|
HC FETAL BIOPHYSICAL PROFILE
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
40200080
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$88.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.64
|
| Rate for Payer: BCBS Complete |
$80.73
|
| Rate for Payer: BCBS MAPPO |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$280.54
|
| Rate for Payer: BCN Commercial |
$265.32
|
| Rate for Payer: BCN Medicare Advantage |
$85.31
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.31
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Mclaren Medicaid |
$76.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.58
|
| Rate for Payer: Meridian Medicaid |
$80.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: PACE Senior Care Partners |
$81.05
|
| Rate for Payer: PACE SWMI |
$85.31
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: PHP Medicare Advantage |
$85.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health HMO/PPO |
$296.89
|
| Rate for Payer: Priority Health Medicare |
$86.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.64
|
| Rate for Payer: Railroad Medicare Medicare |
$85.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$284.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.31
|
| Rate for Payer: UHC Exchange |
$85.31
|
| Rate for Payer: UHC Medicare Advantage |
$85.31
|
| Rate for Payer: UHCCP Medicaid |
$76.88
|
| Rate for Payer: VA VA |
$85.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
OP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$391.71 |
| Rate for Payer: Aetna Commercial |
$369.95
|
| Rate for Payer: Aetna Medicare |
$113.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.01
|
| Rate for Payer: BCBS Complete |
$48.90
|
| Rate for Payer: BCBS MAPPO |
$108.81
|
| Rate for Payer: BCBS Trust/PPO |
$357.80
|
| Rate for Payer: BCN Commercial |
$338.39
|
| Rate for Payer: BCN Medicare Advantage |
$108.81
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$374.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.81
|
| Rate for Payer: Healthscope Commercial |
$391.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.42
|
| Rate for Payer: Mclaren Medicaid |
$46.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.25
|
| Rate for Payer: Meridian Medicaid |
$48.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: Nomi Health Commercial |
$356.89
|
| Rate for Payer: PACE Senior Care Partners |
$103.37
|
| Rate for Payer: PACE SWMI |
$108.81
|
| Rate for Payer: PHP Commercial |
$369.95
|
| Rate for Payer: PHP Medicare Advantage |
$108.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: Priority Health HMO/PPO |
$378.65
|
| Rate for Payer: Priority Health Medicare |
$109.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.60
|
| Rate for Payer: Railroad Medicare Medicare |
$108.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.00
|
| Rate for Payer: UHC Core |
$363.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.81
|
| Rate for Payer: UHC Exchange |
$108.81
|
| Rate for Payer: UHC Medicare Advantage |
$108.81
|
| Rate for Payer: UHCCP Medicaid |
$46.57
|
| Rate for Payer: VA VA |
$108.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.42
|
|
|
HC FETAL FIBRONECTIN
|
Facility
|
IP
|
$435.23
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
30100203
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$282.90 |
| Max. Negotiated Rate |
$391.71 |
| Rate for Payer: Aetna Commercial |
$369.95
|
| Rate for Payer: BCBS Trust/PPO |
$355.28
|
| Rate for Payer: BCN Commercial |
$336.35
|
| Rate for Payer: Cash Price |
$348.18
|
| Rate for Payer: Cofinity Commercial |
$374.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.18
|
| Rate for Payer: Healthscope Commercial |
$391.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.95
|
| Rate for Payer: Nomi Health Commercial |
$356.89
|
| Rate for Payer: PHP Commercial |
$369.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.90
|
| Rate for Payer: Priority Health HMO/PPO |
$378.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.00
|
| Rate for Payer: UHC Core |
$363.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.42
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
IP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.42 |
| Max. Negotiated Rate |
$274.73 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: BCBS Trust/PPO |
$249.18
|
| Rate for Payer: BCN Commercial |
$235.90
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$262.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Healthscope Commercial |
$274.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: Nomi Health Commercial |
$250.31
|
| Rate for Payer: PHP Commercial |
$259.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: Priority Health HMO/PPO |
$265.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.63
