|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$138.05
|
| Rate for Payer: BCN Commercial |
$130.70
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health HMO/PPO |
$147.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.83
|
| Rate for Payer: UHC Core |
$141.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.84
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$169.12
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: Aetna Medicare |
$43.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.85
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$42.28
|
| Rate for Payer: BCBS Trust/PPO |
$139.03
|
| Rate for Payer: BCN Commercial |
$131.49
|
| Rate for Payer: BCN Medicare Advantage |
$42.28
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.28
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.84
|
| Rate for Payer: Mclaren Medicaid |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.39
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| Rate for Payer: PACE Senior Care Partners |
$40.17
|
| Rate for Payer: PACE SWMI |
$42.28
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: PHP Medicare Advantage |
$42.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health HMO/PPO |
$147.13
|
| Rate for Payer: Priority Health Medicare |
$42.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.31
|
| Rate for Payer: Railroad Medicare Medicare |
$42.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.83
|
| Rate for Payer: UHC Core |
$141.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.28
|
| Rate for Payer: UHC Exchange |
$42.28
|
| Rate for Payer: UHC Medicare Advantage |
$42.28
|
| Rate for Payer: UHCCP Medicaid |
$12.94
|
| Rate for Payer: VA VA |
$42.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.84
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$26.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.86
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.82
|
| Rate for Payer: BCN Commercial |
$79.27
|
| Rate for Payer: BCN Medicare Advantage |
$25.49
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Mclaren Medicaid |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.76
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: PACE Senior Care Partners |
$24.22
|
| Rate for Payer: PACE SWMI |
$25.49
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Medicare |
$25.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: Railroad Medicare Medicare |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.49
|
| Rate for Payer: UHC Exchange |
$25.49
|
| Rate for Payer: UHC Medicare Advantage |
$25.49
|
| Rate for Payer: UHCCP Medicaid |
$12.94
|
| Rate for Payer: VA VA |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$101.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$91.76 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: BCBS Trust/PPO |
$83.23
|
| Rate for Payer: BCN Commercial |
$78.79
|
| Rate for Payer: Cash Price |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.57
|
| Rate for Payer: Healthscope Commercial |
$91.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.67
|
| Rate for Payer: Nomi Health Commercial |
$83.61
|
| Rate for Payer: PHP Commercial |
$86.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.47
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$89.17
|
| Rate for Payer: BCN Commercial |
$84.42
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.14
|
| Rate for Payer: BCBS Complete |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$84.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.31
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.31
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.31
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Medicare |
$27.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.31
|
| Rate for Payer: UHC Exchange |
$27.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.31
|
| Rate for Payer: UHCCP Medicaid |
$12.94
|
| Rate for Payer: VA VA |
$27.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$87.43
|
| 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 Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| 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
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$12.94 |
| 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 |
$13.59
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$88.05
|
| 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 |
$12.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: Meridian Medicaid |
$13.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| 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 |
$12.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$27.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| 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 Exchange |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$26.78
|
| Rate for Payer: UHCCP Medicaid |
$12.94
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$87.43
|
