|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$84.11
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$58.54 |
| Max. Negotiated Rate |
$75.70 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: BCBS Trust/PPO |
$69.47
|
| Rate for Payer: BCN Commercial |
$69.47
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cofinity Commercial |
$72.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Healthscope Commercial |
$75.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$68.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.08
|
| Rate for Payer: PHP Commercial |
$71.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.02
|
| Rate for Payer: UHC Core |
$70.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.08
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$84.11
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$75.70 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Aetna Medicare |
$21.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.28
|
| Rate for Payer: BCBS Complete |
$15.57
|
| Rate for Payer: BCBS MAPPO |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$69.15
|
| Rate for Payer: BCN Commercial |
$69.15
|
| Rate for Payer: BCN Medicare Advantage |
$21.03
|
| Rate for Payer: Cash Price |
$67.29
|
| Rate for Payer: Cofinity Commercial |
$72.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.03
|
| Rate for Payer: Healthscope Commercial |
$75.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.08
|
| Rate for Payer: Mclaren Medicaid |
$14.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.08
|
| Rate for Payer: Meridian Medicaid |
$15.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.49
|
| Rate for Payer: Nomi Health Commercial |
$68.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.08
|
| Rate for Payer: PACE Senior Care Partners |
$19.98
|
| Rate for Payer: PACE SWMI |
$21.03
|
| Rate for Payer: PHP Commercial |
$71.49
|
| Rate for Payer: PHP Medicare Advantage |
$21.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.18
|
| Rate for Payer: Priority Health Medicare |
$21.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.54
|
| Rate for Payer: Railroad Medicare Medicare |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.02
|
| Rate for Payer: UHC Core |
$70.23
|
| Rate for Payer: UHC Exchange |
$21.03
|
| Rate for Payer: UHC Medicaid |
$14.83
|
| Rate for Payer: UHC Medicare Advantage |
$21.03
|
| Rate for Payer: UHCCP Medicaid |
$14.83
|
| Rate for Payer: VA VA |
$21.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.08
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$67.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.11
|
| Rate for Payer: BCBS Complete |
$12.50
|
| Rate for Payer: BCBS MAPPO |
$16.89
|
| Rate for Payer: BCBS Trust/PPO |
$55.53
|
| Rate for Payer: BCN Commercial |
$55.53
|
| Rate for Payer: BCN Medicare Advantage |
$16.89
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.89
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.66
|
| Rate for Payer: Mclaren Medicaid |
$11.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.73
|
| Rate for Payer: Meridian Medicaid |
$12.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Nomi Health Commercial |
$55.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PACE Senior Care Partners |
$16.04
|
| Rate for Payer: PACE SWMI |
$16.89
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: PHP Medicare Advantage |
$16.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.77
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.01
|
| Rate for Payer: Railroad Medicare Medicare |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.44
|
| Rate for Payer: UHC Core |
$56.40
|
| Rate for Payer: UHC Exchange |
$16.89
|
| Rate for Payer: UHC Medicaid |
$11.91
|
| Rate for Payer: UHC Medicare Advantage |
$16.89
|
| Rate for Payer: UHCCP Medicaid |
$11.91
|
| Rate for Payer: VA VA |
$16.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.66
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$67.55
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.01 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: BCBS Trust/PPO |
$55.79
|
| Rate for Payer: BCN Commercial |
$55.79
|
| Rate for Payer: Cash Price |
$54.04
|
| Rate for Payer: Cofinity Commercial |
$58.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.04
|
| Rate for Payer: Healthscope Commercial |
$60.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.42
|
| Rate for Payer: Nomi Health Commercial |
$55.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.66
|
| Rate for Payer: PHP Commercial |
$57.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.44
|
| Rate for Payer: UHC Core |
$56.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.66
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,641.95
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,534.80 |
| Max. Negotiated Rate |
$3,277.76 |
| Rate for Payer: Aetna Commercial |
$3,095.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,007.89
|
| Rate for Payer: BCN Commercial |
$3,007.89
|
| Rate for Payer: Cash Price |
$2,913.56
|
| Rate for Payer: Cofinity Commercial |
$3,132.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.56
|
| Rate for Payer: Healthscope Commercial |
$3,277.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.66
|
| Rate for Payer: Nomi Health Commercial |
$2,986.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.46
|
| Rate for Payer: PHP Commercial |
$3,095.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,168.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,534.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,204.92
