|
HC PLATELET ANTIBODY
|
Facility
|
IP
|
$99.88
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: BCBS Trust/PPO |
$81.53
|
| Rate for Payer: BCN Commercial |
$77.19
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health HMO/PPO |
$86.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Core |
$83.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.91
|
|
|
HC PLATELET ANTIBODY
|
Facility
|
OP
|
$99.88
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200129
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$89.89 |
| Rate for Payer: Aetna Commercial |
$84.90
|
| Rate for Payer: Aetna Medicare |
$25.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.21
|
| Rate for Payer: BCBS Complete |
$13.95
|
| Rate for Payer: BCBS MAPPO |
$24.97
|
| Rate for Payer: BCBS Trust/PPO |
$82.11
|
| Rate for Payer: BCN Commercial |
$77.66
|
| Rate for Payer: BCN Medicare Advantage |
$24.97
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cash Price |
$79.90
|
| Rate for Payer: Cofinity Commercial |
$85.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$89.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.91
|
| Rate for Payer: Mclaren Medicaid |
$13.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.22
|
| Rate for Payer: Meridian Medicaid |
$13.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.90
|
| Rate for Payer: Nomi Health Commercial |
$81.90
|
| Rate for Payer: PACE Senior Care Partners |
$23.72
|
| Rate for Payer: PACE SWMI |
$24.97
|
| Rate for Payer: PHP Commercial |
$84.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.92
|
| Rate for Payer: Priority Health HMO/PPO |
$86.90
|
| Rate for Payer: Priority Health Medicare |
$25.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.89
|
| Rate for Payer: UHC Core |
$83.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.97
|
| Rate for Payer: UHC Exchange |
$24.97
|
| Rate for Payer: UHC Medicare Advantage |
$24.97
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$24.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.91
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
OP
|
$279.14
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: Aetna Commercial |
$237.27
|
| Rate for Payer: Aetna Medicare |
$72.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.23
|
| Rate for Payer: BCBS Complete |
$95.48
|
| Rate for Payer: BCBS MAPPO |
$69.78
|
| Rate for Payer: BCBS Trust/PPO |
$229.48
|
| Rate for Payer: BCN Commercial |
$217.03
|
| Rate for Payer: BCN Medicare Advantage |
$69.78
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.78
|
| Rate for Payer: Healthscope Commercial |
$251.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.35
|
| Rate for Payer: Mclaren Medicaid |
$90.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.27
|
| Rate for Payer: Meridian Medicaid |
$95.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.27
|
| Rate for Payer: Nomi Health Commercial |
$228.89
|
| Rate for Payer: PACE Senior Care Partners |
$66.30
|
| Rate for Payer: PACE SWMI |
$69.78
|
| Rate for Payer: PHP Commercial |
$237.27
|
| Rate for Payer: PHP Medicare Advantage |
$69.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO |
$242.85
|
| Rate for Payer: Priority Health Medicare |
$70.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.02
|
| Rate for Payer: Railroad Medicare Medicare |
$69.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.64
|
| Rate for Payer: UHC Core |
$233.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.78
|
| Rate for Payer: UHC Exchange |
$69.78
|
| Rate for Payer: UHC Medicare Advantage |
$69.78
|
| Rate for Payer: UHCCP Medicaid |
$90.93
|
| Rate for Payer: VA VA |
$69.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.35
|
|
|
HC PLATELET CONCENTRATE
|
Facility
|
IP
|
$279.14
|
|
|
Service Code
|
HCPCS P9031
|
| Hospital Charge Code |
39000060
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.44 |
| Max. Negotiated Rate |
$251.23 |
| Rate for Payer: Aetna Commercial |
$237.27
|
| Rate for Payer: BCBS Trust/PPO |
$227.86
|
| Rate for Payer: BCN Commercial |
$215.72
|
| Rate for Payer: Cash Price |
$223.31
|
| Rate for Payer: Cofinity Commercial |
$240.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.31
|
| Rate for Payer: Healthscope Commercial |
$251.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.27
|
| Rate for Payer: Nomi Health Commercial |
$228.89
|
| Rate for Payer: PHP Commercial |
$237.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.44
|
| Rate for Payer: Priority Health HMO/PPO |
$242.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.64
|
| Rate for Payer: UHC Core |
$233.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.35
|
|
|
HC PLATELET COUNT
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$31.56
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC PLATELET COUNT
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
30500012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$3.40