| 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 Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| 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 XII ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.99 |
| 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 |
$14.69
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$88.05
|
| 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 |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: Meridian Medicaid |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| 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 |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: Priority Health HMO/PPO |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$27.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.76
|
| 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 Exchange |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$26.78
|
| Rate for Payer: UHCCP Medicaid |
$13.99
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: Aetna Medicare |
$47.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.74
|
| Rate for Payer: BCBS Complete |
$12.41
|
| Rate for Payer: BCBS MAPPO |
$45.39
|
| Rate for Payer: BCBS Trust/PPO |
$149.26
|
| Rate for Payer: BCN Commercial |
$141.16
|
| Rate for Payer: BCN Medicare Advantage |
$45.39
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$156.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.39
|
| Rate for Payer: Healthscope Commercial |
$163.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.17
|
| Rate for Payer: Mclaren Medicaid |
$11.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.66
|
| Rate for Payer: Meridian Medicaid |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: Nomi Health Commercial |
$148.88
|
| Rate for Payer: PACE Senior Care Partners |
$43.12
|
| Rate for Payer: PACE SWMI |
$45.39
|
| Rate for Payer: PHP Commercial |
$154.33
|
| Rate for Payer: PHP Medicare Advantage |
$45.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health HMO/PPO |
$157.96
|
| Rate for Payer: Priority Health Medicare |
$45.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.65
|
| Rate for Payer: Railroad Medicare Medicare |
$45.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.77
|
| Rate for Payer: UHC Core |
$151.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.39
|
| Rate for Payer: UHC Exchange |
$45.39
|
| Rate for Payer: UHC Medicare Advantage |
$45.39
|
| Rate for Payer: UHCCP Medicaid |
$11.81
|
| Rate for Payer: VA VA |
$45.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.17
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$181.56
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$118.01 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$154.33
|
| Rate for Payer: BCBS Trust/PPO |
$148.21
|
| Rate for Payer: BCN Commercial |
$140.31
|
| Rate for Payer: Cash Price |
$145.25
|
| Rate for Payer: Cofinity Commercial |
$156.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.25
|
| Rate for Payer: Healthscope Commercial |
$163.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.33
|
| Rate for Payer: Nomi Health Commercial |
$148.88
|
| Rate for Payer: PHP Commercial |
$154.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health HMO/PPO |
$157.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.77
|
| Rate for Payer: UHC Core |
$151.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.17
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: Aetna Medicare |
$29.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.02
|
| Rate for Payer: BCBS Complete |
$12.41
|
| Rate for Payer: BCBS MAPPO |
$28.82
|
| Rate for Payer: BCBS Trust/PPO |
$94.76
|
| Rate for Payer: BCN Commercial |
$89.61
|
| Rate for Payer: BCN Medicare Advantage |
$28.82
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.44
|
| Rate for Payer: Mclaren Medicaid |
$11.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: PACE Senior Care Partners |
$27.37
|
| Rate for Payer: PACE SWMI |
$28.82
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$28.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO |
$100.28
|
| Rate for Payer: Priority Health Medicare |
$29.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.22
|
| Rate for Payer: Railroad Medicare Medicare |
$28.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.43
|
| Rate for Payer: UHC Core |
$96.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.82
|
| Rate for Payer: UHC Exchange |
$28.82
|
| Rate for Payer: UHC Medicare Advantage |
$28.82
|
| Rate for Payer: UHCCP Medicaid |
$11.81
|
| Rate for Payer: VA VA |
$28.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.44
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$115.26
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.92 |
| Max. Negotiated Rate |
$103.73 |
| Rate for Payer: Aetna Commercial |
$97.97
|
| Rate for Payer: BCBS Trust/PPO |
$94.09
|
| Rate for Payer: BCN Commercial |
$89.07
|
| Rate for Payer: Cash Price |
$92.21
|
| Rate for Payer: Cofinity Commercial |
$99.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.21
|
| Rate for Payer: Healthscope Commercial |