|
| Rate for Payer: UHC Core |
$3,041.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.46
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,641.95
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$642.08 |
| Max. Negotiated Rate |
$3,277.76 |
| Rate for Payer: Aetna Commercial |
$3,095.66
|
| Rate for Payer: Aetna Medicare |
$946.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,138.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,138.11
|
| Rate for Payer: BCBS Complete |
$674.12
|
| Rate for Payer: BCBS MAPPO |
$910.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,994.05
|
| Rate for Payer: BCN Commercial |
$2,994.05
|
| Rate for Payer: BCN Medicare Advantage |
$910.49
|
| Rate for Payer: Cash Price |
$2,913.56
|
| Rate for Payer: Cofinity Commercial |
$3,132.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.49
|
| Rate for Payer: Healthscope Commercial |
$3,277.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,731.46
|
| Rate for Payer: Mclaren Medicaid |
$642.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.01
|
| Rate for Payer: Meridian Medicaid |
$674.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,047.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,001.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,095.66
|
| Rate for Payer: Nomi Health Commercial |
$2,986.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,731.46
|
| Rate for Payer: PACE Senior Care Partners |
$864.96
|
| Rate for Payer: PACE SWMI |
$910.49
|
| Rate for Payer: PHP Commercial |
$3,095.66
|
| Rate for Payer: PHP Medicare Advantage |
$910.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$642.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,168.50
|
| Rate for Payer: Priority Health Medicare |
$919.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,534.80
|
| Rate for Payer: Railroad Medicare Medicare |
$910.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,204.92
|
| Rate for Payer: UHC Core |
$3,041.03
|
| Rate for Payer: UHC Exchange |
$910.49
|
| Rate for Payer: UHC Medicaid |
$642.08
|
| Rate for Payer: UHC Medicare Advantage |
$910.49
|
| Rate for Payer: UHCCP Medicaid |
$642.08
|
| Rate for Payer: VA VA |
$910.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,731.46
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$419.91
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna Medicare |
$109.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.22
|
| Rate for Payer: BCBS Complete |
$77.73
|
| Rate for Payer: BCBS MAPPO |
$104.98
|
| Rate for Payer: BCBS Trust/PPO |
$345.21
|
| Rate for Payer: BCN Commercial |
$345.21
|
| Rate for Payer: BCN Medicare Advantage |
$104.98
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cofinity Commercial |
$361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.98
|
| Rate for Payer: Healthscope Commercial |
$377.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Mclaren Medicaid |
$74.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.23
|
| Rate for Payer: Meridian Medicaid |
$77.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Nomi Health Commercial |
$344.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PACE Senior Care Partners |
$99.73
|
| Rate for Payer: PACE SWMI |
$104.98
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: PHP Medicare Advantage |
$104.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.32
|
| Rate for Payer: Priority Health Medicare |
$106.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.26
|
| Rate for Payer: Railroad Medicare Medicare |
$104.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.52
|
| Rate for Payer: UHC Core |
$350.62
|
| Rate for Payer: UHC Exchange |
$104.98
|
| Rate for Payer: UHC Medicaid |
$74.03
|
| Rate for Payer: UHC Medicare Advantage |
$104.98
|
| Rate for Payer: UHCCP Medicaid |
$74.03
|
| Rate for Payer: VA VA |
$104.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$419.91
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$292.26 |
| Max. Negotiated Rate |
$377.92 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: BCBS Trust/PPO |
$346.80
|
| Rate for Payer: BCN Commercial |
$346.80
|
| Rate for Payer: Cash Price |
$335.93
|
| Rate for Payer: Cofinity Commercial |
$361.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.93
|
| Rate for Payer: Healthscope Commercial |
$377.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Nomi Health Commercial |
$344.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.52
|
| Rate for Payer: UHC Core |
$350.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$322.46
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$274.09
|
| Rate for Payer: Aetna Medicare |
$83.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.77
|
| Rate for Payer: BCBS Complete |
$59.69
|
| Rate for Payer: BCBS MAPPO |
$80.61
|
| Rate for Payer: BCBS Trust/PPO |
$265.09
|
| Rate for Payer: BCN Commercial |
$265.09
|
| Rate for Payer: BCN Medicare Advantage |
$80.61
|
| Rate for Payer: Cash Price |
$257.97
|
| Rate for Payer: Cofinity Commercial |
$277.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.61
|
| Rate for Payer: Healthscope Commercial |
$290.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.84
|
| Rate for Payer: Mclaren Medicaid |
$56.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.65
|
| Rate for Payer: Meridian Medicaid |
$59.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.09
|
| Rate for Payer: Nomi Health Commercial |
$264.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.84
|
| Rate for Payer: PACE Senior Care Partners |
$76.58
|
| Rate for Payer: PACE SWMI |
$80.61
|