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$31.78
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$3.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.86
|
| Rate for Payer: Nomi Health Commercial |
$31.70
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.13
|
| Rate for Payer: Priority Health HMO/PPO |
$33.63
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.90
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.66
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UHC Medicare Advantage |
$9.66
|
| Rate for Payer: UHCCP Medicaid |
$3.24
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
OP
|
$124.01
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$111.61 |
| Rate for Payer: Aetna Commercial |
$105.41
|
| Rate for Payer: Aetna Medicare |
$32.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.75
|
| Rate for Payer: BCBS Complete |
$18.91
|
| Rate for Payer: BCBS MAPPO |
$31.00
|
| Rate for Payer: BCBS Trust/PPO |
$101.95
|
| Rate for Payer: BCN Commercial |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$31.00
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cofinity Commercial |
$106.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.00
|
| Rate for Payer: Healthscope Commercial |
$111.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.01
|
| Rate for Payer: Mclaren Medicaid |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.55
|
| Rate for Payer: Meridian Medicaid |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.41
|
| Rate for Payer: Nomi Health Commercial |
$101.69
|
| Rate for Payer: PACE Senior Care Partners |
$29.45
|
| Rate for Payer: PACE SWMI |
$31.00
|
| Rate for Payer: PHP Commercial |
$105.41
|
| Rate for Payer: PHP Medicare Advantage |
$31.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.61
|
| Rate for Payer: Priority Health HMO/PPO |
$107.89
|
| Rate for Payer: Priority Health Medicare |
$31.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.09
|
| Rate for Payer: Railroad Medicare Medicare |
$31.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.13
|
| Rate for Payer: UHC Core |
$103.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.00
|
| Rate for Payer: UHC Exchange |
$31.00
|
| Rate for Payer: UHC Medicare Advantage |
$31.00
|
| Rate for Payer: UHCCP Medicaid |
$18.01
|
| Rate for Payer: VA VA |
$31.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.01
|
|
|
HC PLATELET FUNCTION ADP
|
Facility
|
IP
|
$124.01
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500054
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$111.61 |
| Rate for Payer: Aetna Commercial |
$105.41
|
| Rate for Payer: BCBS Trust/PPO |
$101.23
|
| Rate for Payer: BCN Commercial |
$95.83
|
| Rate for Payer: Cash Price |
$99.21
|
| Rate for Payer: Cofinity Commercial |
$106.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.21
|
| Rate for Payer: Healthscope Commercial |
$111.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.41
|
| Rate for Payer: Nomi Health Commercial |
$101.69
|
| Rate for Payer: PHP Commercial |
$105.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.61
|
| Rate for Payer: Priority Health HMO/PPO |
$107.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.13
|
| Rate for Payer: UHC Core |
$103.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.01
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$261.64 |
| Max. Negotiated Rate |
$362.28 |
| Rate for Payer: Aetna Commercial |
$342.15
|
| Rate for Payer: BCBS Trust/PPO |
$328.59
|
| Rate for Payer: BCN Commercial |
$311.08
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cofinity Commercial |
$346.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.02
|
| Rate for Payer: Healthscope Commercial |
$362.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: Nomi Health Commercial |
$330.07
|
| Rate for Payer: PHP Commercial |
$342.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.64
|
| Rate for Payer: Priority Health HMO/PPO |
$350.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.23
|
| Rate for Payer: UHC Core |
$336.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.90
|
|
|
HC PLATELET LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$402.53
|
|
|
Service Code
|
HCPCS P9033
|
| Hospital Charge Code |
39000064
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$362.28 |
| Rate for Payer: Aetna Commercial |
$342.15
|
| Rate for Payer: Aetna Medicare |
$104.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.79
|
| Rate for Payer: BCBS Complete |
$155.93
|
| Rate for Payer: BCBS MAPPO |
$100.63
|
| Rate for Payer: BCBS Trust/PPO |
$330.92
|
| Rate for Payer: BCN Commercial |
$312.97
|
| Rate for Payer: BCN Medicare Advantage |
$100.63
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cash Price |
$322.02
|
| Rate for Payer: Cofinity Commercial |
$346.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.63
|
| Rate for Payer: Healthscope Commercial |