$103.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.97
|
| Rate for Payer: Nomi Health Commercial |
$94.51
|
| Rate for Payer: PHP Commercial |
$97.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.92
|
| Rate for Payer: Priority Health HMO/PPO |
$100.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.43
|
| Rate for Payer: UHC Core |
$96.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.44
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$82.30 |
| Rate for Payer: Aetna Commercial |
$77.73
|
| Rate for Payer: BCBS Trust/PPO |
$74.65
|
| Rate for Payer: BCN Commercial |
$70.67
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$78.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Healthscope Commercial |
$82.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: Nomi Health Commercial |
$74.99
|
| Rate for Payer: PHP Commercial |
$77.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: Priority Health HMO/PPO |
$79.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.48
|
| Rate for Payer: UHC Core |
$76.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.59
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$91.45
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$21.72 |
| Max. Negotiated Rate |
$119.51 |
| Rate for Payer: Aetna Commercial |
$77.73
|
| Rate for Payer: Aetna Medicare |
$23.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.58
|
| Rate for Payer: BCBS Complete |
$119.51
|
| Rate for Payer: BCBS MAPPO |
$22.86
|
| Rate for Payer: BCBS Trust/PPO |
$75.18
|
| Rate for Payer: BCN Commercial |
$71.10
|
| Rate for Payer: BCN Medicare Advantage |
$22.86
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cash Price |
$73.16
|
| Rate for Payer: Cofinity Commercial |
$78.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$82.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.59
|
| Rate for Payer: Mclaren Medicaid |
$113.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.01
|
| Rate for Payer: Meridian Medicaid |
$119.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.73
|
| Rate for Payer: Nomi Health Commercial |
$74.99
|
| Rate for Payer: PACE Senior Care Partners |
$21.72
|
| Rate for Payer: PACE SWMI |
$22.86
|
| Rate for Payer: PHP Commercial |
$77.73
|
| Rate for Payer: PHP Medicare Advantage |
$22.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.44
|
| Rate for Payer: Priority Health HMO/PPO |
$79.56
|
| Rate for Payer: Priority Health Medicare |
$23.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.27
|
| Rate for Payer: Railroad Medicare Medicare |
$22.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.48
|
| Rate for Payer: UHC Core |
$76.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.86
|
| Rate for Payer: UHC Exchange |
$22.86
|
| Rate for Payer: UHC Medicare Advantage |
$22.86
|
| Rate for Payer: UHCCP Medicaid |
$113.81
|
| Rate for Payer: VA VA |
$22.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.59
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,029.92 |
| Max. Negotiated Rate |
$3,902.84 |
| Rate for Payer: Aetna Commercial |
$3,686.02
|
| Rate for Payer: Aetna Medicare |
$1,127.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,355.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,355.15
|
| Rate for Payer: BCBS Complete |
$1,734.60
|
| Rate for Payer: BCBS MAPPO |
$1,084.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,565.03
|
| Rate for Payer: BCN Commercial |
$3,371.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.12
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$3,729.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.12
|
| Rate for Payer: Healthscope Commercial |
$3,902.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,252.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,138.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,246.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: Nomi Health Commercial |
$3,555.92
|
| Rate for Payer: PACE Senior Care Partners |
$1,029.92
|
| Rate for Payer: PACE SWMI |
$1,084.12
|
| Rate for Payer: PHP Commercial |
$3,686.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,772.75
|
| Rate for Payer: Priority Health Medicare |
$1,094.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,905.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,084.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,816.11
|
| Rate for Payer: UHC Core |
$3,620.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,084.12
|
| Rate for Payer: UHC Exchange |
$1,084.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,084.12
|
| Rate for Payer: VA VA |
$1,084.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,252.37
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,336.49
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,818.72 |
| Max. Negotiated Rate |
$3,902.84 |
| Rate for Payer: Aetna Commercial |
$3,686.02
|
| Rate for Payer: BCBS Trust/PPO |
$3,539.88
|
| Rate for Payer: BCN Commercial |
$3,351.24
|
| Rate for Payer: Cash Price |
$3,469.19
|