|
| Rate for Payer: UHC Core |
$254.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.94
|
|
|
HC FETAL PULSE OXIMETRY
|
Facility
|
OP
|
$305.26
|
|
| Hospital Charge Code |
27200122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$274.73 |
| Rate for Payer: Aetna Commercial |
$259.47
|
| Rate for Payer: Aetna Medicare |
$79.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.39
|
| Rate for Payer: BCBS Complete |
$122.10
|
| Rate for Payer: BCBS MAPPO |
$76.31
|
| Rate for Payer: BCBS Trust/PPO |
$250.95
|
| Rate for Payer: BCN Commercial |
$237.34
|
| Rate for Payer: BCN Medicare Advantage |
$76.31
|
| Rate for Payer: Cash Price |
$244.21
|
| Rate for Payer: Cofinity Commercial |
$262.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.31
|
| Rate for Payer: Healthscope Commercial |
$274.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.47
|
| Rate for Payer: Nomi Health Commercial |
$250.31
|
| Rate for Payer: PACE Senior Care Partners |
$72.50
|
| Rate for Payer: PACE SWMI |
$76.31
|
| Rate for Payer: PHP Commercial |
$259.47
|
| Rate for Payer: PHP Medicare Advantage |
$76.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.42
|
| Rate for Payer: Priority Health HMO/PPO |
$265.58
|
| Rate for Payer: Priority Health Medicare |
$77.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.52
|
| Rate for Payer: Railroad Medicare Medicare |
$76.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.63
|
| Rate for Payer: UHC Core |
$254.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.31
|
| Rate for Payer: UHC Exchange |
$76.31
|
| Rate for Payer: UHC Medicare Advantage |
$76.31
|
| Rate for Payer: VA VA |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.94
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
IP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.13 |
| Max. Negotiated Rate |
$66.64 |
| Rate for Payer: Aetna Commercial |
$62.94
|
| Rate for Payer: BCBS Trust/PPO |
$60.45
|
| Rate for Payer: BCN Commercial |
$57.23
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Healthscope Commercial |
$66.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: Nomi Health Commercial |
$60.72
|
| Rate for Payer: PHP Commercial |
$62.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health HMO/PPO |
$64.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.16
|
| Rate for Payer: UHC Core |
$61.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.54
|
|
|
HC FETAL SCREEN ROSETTE
|
Facility
|
OP
|
$74.05
|
|
|
Service Code
|
CPT 85461
|
| Hospital Charge Code |
30500047
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$66.64 |
| Rate for Payer: Aetna Commercial |
$62.94
|
| Rate for Payer: Aetna Medicare |
$19.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.14
|
| Rate for Payer: BCBS Complete |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$18.51
|
| Rate for Payer: BCBS Trust/PPO |
$60.88
|
| Rate for Payer: BCN Commercial |
$57.57
|
| Rate for Payer: BCN Medicare Advantage |
$18.51
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cash Price |
$59.24
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$66.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.54
|
| Rate for Payer: Mclaren Medicaid |
$6.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.44
|
| Rate for Payer: Meridian Medicaid |
$7.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.94
|
| Rate for Payer: Nomi Health Commercial |
$60.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.59
|
| Rate for Payer: PACE SWMI |
$18.51
|
| Rate for Payer: PHP Commercial |
$62.94
|
| Rate for Payer: PHP Medicare Advantage |
$18.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.13
|
| Rate for Payer: Priority Health HMO/PPO |
$64.42
|
| Rate for Payer: Priority Health Medicare |
$18.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.61
|
| Rate for Payer: Railroad Medicare Medicare |
$18.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.16
|
| Rate for Payer: UHC Core |
$61.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.51
|
| Rate for Payer: UHC Exchange |
$18.51
|
| Rate for Payer: UHC Medicare Advantage |
$18.51
|
| Rate for Payer: UHCCP Medicaid |
$6.77
|
| Rate for Payer: VA VA |
$18.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.54
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
IP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: BCBS Trust/PPO |
$168.68
|
| Rate for Payer: BCN Commercial |
$159.69
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$177.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$185.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$169.44
|
| Rate for Payer: PHP Commercial |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health HMO/PPO |
$179.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.84
