|
HC HEM/ONC CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$103.24
|
| Rate for Payer: BCN Commercial |
$103.24
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$23.14
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.76
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$102.76
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Mclaren Medicaid |
$22.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: Meridian Medicaid |
$23.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Exchange |
$31.25
|
| Rate for Payer: UHC Medicaid |
$22.04
|
| Rate for Payer: UHC Medicare Advantage |
$31.25
|
| Rate for Payer: UHCCP Medicaid |
$22.04
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.94
|
| Rate for Payer: BCN Commercial |
$369.94
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Mclaren Medicaid |
$79.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: Meridian Medicaid |
$83.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$113.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Exchange |
$112.50
|
| Rate for Payer: UHC Medicaid |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
| Rate for Payer: UHCCP Medicaid |
$79.33
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$371.65
|
| Rate for Payer: BCN Commercial |
$371.65
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.66
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$61.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Mclaren Medicaid |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: Meridian Medicaid |
$13.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Exchange |
$18.75
|
| Rate for Payer: UHC Medicaid |
$13.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.75
|
| Rate for Payer: UHCCP Medicaid |
$13.22
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.94
|
| Rate for Payer: BCN Commercial |
$61.94
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,185.73
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$825.27 |
| Max. Negotiated Rate |
$1,067.16 |
| Rate for Payer: Aetna Commercial |
$1,007.87
|
| Rate for Payer: BCBS Trust/PPO |
$979.29
|
| Rate for Payer: BCN Commercial |
$979.29
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,019.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Healthscope Commercial |
$1,067.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PHP Commercial |
$1,007.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,031.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.44
|
| Rate for Payer: UHC Core |
$990.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.30
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,185.73
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$1,067.16 |
| Rate for Payer: Aetna Commercial |
$1,007.87
|
| Rate for Payer: Aetna Medicare |
$308.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.54
|
| Rate for Payer: BCBS Complete |
$219.48
|
| Rate for Payer: BCBS MAPPO |
$296.43
|
| Rate for Payer: BCBS Trust/PPO |
$974.79
|
| Rate for Payer: BCN Commercial |
$974.79
|
| Rate for Payer: BCN Medicare Advantage |
$296.43
|
| Rate for Payer: Cash Price |
$948.58
|
| Rate for Payer: Cofinity Commercial |
$1,019.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.43
|
| Rate for Payer: Healthscope Commercial |
$1,067.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$889.30
|
| Rate for Payer: Mclaren Medicaid |
$209.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.25
|
| Rate for Payer: Meridian Medicaid |
$219.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.87
|
| Rate for Payer: Nomi Health Commercial |
$972.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$889.30
|
| Rate for Payer: PACE Senior Care Partners |
$281.61
|
| Rate for Payer: PACE SWMI |
$296.43
|
| Rate for Payer: PHP Commercial |
$1,007.87
|
| Rate for Payer: PHP Medicare Advantage |
$296.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,031.59
|
| Rate for Payer: Priority Health Medicare |
$299.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$825.27
|
| Rate for Payer: Railroad Medicare Medicare |
$296.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,043.44
|
| Rate for Payer: UHC Core |
$990.08
|
| Rate for Payer: UHC Exchange |
$296.43
|
| Rate for Payer: UHC Medicaid |
$209.04
|
| Rate for Payer: UHC Medicare Advantage |
$296.43
|
| Rate for Payer: UHCCP Medicaid |
$209.04
|
| Rate for Payer: VA VA |
$296.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$889.30
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.48
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.67
|
| Rate for Payer: BCN Commercial |
$19.67
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PACE Senior Care Partners |
$5.68
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.82
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UHC Medicaid |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Commercial |
$19.76
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$496.00
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.22 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$421.60
|
| Rate for Payer: BCBS Trust/PPO |
$409.65
|
| Rate for Payer: BCN Commercial |
$409.65
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$426.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.80
|
| Rate for Payer: Healthscope Commercial |
$446.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.60
|
| Rate for Payer: Nomi Health Commercial |
$406.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.00
|
| Rate for Payer: PHP Commercial |