| Rate for Payer: PHP Commercial |
$274.09
|
| Rate for Payer: PHP Medicare Advantage |
$80.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.54
|
| Rate for Payer: Priority Health Medicare |
$81.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.43
|
| Rate for Payer: Railroad Medicare Medicare |
$80.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.76
|
| Rate for Payer: UHC Core |
$269.25
|
| Rate for Payer: UHC Exchange |
$80.61
|
| Rate for Payer: UHC Medicaid |
$56.85
|
| Rate for Payer: UHC Medicare Advantage |
$80.61
|
| Rate for Payer: UHCCP Medicaid |
$56.85
|
| Rate for Payer: VA VA |
$80.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.84
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$322.46
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$224.43 |
| Max. Negotiated Rate |
$290.21 |
| Rate for Payer: Aetna Commercial |
$274.09
|
| Rate for Payer: BCBS Trust/PPO |
$266.32
|
| Rate for Payer: BCN Commercial |
$266.32
|
| Rate for Payer: Cash Price |
$257.97
|
| Rate for Payer: Cofinity Commercial |
$277.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.97
|
| Rate for Payer: Healthscope Commercial |
$290.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.09
|
| Rate for Payer: Nomi Health Commercial |
$264.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.84
|
| Rate for Payer: PHP Commercial |
$274.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.76
|
| Rate for Payer: UHC Core |
$269.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.84
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$41.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.00
|
| Rate for Payer: BCBS Complete |
$29.62
|
| Rate for Payer: BCBS MAPPO |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.54
|
| Rate for Payer: BCN Commercial |
$131.54
|
| Rate for Payer: BCN Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Mclaren Medicaid |
$28.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.00
|
| Rate for Payer: Meridian Medicaid |
$29.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: Nomi Health Commercial |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE Senior Care Partners |
$38.00
|
| Rate for Payer: PACE SWMI |
$40.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: PHP Medicare Advantage |
$40.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.20
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.80
|
| Rate for Payer: UHC Core |
$133.60
|
| Rate for Payer: UHC Exchange |
$40.00
|
| Rate for Payer: UHC Medicaid |
$28.21
|
| Rate for Payer: UHC Medicare Advantage |
$40.00
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$5,170.88
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$1,819.25 |
| Max. Negotiated Rate |
$4,653.79 |
| Rate for Payer: Aetna Commercial |
$4,395.25
|
| Rate for Payer: Aetna Medicare |
$1,991.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,393.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,393.75
|
| Rate for Payer: BCBS MAPPO |
$1,915.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,270.63
|
| Rate for Payer: BCN Commercial |
$4,270.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,915.00
|
| Rate for Payer: Cash Price |
$4,136.70
|
| Rate for Payer: Cash Price |
$4,136.70
|
| Rate for Payer: Cofinity Commercial |
$4,446.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,136.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,915.00
|
| Rate for Payer: Healthscope Commercial |
$4,653.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,878.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,010.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,202.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,106.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,395.25
|
| Rate for Payer: Nomi Health Commercial |
$4,240.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,878.16
|
| Rate for Payer: PACE Senior Care Partners |
$1,819.25
|
| Rate for Payer: PACE SWMI |
$1,915.00
|
| Rate for Payer: PHP Commercial |
$4,395.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,915.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,498.67
|
| Rate for Payer: Priority Health Medicare |
$1,934.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,598.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,915.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,550.37
|
| Rate for Payer: UHC Core |
$4,317.68
|
| Rate for Payer: UHC Exchange |
$1,915.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,915.00
|
| Rate for Payer: VA VA |
$1,915.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,878.16
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,926.69
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,340.98 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.25
|
| Rate for Payer: BCN Commercial |
$1,591.25
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,676.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,340.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.49
|
| Rate for Payer: UHC Core |
$1,608.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.02
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,926.69
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna Medicare |
$500.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$602.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$602.09
|
| Rate for Payer: BCBS Complete |
$356.63
|
| Rate for Payer: BCBS MAPPO |
$481.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.93
|
| Rate for Payer: BCN Commercial |
$1,583.93
|
| Rate for Payer: BCN Medicare Advantage |
$481.67
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.67