|
| Rate for Payer: UHC Core |
$172.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.98
|
|
|
HC FETUS EACH ADDL GESTATION
|
Facility
|
OP
|
$206.64
|
|
|
Service Code
|
CPT 74713
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$49.08 |
| Max. Negotiated Rate |
$185.98 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$53.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.58
|
| Rate for Payer: BCBS Complete |
$82.66
|
| Rate for Payer: BCBS MAPPO |
$51.66
|
| Rate for Payer: BCBS Trust/PPO |
$169.88
|
| Rate for Payer: BCN Commercial |
$160.66
|
| Rate for Payer: BCN Medicare Advantage |
$51.66
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$177.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.66
|
| Rate for Payer: Healthscope Commercial |
$185.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.64
|
| Rate for Payer: Nomi Health Commercial |
$169.44
|
| Rate for Payer: PACE Senior Care Partners |
$49.08
|
| Rate for Payer: PACE SWMI |
$51.66
|
| Rate for Payer: PHP Commercial |
$175.64
|
| Rate for Payer: PHP Medicare Advantage |
$51.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.32
|
| Rate for Payer: Priority Health HMO/PPO |
$179.78
|
| Rate for Payer: Priority Health Medicare |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.45
|
| Rate for Payer: Railroad Medicare Medicare |
$51.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.84
|
| Rate for Payer: UHC Core |
$172.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.66
|
| Rate for Payer: UHC Exchange |
$51.66
|
| Rate for Payer: UHC Medicare Advantage |
$51.66
|
| Rate for Payer: VA VA |
$51.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.98
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
OP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: Aetna Medicare |
$81.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.54
|
| Rate for Payer: BCBS Complete |
$183.51
|
| Rate for Payer: BCBS MAPPO |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$256.59
|
| Rate for Payer: BCN Commercial |
$242.67
|
| Rate for Payer: BCN Medicare Advantage |
$78.03
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.03
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Mclaren Medicaid |
$174.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.93
|
| Rate for Payer: Meridian Medicaid |
$183.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PACE Senior Care Partners |
$74.13
|
| Rate for Payer: PACE SWMI |
$78.03
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: PHP Medicare Advantage |
$78.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Medicare |
$78.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: Railroad Medicare Medicare |
$78.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.03
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UHC Medicare Advantage |
$78.03
|
| Rate for Payer: UHCCP Medicaid |
$174.76
|
| Rate for Payer: VA VA |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC FETUS SINGLE OR FIRST GESTATION
|
Facility
|
IP
|
$312.12
|
|
|
Service Code
|
CPT 74712
|
| Hospital Charge Code |
61000083
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$202.88 |
| Max. Negotiated Rate |
$280.91 |
| Rate for Payer: Aetna Commercial |
$265.30
|
| Rate for Payer: BCBS Trust/PPO |
$254.78
|
| Rate for Payer: BCN Commercial |
$241.21
|
| Rate for Payer: Cash Price |
$249.70
|
| Rate for Payer: Cofinity Commercial |
$268.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.70
|
| Rate for Payer: Healthscope Commercial |
$280.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.30
|
| Rate for Payer: Nomi Health Commercial |
$255.94
|
| Rate for Payer: PHP Commercial |
$265.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.88
|
| Rate for Payer: Priority Health HMO/PPO |
$271.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.67
|
| Rate for Payer: UHC Core |
$260.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.09
|
|
|
HC FFR DEVICE
|
Facility
|
IP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,362.72 |
| Max. Negotiated Rate |
$1,886.85 |
| Rate for Payer: Aetna Commercial |
$1,782.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.37
|
| Rate for Payer: BCN Commercial |
$1,620.18
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,802.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Healthscope Commercial |
$1,886.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,572.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.03
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: PHP Commercial |
$1,782.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,823.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,404.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,844.92
|
| Rate for Payer: UHC Core |