$421.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.48
|
| Rate for Payer: UHC Core |
$414.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.00
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$496.00
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$446.40 |
| Rate for Payer: Aetna Commercial |
$421.60
|
| Rate for Payer: Aetna Medicare |
$128.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$155.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$155.00
|
| Rate for Payer: BCBS Complete |
$91.81
|
| Rate for Payer: BCBS MAPPO |
$124.00
|
| Rate for Payer: BCBS Trust/PPO |
$407.76
|
| Rate for Payer: BCN Commercial |
$407.76
|
| Rate for Payer: BCN Medicare Advantage |
$124.00
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$426.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$446.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.00
|
| Rate for Payer: Mclaren Medicaid |
$87.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.20
|
| Rate for Payer: Meridian Medicaid |
$91.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.60
|
| Rate for Payer: Nomi Health Commercial |
$406.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.00
|
| Rate for Payer: PACE Senior Care Partners |
$117.80
|
| Rate for Payer: PACE SWMI |
$124.00
|
| Rate for Payer: PHP Commercial |
$421.60
|
| Rate for Payer: PHP Medicare Advantage |
$124.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.52
|
| Rate for Payer: Priority Health Medicare |
$125.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.22
|
| Rate for Payer: Railroad Medicare Medicare |
$124.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.48
|
| Rate for Payer: UHC Core |
$414.16
|
| Rate for Payer: UHC Exchange |
$124.00
|
| Rate for Payer: UHC Medicaid |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$124.00
|
| Rate for Payer: UHCCP Medicaid |
$87.44
|
| Rate for Payer: VA VA |
$124.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.00
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,464.14
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,803.04 |
| Max. Negotiated Rate |
$4,917.73 |
| Rate for Payer: Aetna Commercial |
$4,644.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,512.83
|
| Rate for Payer: BCN Commercial |
$4,512.83
|
| Rate for Payer: Cash Price |
$4,371.31
|
| Rate for Payer: Cofinity Commercial |
$4,699.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,371.31
|
| Rate for Payer: Healthscope Commercial |
$4,917.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,098.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,644.52
|
| Rate for Payer: Nomi Health Commercial |
$4,480.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,098.10
|
| Rate for Payer: PHP Commercial |
$4,644.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,753.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,803.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,808.44
|
| Rate for Payer: UHC Core |
$4,562.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,098.10
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,464.14
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$963.33 |
| Max. Negotiated Rate |
$4,917.73 |
| Rate for Payer: Aetna Commercial |
$4,644.52
|
| Rate for Payer: Aetna Medicare |
$1,420.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,707.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,707.54
|
| Rate for Payer: BCBS Complete |
$1,011.41
|
| Rate for Payer: BCBS MAPPO |
$1,366.04
|
| Rate for Payer: BCBS Trust/PPO |
$4,492.07
|
| Rate for Payer: BCN Commercial |
$4,492.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,366.04
|
| Rate for Payer: Cash Price |
$4,371.31
|
| Rate for Payer: Cofinity Commercial |
$4,699.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,371.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,366.04
|
| Rate for Payer: Healthscope Commercial |
$4,917.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,098.10
|
| Rate for Payer: Mclaren Medicaid |
$963.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,434.34
|
| Rate for Payer: Meridian Medicaid |
$1,011.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,570.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,502.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,644.52
|
| Rate for Payer: Nomi Health Commercial |
$4,480.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,098.10
|
| Rate for Payer: PACE Senior Care Partners |
$1,297.73
|
| Rate for Payer: PACE SWMI |
$1,366.04
|
| Rate for Payer: PHP Commercial |
$4,644.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,366.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$963.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,753.80
|
| Rate for Payer: Priority Health Medicare |
$1,379.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,803.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,366.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,808.44
|
| Rate for Payer: UHC Core |
$4,562.56
|
| Rate for Payer: UHC Exchange |
$1,366.04
|
| Rate for Payer: UHC Medicaid |
$963.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,366.04
|
| Rate for Payer: UHCCP Medicaid |
$963.33
|
| Rate for Payer: VA VA |
$1,366.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,098.10
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$159.18
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.79 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: BCBS Trust/PPO |
$131.47
|
| Rate for Payer: BCN Commercial |
$131.47