$362.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.90
|
| Rate for Payer: Mclaren Medicaid |
$148.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.66
|
| Rate for Payer: Meridian Medicaid |
$155.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.15
|
| Rate for Payer: Nomi Health Commercial |
$330.07
|
| Rate for Payer: PACE Senior Care Partners |
$95.60
|
| Rate for Payer: PACE SWMI |
$100.63
|
| Rate for Payer: PHP Commercial |
$342.15
|
| Rate for Payer: PHP Medicare Advantage |
$100.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.64
|
| Rate for Payer: Priority Health HMO/PPO |
$350.20
|
| Rate for Payer: Priority Health Medicare |
$101.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$269.70
|
| Rate for Payer: Railroad Medicare Medicare |
$100.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.23
|
| Rate for Payer: UHC Core |
$336.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.63
|
| Rate for Payer: UHC Exchange |
$100.63
|
| Rate for Payer: UHC Medicare Advantage |
$100.63
|
| Rate for Payer: UHCCP Medicaid |
$148.50
|
| Rate for Payer: VA VA |
$100.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.90
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
OP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$82.69
|
| Rate for Payer: Aetna Medicare |
$25.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.40
|
| Rate for Payer: BCBS Complete |
$18.91
|
| Rate for Payer: BCBS MAPPO |
$24.32
|
| Rate for Payer: BCBS Trust/PPO |
$79.97
|
| Rate for Payer: BCN Commercial |
$75.64
|
| Rate for Payer: BCN Medicare Advantage |
$24.32
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$87.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.96
|
| Rate for Payer: Mclaren Medicaid |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.54
|
| Rate for Payer: Meridian Medicaid |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: PACE Senior Care Partners |
$23.10
|
| Rate for Payer: PACE SWMI |
$24.32
|
| Rate for Payer: PHP Commercial |
$82.69
|
| Rate for Payer: PHP Medicare Advantage |
$24.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health HMO/PPO |
$84.63
|
| Rate for Payer: Priority Health Medicare |
$24.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.18
|
| Rate for Payer: Railroad Medicare Medicare |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.61
|
| Rate for Payer: UHC Core |
$81.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.32
|
| Rate for Payer: UHC Exchange |
$24.32
|
| Rate for Payer: UHC Medicare Advantage |
$24.32
|
| Rate for Payer: UHCCP Medicaid |
$18.01
|
| Rate for Payer: VA VA |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.96
|
|
|
HC PLATELET RESISTANCE TEST CMPT
|
Facility
|
IP
|
$97.28
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500053
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$63.23 |
| Max. Negotiated Rate |
$87.55 |
| Rate for Payer: Aetna Commercial |
$82.69
|
| Rate for Payer: BCBS Trust/PPO |
$79.41
|
| Rate for Payer: BCN Commercial |
$75.18
|
| Rate for Payer: Cash Price |
$77.82
|
| Rate for Payer: Cofinity Commercial |
$83.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.82
|
| Rate for Payer: Healthscope Commercial |
$87.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.69
|
| Rate for Payer: Nomi Health Commercial |
$79.77
|
| Rate for Payer: PHP Commercial |
$82.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.23
|
| Rate for Payer: Priority Health HMO/PPO |
$84.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.61
|
| Rate for Payer: UHC Core |
$81.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.96
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
IP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$60.19 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: BCBS Trust/PPO |
$75.59
|
| Rate for Payer: BCN Commercial |
$71.56
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC PLAVIX RESISTANCE TEST
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500072
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.94
|
| Rate for Payer: BCBS Complete |
$18.91
|
| Rate for Payer: BCBS MAPPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$72.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.15
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Mclaren Medicaid |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.31
|
| Rate for Payer: Meridian Medicaid |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: PACE Senior Care Partners |
$21.99
|
| Rate for Payer: PACE SWMI |
$23.15
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$23.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.19
|
| Rate for Payer: Priority Health HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Medicare |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.04
|
| Rate for Payer: Railroad Medicare Medicare |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.15
|
| Rate for Payer: UHC Exchange |
$23.15
|