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.02
|
| Rate for Payer: Mclaren Medicaid |
$339.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.76
|
| Rate for Payer: Meridian Medicaid |
$356.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PACE Senior Care Partners |
$457.59
|
| Rate for Payer: PACE SWMI |
$481.67
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: PHP Medicare Advantage |
$481.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,676.22
|
| Rate for Payer: Priority Health Medicare |
$486.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,340.98
|
| Rate for Payer: Railroad Medicare Medicare |
$481.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.49
|
| Rate for Payer: UHC Core |
$1,608.79
|
| Rate for Payer: UHC Exchange |
$481.67
|
| Rate for Payer: UHC Medicaid |
$339.68
|
| Rate for Payer: UHC Medicare Advantage |
$481.67
|
| Rate for Payer: UHCCP Medicaid |
$339.68
|
| Rate for Payer: VA VA |
$481.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.02
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,340.98 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.25
|
| Rate for Payer: BCN Commercial |
$1,591.25
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,676.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,340.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.49
|
| Rate for Payer: UHC Core |
$1,608.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.02
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,926.69
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$1,734.02 |
| Rate for Payer: Aetna Commercial |
$1,637.69
|
| Rate for Payer: Aetna Medicare |
$500.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$602.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$602.09
|
| Rate for Payer: BCBS Complete |
$356.63
|
| Rate for Payer: BCBS MAPPO |
$481.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.93
|
| Rate for Payer: BCN Commercial |
$1,583.93
|
| Rate for Payer: BCN Medicare Advantage |
$481.67
|
| Rate for Payer: Cash Price |
$1,541.35
|
| Rate for Payer: Cofinity Commercial |
$1,656.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,541.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.67
|
| Rate for Payer: Healthscope Commercial |
$1,734.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,445.02
|
| Rate for Payer: Mclaren Medicaid |
$339.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.76
|
| Rate for Payer: Meridian Medicaid |
$356.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$529.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,637.69
|
| Rate for Payer: Nomi Health Commercial |
$1,579.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,445.02
|
| Rate for Payer: PACE Senior Care Partners |
$457.59
|
| Rate for Payer: PACE SWMI |
$481.67
|
| Rate for Payer: PHP Commercial |
$1,637.69
|
| Rate for Payer: PHP Medicare Advantage |
$481.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,676.22
|
| Rate for Payer: Priority Health Medicare |
$486.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,340.98
|
| Rate for Payer: Railroad Medicare Medicare |
$481.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.49
|
| Rate for Payer: UHC Core |
$1,608.79
|
| Rate for Payer: UHC Exchange |
$481.67
|
| Rate for Payer: UHC Medicaid |
$339.68
|
| Rate for Payer: UHC Medicare Advantage |
$481.67
|
| Rate for Payer: UHCCP Medicaid |
$339.68
|
| Rate for Payer: VA VA |
$481.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,445.02
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$24.54
|
| Rate for Payer: BCN Commercial |
$24.54
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.14
|
| Rate for Payer: UHC Core |
$24.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.28
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.71
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$26.74 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.50
|
| Rate for Payer: BCBS MAPPO |
$7.43
|
| Rate for Payer: BCBS Trust/PPO |
$24.42
|
| Rate for Payer: BCN Commercial |
$24.42
|
| Rate for Payer: BCN Medicare Advantage |
$7.43
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$25.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.43
|
| Rate for Payer: Healthscope Commercial |
$26.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.28
|
| Rate for Payer: Mclaren Medicaid |
$5.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.80
|
| Rate for Payer: Meridian Medicaid |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.25
|
| Rate for Payer: Nomi Health Commercial |
$24.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.28
|
| Rate for Payer: PACE Senior Care Partners |
$7.06
|
| Rate for Payer: PACE SWMI |
$7.43
|
| Rate for Payer: PHP Commercial |
$25.25
|
| Rate for Payer: PHP Medicare Advantage |
$7.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.85
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.68
|
| Rate for Payer: Railroad Medicare Medicare |
$7.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.14
|
| Rate for Payer: UHC Core |
$24.81
|
| Rate for Payer: UHC Exchange |
$7.43
|
| Rate for Payer: UHC Medicaid |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.43
|
| Rate for Payer: UHCCP Medicaid |
$5.24
|
| Rate for Payer: VA VA |
$7.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.28
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.74 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.81
|
| Rate for Payer: BCBS Complete |
$12.33
|
| Rate for Payer: BCBS MAPPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$54.74
|
| Rate for Payer: BCN Medicare Advantage |