$1,750.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,572.38
|
|
|
HC FFR DEVICE
|
Facility
|
OP
|
$2,096.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27200242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.92 |
| Max. Negotiated Rate |
$1,886.85 |
| Rate for Payer: Aetna Commercial |
$1,782.03
|
| Rate for Payer: Aetna Medicare |
$545.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$655.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$655.16
|
| Rate for Payer: BCBS Complete |
$838.60
|
| Rate for Payer: BCBS MAPPO |
$524.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,723.53
|
| Rate for Payer: BCN Commercial |
$1,630.03
|
| Rate for Payer: BCN Medicare Advantage |
$524.12
|
| Rate for Payer: Cash Price |
$1,677.20
|
| Rate for Payer: Cofinity Commercial |
$1,802.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,677.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.12
|
| Rate for Payer: Healthscope Commercial |
$1,886.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,572.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$602.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,782.03
|
| Rate for Payer: Nomi Health Commercial |
$1,719.13
|
| Rate for Payer: PACE Senior Care Partners |
$497.92
|
| Rate for Payer: PACE SWMI |
$524.12
|
| Rate for Payer: PHP Commercial |
$1,782.03
|
| Rate for Payer: PHP Medicare Advantage |
$524.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,823.95
|
| Rate for Payer: Priority Health Medicare |
$529.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,404.65
|
| Rate for Payer: Railroad Medicare Medicare |
$524.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,844.92
|
| Rate for Payer: UHC Core |
$1,750.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.12
|
| Rate for Payer: UHC Exchange |
$524.12
|
| Rate for Payer: UHC Medicare Advantage |
$524.12
|
| Rate for Payer: VA VA |
$524.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,572.38
|
|
|
HC FFR MEASUREMENT
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,166.08
|
| Rate for Payer: BCN Commercial |
$2,997.36
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,374.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,598.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,413.14
|
| Rate for Payer: UHC Core |
$3,238.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC FFR MEASUREMENT
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93571
|
| Hospital Charge Code |
48100027
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$921.16 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna Medicare |
$1,008.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,212.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,212.05
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS MAPPO |
$969.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,188.57
|
| Rate for Payer: BCN Commercial |
$3,015.59
|
| Rate for Payer: BCN Medicare Advantage |
$969.64
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$969.64
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,018.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,115.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: PACE Senior Care Partners |
$921.16
|
| Rate for Payer: PACE SWMI |
$969.64
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: PHP Medicare Advantage |
$969.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,374.36
|
| Rate for Payer: Priority Health Medicare |
$979.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,598.64
|
| Rate for Payer: Railroad Medicare Medicare |
$969.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,413.14
|
| Rate for Payer: UHC Core |
$3,238.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$969.64
|
| Rate for Payer: UHC Exchange |
$969.64
|
| Rate for Payer: UHC Medicare Advantage |
$969.64
|
| Rate for Payer: VA VA |
$969.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
IP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Aetna Commercial |
$714.48
|
| Rate for Payer: BCBS Trust/PPO |
$686.15
|
| Rate for Payer: BCN Commercial |
$649.58
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$722.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Healthscope Commercial |
$756.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: PHP Commercial |
$714.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health HMO/PPO |
$731.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$563.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.69
|
| Rate for Payer: UHC Core |
$701.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.42
|
|
|
HC FFR MEASUREMENT ADD VESS
|
Facility
|
OP
|
$840.56
|
|
|
Service Code
|
CPT 93572
|
| Hospital Charge Code |
48100028
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$199.63 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Aetna Commercial |