| Rate for Payer: UHC Medicare Advantage |
$23.15
|
| Rate for Payer: UHCCP Medicaid |
$18.01
|
| Rate for Payer: VA VA |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
IP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,262.58 |
| Max. Negotiated Rate |
$1,748.19 |
| Rate for Payer: Aetna Commercial |
$1,651.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,585.61
|
| Rate for Payer: BCN Commercial |
$1,501.11
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,670.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Healthscope Commercial |
$1,748.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: PHP Commercial |
$1,651.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,689.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,301.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.34
|
| Rate for Payer: UHC Core |
$1,621.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.82
|
|
|
HC PLMT INTERSTITIAL DEVICE RAD THER, PROST, SNGLE/MULT
|
Facility
|
OP
|
$1,942.43
|
|
|
Service Code
|
CPT 55876
|
| Hospital Charge Code |
36100577
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.33 |
| Max. Negotiated Rate |
$1,748.19 |
| Rate for Payer: Aetna Commercial |
$1,651.07
|
| Rate for Payer: Aetna Medicare |
$505.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$607.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$607.01
|
| Rate for Payer: BCBS Complete |
$1,038.78
|
| Rate for Payer: BCBS MAPPO |
$485.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,596.87
|
| Rate for Payer: BCN Commercial |
$1,510.24
|
| Rate for Payer: BCN Medicare Advantage |
$485.61
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cash Price |
$1,553.94
|
| Rate for Payer: Cofinity Commercial |
$1,670.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,553.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.61
|
| Rate for Payer: Healthscope Commercial |
$1,748.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,456.82
|
| Rate for Payer: Mclaren Medicaid |
$989.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.89
|
| Rate for Payer: Meridian Medicaid |
$1,038.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,651.07
|
| Rate for Payer: Nomi Health Commercial |
$1,592.79
|
| Rate for Payer: PACE Senior Care Partners |
$461.33
|
| Rate for Payer: PACE SWMI |
$485.61
|
| Rate for Payer: PHP Commercial |
$1,651.07
|
| Rate for Payer: PHP Medicare Advantage |
$485.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$989.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,262.58
|
| Rate for Payer: Priority Health HMO/PPO |
$1,689.91
|
| Rate for Payer: Priority Health Medicare |
$490.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,301.43
|
| Rate for Payer: Railroad Medicare Medicare |
$485.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,709.34
|
| Rate for Payer: UHC Core |
$1,621.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$485.61
|
| Rate for Payer: UHC Exchange |
$485.61
|
| Rate for Payer: UHC Medicare Advantage |
$485.61
|
| Rate for Payer: UHCCP Medicaid |
$989.25
|
| Rate for Payer: VA VA |
$485.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,456.82
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
IP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,432.80 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,799.37
|
| Rate for Payer: BCN Commercial |
$1,703.48
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PHP Commercial |
$1,873.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.78
|
| Rate for Payer: UHC Core |
$1,840.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.22
|
|
|
HC PLT PHER LEUKO REDUCED
|
Facility
|
OP
|
$2,204.30
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
39000071
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$352.17 |
| Max. Negotiated Rate |
$1,983.87 |
| Rate for Payer: Aetna Commercial |
$1,873.65
|
| Rate for Payer: Aetna Medicare |
$573.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$688.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$688.84
|
| Rate for Payer: BCBS Complete |
$369.81
|
| Rate for Payer: BCBS MAPPO |
$551.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,812.16
|
| Rate for Payer: BCN Commercial |
$1,713.84
|
| Rate for Payer: BCN Medicare Advantage |
$551.08
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cash Price |
$1,763.44
|
| Rate for Payer: Cofinity Commercial |
$1,895.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,763.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.08
|
| Rate for Payer: Healthscope Commercial |
$1,983.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,653.22
|
| Rate for Payer: Mclaren Medicaid |
$352.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$578.63
|
| Rate for Payer: Meridian Medicaid |
$369.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$633.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,873.65
|
| Rate for Payer: Nomi Health Commercial |