$16.65
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Mclaren Medicaid |
$11.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.48
|
| Rate for Payer: Meridian Medicaid |
$12.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PACE Senior Care Partners |
$15.82
|
| Rate for Payer: PACE SWMI |
$16.65
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Medicare |
$16.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: Railroad Medicare Medicare |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: UHC Exchange |
$16.65
|
| Rate for Payer: UHC Medicaid |
$11.74
|
| Rate for Payer: UHC Medicare Advantage |
$16.65
|
| Rate for Payer: UHCCP Medicaid |
$11.74
|
| Rate for Payer: VA VA |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$66.59
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.35 |
| Max. Negotiated Rate |
$59.93 |
| Rate for Payer: Aetna Commercial |
$56.60
|
| Rate for Payer: BCBS Trust/PPO |
$55.00
|
| Rate for Payer: BCN Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$53.27
|
| Rate for Payer: Cofinity Commercial |
$57.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.27
|
| Rate for Payer: Healthscope Commercial |
$59.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.60
|
| Rate for Payer: Nomi Health Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.94
|
| Rate for Payer: PHP Commercial |
$56.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.60
|
| Rate for Payer: UHC Core |
$55.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.94
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.64 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$108.25
|
| Rate for Payer: BCBS Trust/PPO |
$105.18
|
| Rate for Payer: BCN Commercial |
$105.18
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$109.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Healthscope Commercial |
$114.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PHP Commercial |
$108.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.07
|
| Rate for Payer: UHC Core |
$106.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.51
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$127.35
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$108.25
|
| Rate for Payer: Aetna Medicare |
$33.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.80
|
| Rate for Payer: BCBS Complete |
$23.57
|
| Rate for Payer: BCBS MAPPO |
$31.84
|
| Rate for Payer: BCBS Trust/PPO |
$104.69
|
| Rate for Payer: BCN Commercial |
$104.69
|
| Rate for Payer: BCN Medicare Advantage |
$31.84
|
| Rate for Payer: Cash Price |
$101.88
|
| Rate for Payer: Cofinity Commercial |
$109.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$114.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.51
|
| Rate for Payer: Mclaren Medicaid |
$22.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.43
|
| Rate for Payer: Meridian Medicaid |
$23.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.25
|
| Rate for Payer: Nomi Health Commercial |
$104.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.51
|
| Rate for Payer: PACE Senior Care Partners |
$30.25
|
| Rate for Payer: PACE SWMI |
$31.84
|
| Rate for Payer: PHP Commercial |
$108.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.79
|
| Rate for Payer: Priority Health Medicare |
$32.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.64
|
| Rate for Payer: Railroad Medicare Medicare |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.07
|
| Rate for Payer: UHC Core |
$106.34
|
| Rate for Payer: UHC Exchange |
$31.84
|
| Rate for Payer: UHC Medicaid |
$22.45
|
| Rate for Payer: UHC Medicare Advantage |
$31.84
|
| Rate for Payer: UHCCP Medicaid |
$22.45
|
| Rate for Payer: VA VA |
$31.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.51
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: BCBS Trust/PPO |
$90.57
|
| Rate for Payer: BCN Commercial |
$90.57
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$109.66
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna Commercial |
$93.21
|
| Rate for Payer: Aetna Medicare |
$28.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.27
|
| Rate for Payer: BCBS Complete |
$20.30
|
| Rate for Payer: BCBS MAPPO |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$90.15
|
| Rate for Payer: BCN Commercial |
$90.15
|
| Rate for Payer: BCN Medicare Advantage |
$27.41
|
| Rate for Payer: Cash Price |
$87.73
|
| Rate for Payer: Cofinity Commercial |
$94.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.41
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.25
|
| Rate for Payer: Mclaren Medicaid |
$19.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.79
|
| Rate for Payer: Meridian Medicaid |
$20.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.21
|
| Rate for Payer: Nomi Health Commercial |
$89.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.25
|
| Rate for Payer: PACE Senior Care Partners |
$26.04
|
| Rate for Payer: PACE SWMI |
$27.41
|
| Rate for Payer: PHP Commercial |
$93.21
|
| Rate for Payer: PHP Medicare Advantage |
$27.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.40
|
| Rate for Payer: Priority Health Medicare |
$27.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.32
|
| Rate for Payer: Railroad Medicare Medicare |
$27.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.50
|
| Rate for Payer: UHC Core |
$91.57
|
| Rate for Payer: UHC Exchange |
$27.41
|
| Rate for Payer: UHC Medicaid |
$19.33
|
| Rate for Payer: UHC Medicare Advantage |
$27.41
|
| Rate for Payer: UHCCP Medicaid |
$19.33
|
| Rate for Payer: VA VA |
$27.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.25
|
|