$714.48
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.68
|
| Rate for Payer: BCBS Complete |
$336.22
|
| Rate for Payer: BCBS MAPPO |
$210.14
|
| Rate for Payer: BCBS Trust/PPO |
$691.02
|
| Rate for Payer: BCN Commercial |
$653.54
|
| Rate for Payer: BCN Medicare Advantage |
$210.14
|
| Rate for Payer: Cash Price |
$672.45
|
| Rate for Payer: Cofinity Commercial |
$722.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.14
|
| Rate for Payer: Healthscope Commercial |
$756.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.48
|
| Rate for Payer: Nomi Health Commercial |
$689.26
|
| Rate for Payer: PACE Senior Care Partners |
$199.63
|
| Rate for Payer: PACE SWMI |
$210.14
|
| Rate for Payer: PHP Commercial |
$714.48
|
| Rate for Payer: PHP Medicare Advantage |
$210.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.36
|
| Rate for Payer: Priority Health HMO/PPO |
$731.29
|
| Rate for Payer: Priority Health Medicare |
$212.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$563.18
|
| Rate for Payer: Railroad Medicare Medicare |
$210.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.69
|
| Rate for Payer: UHC Core |
$701.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.14
|
| Rate for Payer: UHC Exchange |
$210.14
|
| Rate for Payer: UHC Medicare Advantage |
$210.14
|
| Rate for Payer: VA VA |
$210.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.42
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
OP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.65 |
| Max. Negotiated Rate |
$2,408.79 |
| Rate for Payer: Aetna Commercial |
$2,274.97
|
| Rate for Payer: Aetna Medicare |
$695.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$836.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$836.38
|
| Rate for Payer: BCBS Complete |
$1,070.57
|
| Rate for Payer: BCBS MAPPO |
$669.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,200.29
|
| Rate for Payer: BCN Commercial |
$2,080.92
|
| Rate for Payer: BCN Medicare Advantage |
$669.11
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.11
|
| Rate for Payer: Healthscope Commercial |
$2,408.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,007.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$769.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: PACE Senior Care Partners |
$635.65
|
| Rate for Payer: PACE SWMI |
$669.11
|
| Rate for Payer: PHP Commercial |
$2,274.97
|
| Rate for Payer: PHP Medicare Advantage |
$669.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,328.49
|
| Rate for Payer: Priority Health Medicare |
$675.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,793.21
|
| Rate for Payer: Railroad Medicare Medicare |
$669.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,355.26
|
| Rate for Payer: UHC Core |
$2,234.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$669.11
|
| Rate for Payer: UHC Exchange |
$669.11
|
| Rate for Payer: UHC Medicare Advantage |
$669.11
|
| Rate for Payer: VA VA |
$669.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,007.32
|
|
|
HC FIBEROPTIC IABP KIT
|
Facility
|
IP
|
$2,676.43
|
|
| Hospital Charge Code |
27200301
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,739.68 |
| Max. Negotiated Rate |
$2,408.79 |
| Rate for Payer: Aetna Commercial |
$2,274.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,184.77
|
| Rate for Payer: BCN Commercial |
$2,068.35
|
| Rate for Payer: Cash Price |
$2,141.14
|
| Rate for Payer: Cofinity Commercial |
$2,301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,141.14
|
| Rate for Payer: Healthscope Commercial |
$2,408.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,007.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,274.97
|
| Rate for Payer: Nomi Health Commercial |
$2,194.67
|
| Rate for Payer: PHP Commercial |
$2,274.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,739.68
|
| Rate for Payer: Priority Health HMO/PPO |
$2,328.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,793.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,355.26
|
| Rate for Payer: UHC Core |
$2,234.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,007.32
|
|
|
HC FIBRINOGEN
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.03
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.23
|
| Rate for Payer: BCN Commercial |
$59.80
|
| Rate for Payer: BCN Medicare Advantage |
$19.23
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.19
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PACE Senior Care Partners |
$18.27
|
| Rate for Payer: PACE SWMI |
$19.23
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Medicare |
$19.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.23
|
| Rate for Payer: UHC Exchange |
$19.23
|
| Rate for Payer: UHC Medicare Advantage |