$1,807.53
|
| Rate for Payer: PACE Senior Care Partners |
$523.52
|
| Rate for Payer: PACE SWMI |
$551.08
|
| Rate for Payer: PHP Commercial |
$1,873.65
|
| Rate for Payer: PHP Medicare Advantage |
$551.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,432.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,917.74
|
| Rate for Payer: Priority Health Medicare |
$556.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,476.88
|
| Rate for Payer: Railroad Medicare Medicare |
$551.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,939.78
|
| Rate for Payer: UHC Core |
$1,840.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.08
|
| Rate for Payer: UHC Exchange |
$551.08
|
| Rate for Payer: UHC Medicare Advantage |
$551.08
|
| Rate for Payer: UHCCP Medicaid |
$352.17
|
| Rate for Payer: VA VA |
$551.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,653.22
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
OP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$488.50 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: Aetna Medicare |
$750.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$902.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$902.08
|
| Rate for Payer: BCBS Complete |
$512.96
|
| Rate for Payer: BCBS MAPPO |
$721.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,373.13
|
| Rate for Payer: BCN Commercial |
$2,244.39
|
| Rate for Payer: BCN Medicare Advantage |
$721.67
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.67
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,165.00
|
| Rate for Payer: Mclaren Medicaid |
$488.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.75
|
| Rate for Payer: Meridian Medicaid |
$512.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$829.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PACE Senior Care Partners |
$685.58
|
| Rate for Payer: PACE SWMI |
$721.67
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: PHP Medicare Advantage |
$721.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,511.40
|
| Rate for Payer: Priority Health Medicare |
$728.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,934.07
|
| Rate for Payer: Railroad Medicare Medicare |
$721.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,540.27
|
| Rate for Payer: UHC Core |
$2,410.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.67
|
| Rate for Payer: UHC Exchange |
$721.67
|
| Rate for Payer: UHC Medicare Advantage |
$721.67
|
| Rate for Payer: UHCCP Medicaid |
$488.50
|
| Rate for Payer: VA VA |
$721.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,165.00
|
|
|
HC PLT PHER LEUKO REDUCED IRRAD
|
Facility
|
IP
|
$2,886.67
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000070
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,876.34 |
| Max. Negotiated Rate |
$2,598.00 |
| Rate for Payer: Aetna Commercial |
$2,453.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,356.39
|
| Rate for Payer: BCN Commercial |
$2,230.82
|
| Rate for Payer: Cash Price |
$2,309.34
|
| Rate for Payer: Cofinity Commercial |
$2,482.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,309.34
|
| Rate for Payer: Healthscope Commercial |
$2,598.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,453.67
|
| Rate for Payer: Nomi Health Commercial |
$2,367.07
|
| Rate for Payer: PHP Commercial |
$2,453.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,876.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,511.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,934.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,540.27
|
| Rate for Payer: UHC Core |
$2,410.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,165.00
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
IP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$874.41 |
| Max. Negotiated Rate |
$1,210.72 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.12
|
| Rate for Payer: BCN Commercial |
$1,039.60
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,183.81
|
| Rate for Payer: UHC Core |
$1,123.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.93
|
|
|
HC PLT PHER LR IRR WASH
|
Facility
|
OP
|
$1,345.24
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
39000081
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$319.49 |
| Max. Negotiated Rate |
$1,210.72 |
| Rate for Payer: Aetna Commercial |
$1,143.45
|
| Rate for Payer: Aetna Medicare |
$349.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$420.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$420.39
|
| Rate for Payer: BCBS Complete |
$512.96
|
| Rate for Payer: BCBS MAPPO |
$336.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,105.92
|
| Rate for Payer: BCN Commercial |
$1,045.92
|
| Rate for Payer: BCN Medicare Advantage |
$336.31
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cash Price |
$1,076.19
|
| Rate for Payer: Cofinity Commercial |
$1,156.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,076.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.31
