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: PHP Medicare Advantage |
$41.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.25
|
| Rate for Payer: Priority Health Medicare |
$41.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.12
|
| Rate for Payer: Railroad Medicare Medicare |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.90
|
| Rate for Payer: UHC Core |
$138.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.45
|
| Rate for Payer: UHC Medicare Advantage |
$42.69
|
| Rate for Payer: VA VA |
$41.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.35
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$101.12 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: BCBS Trust/PPO |
$128.13
|
| Rate for Payer: BCN Commercial |
$128.13
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.90
|
| Rate for Payer: UHC Core |
$138.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.35
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$25.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.24
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$77.72
|
| Rate for Payer: BCN Commercial |
$77.72
|
| Rate for Payer: BCN Medicare Advantage |
$24.99
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PACE Senior Care Partners |
$23.74
|
| Rate for Payer: PACE SWMI |
$24.99
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$24.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.97
|
| Rate for Payer: Priority Health Medicare |
$24.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.97
|
| Rate for Payer: Railroad Medicare Medicare |
$24.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.99
|
| Rate for Payer: UHC Medicare Advantage |
$25.74
|
| Rate for Payer: VA VA |
$24.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: BCBS Trust/PPO |
$77.25
|
| Rate for Payer: BCN Commercial |
$77.25
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Core |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$27.58
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.14
|
| Rate for Payer: BCN Commercial |
$81.14
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$81.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$13.21
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$64.04 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.14
|
| Rate for Payer: BCN Commercial |
$81.14
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$81.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$108.56 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: BCBS Trust/PPO |
$137.56
|
| Rate for Payer: BCN Commercial |
$137.56
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.64
|
| Rate for Payer: UHC Core |
$148.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna Medicare |
$46.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.62
|
| Rate for Payer: BCBS Complete |
$12.66
|
| Rate for Payer: BCBS MAPPO |
$44.50
|
| Rate for Payer: BCBS Trust/PPO |
$138.40
|
| Rate for Payer: BCN Commercial |
$138.40
|
| Rate for Payer: BCN Medicare Advantage |
$44.50
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Mclaren Medicaid |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$12.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PACE Senior Care Partners |
$42.28
|
| Rate for Payer: PACE SWMI |
$44.50
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: PHP Medicare Advantage |
$44.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.86
|
| Rate for Payer: Priority Health Medicare |
$44.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.56
|
| Rate for Payer: Railroad Medicare Medicare |
$44.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.64
|
| Rate for Payer: UHC Core |
$148.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.50
|
| Rate for Payer: UHC Medicare Advantage |
$45.84
|
| Rate for Payer: VA VA |
$44.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.33
|
| Rate for Payer: BCN Commercial |
$87.33
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.31
|
| Rate for Payer: BCBS Complete |
$12.66
|
| Rate for Payer: BCBS MAPPO |
$28.25
|
| Rate for Payer: BCBS Trust/PPO |
$87.86
|
| Rate for Payer: BCN Commercial |
$87.86
|
| Rate for Payer: BCN Medicare Advantage |
$28.25
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.25
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$12.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Senior Care Partners |
$26.84
|
| Rate for Payer: PACE SWMI |
$28.25
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$28.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: Railroad Medicare Medicare |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.25
|
| Rate for Payer: UHC Medicare Advantage |
$29.10
|
| Rate for Payer: VA VA |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