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.08
|
| Rate for Payer: UHC Core |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.39
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$159.18
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$135.30
|
| Rate for Payer: Aetna Medicare |
$41.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.74
|
| Rate for Payer: BCBS Complete |
$29.46
|
| Rate for Payer: BCBS MAPPO |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$130.86
|
| Rate for Payer: BCN Commercial |
$130.86
|
| Rate for Payer: BCN Medicare Advantage |
$39.80
|
| Rate for Payer: Cash Price |
$127.34
|
| Rate for Payer: Cofinity Commercial |
$136.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.80
|
| Rate for Payer: Healthscope Commercial |
$143.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.39
|
| Rate for Payer: Mclaren Medicaid |
$28.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.78
|
| Rate for Payer: Meridian Medicaid |
$29.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.30
|
| Rate for Payer: Nomi Health Commercial |
$130.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.39
|
| Rate for Payer: PACE Senior Care Partners |
$37.81
|
| Rate for Payer: PACE SWMI |
$39.80
|
| Rate for Payer: PHP Commercial |
$135.30
|
| Rate for Payer: PHP Medicare Advantage |
$39.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$138.49
|
| Rate for Payer: Priority Health Medicare |
$40.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.79
|
| Rate for Payer: Railroad Medicare Medicare |
$39.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.08
|
| Rate for Payer: UHC Core |
$132.92
|
| Rate for Payer: UHC Exchange |
$39.80
|
| Rate for Payer: UHC Medicaid |
$28.06
|
| Rate for Payer: UHC Medicare Advantage |
$39.80
|
| Rate for Payer: UHCCP Medicaid |
$28.06
|
| Rate for Payer: VA VA |
$39.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.39
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$79.59
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: BCBS Trust/PPO |
$65.73
|
| Rate for Payer: BCN Commercial |
$65.73
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$79.59
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$67.65
|
| Rate for Payer: Aetna Medicare |
$20.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.87
|
| Rate for Payer: BCBS Complete |
$14.73
|
| Rate for Payer: BCBS MAPPO |
$19.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.43
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.90
|
| Rate for Payer: Cash Price |
$63.67
|
| Rate for Payer: Cofinity Commercial |
$68.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.90
|
| Rate for Payer: Healthscope Commercial |
$71.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.69
|
| Rate for Payer: Mclaren Medicaid |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.89
|
| Rate for Payer: Meridian Medicaid |
$14.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.65
|
| Rate for Payer: Nomi Health Commercial |
$65.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.69
|
| Rate for Payer: PACE Senior Care Partners |
$18.90
|
| Rate for Payer: PACE SWMI |
$19.90
|
| Rate for Payer: PHP Commercial |
$67.65
|
| Rate for Payer: PHP Medicare Advantage |
$19.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$69.24
|
| Rate for Payer: Priority Health Medicare |
$20.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.39
|
| Rate for Payer: Railroad Medicare Medicare |
$19.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.04
|
| Rate for Payer: UHC Core |
$66.46
|
| Rate for Payer: UHC Exchange |
$19.90
|
| Rate for Payer: UHC Medicaid |
$14.03
|
| Rate for Payer: UHC Medicare Advantage |
$19.90
|
| Rate for Payer: UHCCP Medicaid |
$14.03
|
| Rate for Payer: VA VA |
$19.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.69
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$47.24
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: BCBS Trust/PPO |
$39.02
|
| Rate for Payer: BCN Commercial |
$39.02
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.57
|
| Rate for Payer: UHC Core |
$39.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.43
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$47.24
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.76
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: BCBS MAPPO |
$11.81
|
| Rate for Payer: BCBS Trust/PPO |
$38.84
|
| Rate for Payer: BCN Commercial |
$38.84
|
| Rate for Payer: BCN Medicare Advantage |
$11.81
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Cofinity Commercial |
$40.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.81
|
| Rate for Payer: Healthscope Commercial |
$42.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.43
|
| Rate for Payer: Mclaren Medicaid |
$8.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.40
|
| Rate for Payer: Meridian Medicaid |
$8.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.15
|
| Rate for Payer: Nomi Health Commercial |
$38.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.43
|
| Rate for Payer: PACE Senior Care Partners |
$11.22
|
| Rate for Payer: PACE SWMI |
$11.81
|
| Rate for Payer: PHP Commercial |
$40.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.10
|
| Rate for Payer: Priority Health Medicare |
$11.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.88
|
| Rate for Payer: Railroad Medicare Medicare |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.57
|
| Rate for Payer: UHC Core |
$39.45
|
| Rate for Payer: UHC Exchange |
$11.81
|
| Rate for Payer: UHC Medicaid |