| Rate for Payer: Cofinity Commercial |
$3,729.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,469.19
|
| Rate for Payer: Healthscope Commercial |
$3,902.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,252.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,686.02
|
| Rate for Payer: Nomi Health Commercial |
$3,555.92
|
| Rate for Payer: PHP Commercial |
$3,686.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,818.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,772.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,905.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,816.11
|
| Rate for Payer: UHC Core |
$3,620.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,252.37
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
IP
|
$8,726.47
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,672.21 |
| Max. Negotiated Rate |
$7,853.82 |
| Rate for Payer: Aetna Commercial |
$7,417.50
|
| Rate for Payer: BCBS Trust/PPO |
$7,123.42
|
| Rate for Payer: BCN Commercial |
$6,743.82
|
| Rate for Payer: Cash Price |
$6,981.18
|
| Rate for Payer: Cofinity Commercial |
$7,504.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.18
|
| Rate for Payer: Healthscope Commercial |
$7,853.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,544.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,417.50
|
| Rate for Payer: Nomi Health Commercial |
$7,155.71
|
| Rate for Payer: PHP Commercial |
$7,417.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,672.21
|
| Rate for Payer: Priority Health HMO/PPO |
$7,592.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,846.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,679.29
|
| Rate for Payer: UHC Core |
$7,286.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,544.85
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,726.47
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,072.54 |
| Max. Negotiated Rate |
$7,853.82 |
| Rate for Payer: Aetna Commercial |
$7,417.50
|
| Rate for Payer: Aetna Medicare |
$2,268.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,727.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,727.02
|
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: BCBS MAPPO |
$2,181.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,174.03
|
| Rate for Payer: BCN Commercial |
$6,784.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,181.62
|
| Rate for Payer: Cash Price |
$6,981.18
|
| Rate for Payer: Cash Price |
$6,981.18
|
| Rate for Payer: Cofinity Commercial |
$7,504.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,981.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,181.62
|
| Rate for Payer: Healthscope Commercial |
$7,853.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,544.85
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,290.70
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,508.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,417.50
|
| Rate for Payer: Nomi Health Commercial |
$7,155.71
|
| Rate for Payer: PACE Senior Care Partners |
$2,072.54
|
| Rate for Payer: PACE SWMI |
$2,181.62
|
| Rate for Payer: PHP Commercial |
$7,417.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,181.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,672.21
|
| Rate for Payer: Priority Health HMO/PPO |
$7,592.03
|
| Rate for Payer: Priority Health Medicare |
$2,203.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,846.73
|
| Rate for Payer: Railroad Medicare Medicare |
$2,181.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,679.29
|
| Rate for Payer: UHC Core |
$7,286.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,181.62
|
| Rate for Payer: UHC Exchange |
$2,181.62
|
| Rate for Payer: UHC Medicare Advantage |
$2,181.62
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
| Rate for Payer: VA VA |
$2,181.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,544.85
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
OP
|
$154.10
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$138.69 |
| Rate for Payer: Aetna Commercial |
$130.98
|
| Rate for Payer: Aetna Medicare |
$40.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.16
|
| Rate for Payer: BCBS Complete |
$14.25
|
| Rate for Payer: BCBS MAPPO |
$38.52
|
| Rate for Payer: BCBS Trust/PPO |
$126.69
|
| Rate for Payer: BCN Commercial |
$119.81
|
| Rate for Payer: BCN Medicare Advantage |
$38.52
|
| Rate for Payer: Cash Price |
$123.28
|
| Rate for Payer: Cash Price |
$123.28
|
| Rate for Payer: Cofinity Commercial |
$132.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.52
|
| Rate for Payer: Healthscope Commercial |
$138.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.58
|
| Rate for Payer: Mclaren Medicaid |
$13.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.45
|
| Rate for Payer: Meridian Medicaid |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.98
|
| Rate for Payer: Nomi Health Commercial |
$126.36
|
| Rate for Payer: PACE Senior Care Partners |
$36.60
|
| Rate for Payer: PACE SWMI |
$38.52
|
| Rate for Payer: PHP Commercial |
$130.98
|