|
| Rate for Payer: Healthscope Commercial |
$1,210.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,008.93
|
| Rate for Payer: Mclaren Medicaid |
$488.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$353.13
|
| Rate for Payer: Meridian Medicaid |
$512.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,143.45
|
| Rate for Payer: Nomi Health Commercial |
$1,103.10
|
| Rate for Payer: PACE Senior Care Partners |
$319.49
|
| Rate for Payer: PACE SWMI |
$336.31
|
| Rate for Payer: PHP Commercial |
$1,143.45
|
| Rate for Payer: PHP Medicare Advantage |
$336.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$874.41
|
| Rate for Payer: Priority Health HMO/PPO |
$1,170.36
|
| Rate for Payer: Priority Health Medicare |
$339.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.31
|
| Rate for Payer: Railroad Medicare Medicare |
$336.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,183.81
|
| Rate for Payer: UHC Core |
$1,123.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.31
|
| Rate for Payer: UHC Exchange |
$336.31
|
| Rate for Payer: UHC Medicare Advantage |
$336.31
|
| Rate for Payer: UHCCP Medicaid |
$488.50
|
| Rate for Payer: VA VA |
$336.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,008.93
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
OP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: Aetna Medicare |
$76.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.33
|
| Rate for Payer: BCBS Complete |
$118.19
|
| Rate for Payer: BCBS MAPPO |
$73.87
|
| Rate for Payer: BCBS Trust/PPO |
$242.91
|
| Rate for Payer: BCN Commercial |
$229.73
|
| Rate for Payer: BCN Medicare Advantage |
$73.87
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.87
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: PACE Senior Care Partners |
$70.17
|
| Rate for Payer: PACE SWMI |
$73.87
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$73.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health HMO/PPO |
$257.06
|
| Rate for Payer: Priority Health Medicare |
$74.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.96
|
| Rate for Payer: Railroad Medicare Medicare |
$73.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.01
|
| Rate for Payer: UHC Core |
$246.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.87
|
| Rate for Payer: UHC Exchange |
$73.87
|
| Rate for Payer: UHC Medicare Advantage |
$73.87
|
| Rate for Payer: VA VA |
$73.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.60
|
|
|
HC PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT (PCV13) IM
|
Facility
|
IP
|
$295.47
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
63600074
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.06 |
| Max. Negotiated Rate |
$265.92 |
| Rate for Payer: Aetna Commercial |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$241.19
|
| Rate for Payer: BCN Commercial |
$228.34
|
| Rate for Payer: Cash Price |
$236.38
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.38
|
| Rate for Payer: Healthscope Commercial |
$265.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.15
|
| Rate for Payer: Nomi Health Commercial |
$242.29
|
| Rate for Payer: PHP Commercial |
$251.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.06
|
| Rate for Payer: Priority Health HMO/PPO |
$257.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.01
|
| Rate for Payer: UHC Core |
$246.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.60
|
|
|
HC PNEUMOCOCCAL IGG AB CMPTS
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200190
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Aetna Commercial |
$20.83
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.66
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$6.13
|
| Rate for Payer: BCBS Trust/PPO |
$20.15
|
| Rate for Payer: BCN Commercial |
$19.06
|
| Rate for Payer: BCN Medicare Advantage |
$6.13
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cash Price |
$19.61
|
| Rate for Payer: Cofinity Commercial |
$21.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.13
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.38
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.83
|
| Rate for Payer: Nomi Health Commercial |
$20.10
|
| Rate for Payer: PACE Senior Care Partners |
$5.82
|
| Rate for Payer: PACE SWMI |
$6.13
|
| Rate for Payer: PHP Commercial |
$20.83
|
| Rate for Payer: PHP Medicare Advantage |
$6.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.93
|
| Rate for Payer: Priority Health HMO/PPO |
$21.32
|
| Rate for Payer: Priority Health Medicare |
$6.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.57
|
| Rate for Payer: UHC Core |
$20.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.13
|
| Rate for Payer: UHC Exchange |
$6.13
|
| Rate for Payer: UHC Medicare Advantage |
$6.13
|
| Rate for Payer: UHCCP Medicaid |
$10.84
|
| Rate for Payer: VA VA |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.38
|
|