$8.33
|
| Rate for Payer: UHC Medicare Advantage |
$11.81
|
| Rate for Payer: UHCCP Medicaid |
$8.33
|
| Rate for Payer: VA VA |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.43
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$249.38
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$173.57 |
| Max. Negotiated Rate |
$224.44 |
| Rate for Payer: Aetna Commercial |
$211.97
|
| Rate for Payer: BCBS Trust/PPO |
$205.96
|
| Rate for Payer: BCN Commercial |
$205.96
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$214.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.50
|
| Rate for Payer: Healthscope Commercial |
$224.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.97
|
| Rate for Payer: Nomi Health Commercial |
$204.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.03
|
| Rate for Payer: PHP Commercial |
$211.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$216.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.45
|
| Rate for Payer: UHC Core |
$208.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.03
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$249.38
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$224.44 |
| Rate for Payer: Aetna Commercial |
$211.97
|
| Rate for Payer: Aetna Medicare |
$64.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.93
|
| Rate for Payer: BCBS Complete |
$46.16
|
| Rate for Payer: BCBS MAPPO |
$62.34
|
| Rate for Payer: BCBS Trust/PPO |
$205.02
|
| Rate for Payer: BCN Commercial |
$205.02
|
| Rate for Payer: BCN Medicare Advantage |
$62.34
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$214.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.34
|
| Rate for Payer: Healthscope Commercial |
$224.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.03
|
| Rate for Payer: Mclaren Medicaid |
$43.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.46
|
| Rate for Payer: Meridian Medicaid |
$46.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.97
|
| Rate for Payer: Nomi Health Commercial |
$204.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.03
|
| Rate for Payer: PACE Senior Care Partners |
$59.23
|
| Rate for Payer: PACE SWMI |
$62.34
|
| Rate for Payer: PHP Commercial |
$211.97
|
| Rate for Payer: PHP Medicare Advantage |
$62.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$216.96
|
| Rate for Payer: Priority Health Medicare |
$62.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.57
|
| Rate for Payer: Railroad Medicare Medicare |
$62.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.45
|
| Rate for Payer: UHC Core |
$208.23
|
| Rate for Payer: UHC Exchange |
$62.34
|
| Rate for Payer: UHC Medicaid |
$43.97
|
| Rate for Payer: UHC Medicare Advantage |
$62.34
|
| Rate for Payer: UHCCP Medicaid |
$43.97
|
| Rate for Payer: VA VA |
$62.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.03
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.27
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$34.90
|
| Rate for Payer: BCN Commercial |
$34.90
|
| Rate for Payer: BCN Medicare Advantage |
$10.61
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.61
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Mclaren Medicaid |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.14
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PACE Senior Care Partners |
$10.08
|
| Rate for Payer: PACE SWMI |
$10.61
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: PHP Medicare Advantage |
$10.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.93
|
| Rate for Payer: Priority Health Medicare |
$10.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.36
|
| Rate for Payer: UHC Core |
$35.45
|
| Rate for Payer: UHC Exchange |
$10.61
|
| Rate for Payer: UHC Medicaid |
$7.48
|
| Rate for Payer: UHC Medicare Advantage |
$10.61
|
| Rate for Payer: UHCCP Medicaid |
$7.48
|
| Rate for Payer: VA VA |
$10.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$38.20 |
| Rate for Payer: Aetna Commercial |
$36.08
|
| Rate for Payer: BCBS Trust/PPO |
$35.06
|
| Rate for Payer: BCN Commercial |
$35.06
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$36.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$38.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: PHP Commercial |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$36.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.36
|
| Rate for Payer: UHC Core |
$35.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.84
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
IP
|
$3,622.26
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,521.09 |
| Max. Negotiated Rate |
$3,260.03 |
| Rate for Payer: Aetna Commercial |
$3,078.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,991.62
|
| Rate for Payer: BCN Commercial |
$2,991.62
|
| Rate for Payer: Cash Price |
$2,897.81
|
| Rate for Payer: Cofinity Commercial |
$3,115.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,897.81
|
| Rate for Payer: Healthscope Commercial |
$3,260.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,716.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,078.92
|
| Rate for Payer: Nomi Health Commercial |
$2,970.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,716.70
|
| Rate for Payer: PHP Commercial |
$3,078.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,151.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,521.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,187.59
|
| Rate for Payer: UHC Core |
$3,024.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,716.70
|
|