| Rate for Payer: PHP Medicare Advantage |
$38.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.16
|
| Rate for Payer: Priority Health HMO/PPO |
$134.07
|
| Rate for Payer: Priority Health Medicare |
$38.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.25
|
| Rate for Payer: Railroad Medicare Medicare |
$38.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.61
|
| Rate for Payer: UHC Core |
$128.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.52
|
| Rate for Payer: UHC Exchange |
$38.52
|
| Rate for Payer: UHC Medicare Advantage |
$38.52
|
| Rate for Payer: UHCCP Medicaid |
$13.57
|
| Rate for Payer: VA VA |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.58
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
IP
|
$154.10
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.16 |
| Max. Negotiated Rate |
$138.69 |
| Rate for Payer: Aetna Commercial |
$130.98
|
| Rate for Payer: BCBS Trust/PPO |
$125.79
|
| Rate for Payer: BCN Commercial |
$119.09
|
| Rate for Payer: Cash Price |
$123.28
|
| Rate for Payer: Cofinity Commercial |
$132.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.28
|
| Rate for Payer: Healthscope Commercial |
$138.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.98
|
| Rate for Payer: Nomi Health Commercial |
$126.36
|
| Rate for Payer: PHP Commercial |
$130.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.16
|
| Rate for Payer: Priority Health HMO/PPO |
$134.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.61
|
| Rate for Payer: UHC Core |
$128.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.58
|
|
|
HC FDG PER DOSE
|
Facility
|
IP
|
$777.96
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$505.67 |
| Max. Negotiated Rate |
$700.16 |
| Rate for Payer: Aetna Commercial |
$661.27
|
| Rate for Payer: BCBS Trust/PPO |
$635.05
|
| Rate for Payer: BCN Commercial |
$601.21
|
| Rate for Payer: Cash Price |
$622.37
|
| Rate for Payer: Cofinity Commercial |
$669.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.37
|
| Rate for Payer: Healthscope Commercial |
$700.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.27
|
| Rate for Payer: Nomi Health Commercial |
$637.93
|
| Rate for Payer: PHP Commercial |
$661.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.67
|
| Rate for Payer: Priority Health HMO/PPO |
$676.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.60
|
| Rate for Payer: UHC Core |
$649.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.47
|
|
|
HC FDG PER DOSE
|
Facility
|
OP
|
$777.96
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$184.77 |
| Max. Negotiated Rate |
$700.16 |
| Rate for Payer: Aetna Commercial |
$661.27
|
| Rate for Payer: Aetna Medicare |
$202.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.11
|
| Rate for Payer: BCBS Complete |
$311.18
|
| Rate for Payer: BCBS MAPPO |
$194.49
|
| Rate for Payer: BCBS Trust/PPO |
$639.56
|
| Rate for Payer: BCN Commercial |
$604.86
|
| Rate for Payer: BCN Medicare Advantage |
$194.49
|
| Rate for Payer: Cash Price |
$622.37
|
| Rate for Payer: Cofinity Commercial |
$669.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$622.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.49
|
| Rate for Payer: Healthscope Commercial |
$700.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$583.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661.27
|
| Rate for Payer: Nomi Health Commercial |
$637.93
|
| Rate for Payer: PACE Senior Care Partners |
$184.77
|
| Rate for Payer: PACE SWMI |
$194.49
|
| Rate for Payer: PHP Commercial |
$661.27
|
| Rate for Payer: PHP Medicare Advantage |
$194.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.67
|
| Rate for Payer: Priority Health HMO/PPO |
$676.83
|
| Rate for Payer: Priority Health Medicare |
$196.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$521.23
|
| Rate for Payer: Railroad Medicare Medicare |
$194.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.60
|
| Rate for Payer: UHC Core |
$649.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.49
|
| Rate for Payer: UHC Exchange |
$194.49
|
| Rate for Payer: UHC Medicare Advantage |
$194.49
|
| Rate for Payer: VA VA |
$194.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$583.47
|
|
|
HC FECAL FAT QUALITATIVE
|
Facility
|
IP
|
$34.22
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
30100198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$29.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.93
|
| Rate for Payer: BCN Commercial |
$26.45
|
| Rate for Payer: Cash Price |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$29.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.38
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.09
|
| Rate for Payer: Nomi Health Commercial |
$28.06
|
| Rate for Payer: PHP Commercial |
$29.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.24
|
| Rate for Payer: Priority Health HMO/PPO |
$29.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.11
|
| Rate for Payer: UHC Core |
$28.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.66
|
|