$19.23
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
| Rate for Payer: VA VA |
$19.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
|
HC FIBRINOGEN
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500045
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: BCBS Trust/PPO |
$62.78
|
| Rate for Payer: BCN Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.96 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: BCBS Trust/PPO |
$237.30
|
| Rate for Payer: BCN Commercial |
$224.65
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health HMO/PPO |
$252.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.82
|
| Rate for Payer: UHC Core |
$242.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.03
|
|
|
HC FIBROTEST-ACTITEST, S
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
CPT 81596
|
| Hospital Charge Code |
30000155
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna Medicare |
$75.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.84
|
| Rate for Payer: BCBS Complete |
$54.81
|
| Rate for Payer: BCBS MAPPO |
$72.67
|
| Rate for Payer: BCBS Trust/PPO |
$238.98
|
| Rate for Payer: BCN Commercial |
$226.02
|
| Rate for Payer: BCN Medicare Advantage |
$72.67
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.67
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.03
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.31
|
| Rate for Payer: Meridian Medicaid |
$54.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.09
|
| Rate for Payer: Nomi Health Commercial |
$238.37
|
| Rate for Payer: PACE Senior Care Partners |
$69.04
|
| Rate for Payer: PACE SWMI |
$72.67
|
| Rate for Payer: PHP Commercial |
$247.09
|
| Rate for Payer: PHP Medicare Advantage |
$72.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health HMO/PPO |
$252.91
|
| Rate for Payer: Priority Health Medicare |
$73.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.77
|
| Rate for Payer: Railroad Medicare Medicare |
$72.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.82
|
| Rate for Payer: UHC Core |
$242.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.67
|
| Rate for Payer: UHC Exchange |
$72.67
|
| Rate for Payer: UHC Medicare Advantage |
$72.67
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
| Rate for Payer: VA VA |
$72.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.03
|
|
|
HC FILSHIE CLIP
|
Facility
|
OP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: Aetna Commercial |
$285.45
|
| Rate for Payer: Aetna Medicare |
$87.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.94
|
| Rate for Payer: BCBS Complete |
$134.33
|
| Rate for Payer: BCBS MAPPO |
$83.95
|
| Rate for Payer: BCBS Trust/PPO |
$276.08
|
| Rate for Payer: BCN Commercial |
$261.10
|
| Rate for Payer: BCN Medicare Advantage |
$83.95
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$288.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.95
|
| Rate for Payer: Healthscope Commercial |
$302.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: Nomi Health Commercial |
$275.37
|
| Rate for Payer: PACE Senior Care Partners |
$79.76
|
| Rate for Payer: PACE SWMI |
$83.95
|
| Rate for Payer: PHP Commercial |
$285.45
|
| Rate for Payer: PHP Medicare Advantage |
$83.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: Priority Health HMO/PPO |
$292.16
|
| Rate for Payer: Priority Health Medicare |
$84.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.00
|
| Rate for Payer: Railroad Medicare Medicare |
$83.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.52
|
| Rate for Payer: UHC Core |
$280.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.95
|
| Rate for Payer: UHC Exchange |
$83.95
|
| Rate for Payer: UHC Medicare Advantage |
$83.95
|
| Rate for Payer: VA VA |
$83.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.87
|
|
|
HC FILSHIE CLIP
|
Facility
|
IP
|
$335.82
|
|
| Hospital Charge Code |
27000076
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$302.24 |
| Rate for Payer: Aetna Commercial |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$274.13
|
| Rate for Payer: BCN Commercial |
$259.52
|
| Rate for Payer: Cash Price |
$268.66
|
| Rate for Payer: Cofinity Commercial |
$288.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.66
|
| Rate for Payer: Healthscope Commercial |
$302.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$251.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.45
|
| Rate for Payer: Nomi Health Commercial |
$275.37
|
| Rate for Payer: PHP Commercial |
$285.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.28
|
| Rate for Payer: Priority Health HMO/PPO |
$292.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.52
|
| Rate for Payer: UHC Core |
$280.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$251.87
|
|
