|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.41
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.43
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$19.98
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$18.59
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$19.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.12
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.23
|
| Rate for Payer: BCBS Complete |
$63.01
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.50
|
| Rate for Payer: BCN Commercial |
$122.47
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: PACE Senior Care Partners |
$37.41
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health HMO/PPO |
$137.04
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.54
|
| Rate for Payer: Railroad Medicare Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.62
|
| Rate for Payer: UHC Core |
$131.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.39 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: BCBS Trust/PPO |
$128.58
|
| Rate for Payer: BCN Commercial |
$121.73
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health HMO/PPO |
$137.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.62
|
| Rate for Payer: UHC Core |
$131.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,156.94 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.94
|
| Rate for Payer: BCN Commercial |
$1,375.51
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,548.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.32
|
| Rate for Payer: UHC Core |
$1,486.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$422.73 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna Medicare |
$462.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.22
|
| Rate for Payer: BCBS Complete |
$789.81
|
| Rate for Payer: BCBS MAPPO |
$444.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.26
|
| Rate for Payer: BCN Commercial |
$1,383.88
|
| Rate for Payer: BCN Medicare Advantage |
$444.98
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.98
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Mclaren Medicaid |
$752.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.23
|
| Rate for Payer: Meridian Medicaid |
$789.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: PACE Senior Care Partners |
$422.73
|
| Rate for Payer: PACE SWMI |
$444.98
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: PHP Medicare Advantage |
$444.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$752.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,548.52
|
| Rate for Payer: Priority Health Medicare |
$449.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.54
|
| Rate for Payer: Railroad Medicare Medicare |
$444.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.32
|
| Rate for Payer: UHC Core |
$1,486.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.98
|
| Rate for Payer: UHC Exchange |
$444.98
|
| Rate for Payer: UHC Medicare Advantage |
$444.98
|
| Rate for Payer: UHCCP Medicaid |
$752.15
|
| Rate for Payer: VA VA |
$444.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: BCBS Trust/PPO |
$109.40
|
| Rate for Payer: BCN Commercial |
$103.57
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO |
$116.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.94
|
| Rate for Payer: UHC Core |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna Medicare |
$34.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.88
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: BCBS MAPPO |
$33.51
|
| Rate for Payer: BCBS Trust/PPO |
$110.18
|
| Rate for Payer: BCN Commercial |
$104.20
|
| Rate for Payer: BCN Medicare Advantage |
$33.51
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.51
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: PACE Senior Care Partners |
$31.83
|
| Rate for Payer: PACE SWMI |
$33.51
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: PHP Medicare Advantage |
$33.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO |
$116.60
|
| Rate for Payer: Priority Health Medicare |
$33.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.79
|
| Rate for Payer: Railroad Medicare Medicare |
$33.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.94
|
| Rate for Payer: UHC Core |
$111.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.51
|
| Rate for Payer: UHC Exchange |
$33.51
|
| Rate for Payer: UHC Medicare Advantage |
$33.51
|
| Rate for Payer: VA VA |
$33.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: BCBS Trust/PPO |
$112.36
|
| Rate for Payer: BCN Commercial |
$106.37
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$35.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.01
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: BCBS MAPPO |
$34.41
|
| Rate for Payer: BCBS Trust/PPO |
$113.15
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$34.41
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: PACE Senior Care Partners |
$32.69
|
| Rate for Payer: PACE SWMI |
$34.41
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: PHP Medicare Advantage |
$34.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Medicare |
$34.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: Railroad Medicare Medicare |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.41
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicare Advantage |
$34.41
|
| Rate for Payer: VA VA |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna Medicare |
$37.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.63
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: BCBS MAPPO |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$117.42
|
| Rate for Payer: BCN Commercial |
$111.05
|
| Rate for Payer: BCN Medicare Advantage |
$35.71
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.71
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: PACE Senior Care Partners |
$33.92
|
| Rate for Payer: PACE SWMI |
$35.71
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: PHP Medicare Advantage |
$35.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO |
$124.26
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.70
|
| Rate for Payer: Railroad Medicare Medicare |
$35.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.69
|
| Rate for Payer: UHC Core |
$119.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.71
|
| Rate for Payer: UHC Exchange |
$35.71
|
| Rate for Payer: UHC Medicare Advantage |
$35.71
|
| Rate for Payer: VA VA |
$35.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: BCBS Trust/PPO |
$116.59
|
| Rate for Payer: BCN Commercial |
$110.38
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO |
$124.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.69
|
| Rate for Payer: UHC Core |
$119.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$30.95 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: BCBS Trust/PPO |
$38.86
|
| Rate for Payer: BCN Commercial |
$36.79
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health HMO/PPO |
$41.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.90
|
| Rate for Payer: UHC Core |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.71
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$47.61
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$42.85 |
| Rate for Payer: Aetna Commercial |
$40.47
|
| Rate for Payer: Aetna Medicare |
$12.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.88
|
| Rate for Payer: BCBS Complete |
$19.04
|
| Rate for Payer: BCBS MAPPO |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$39.14
|
| Rate for Payer: BCN Commercial |
$37.02
|
| Rate for Payer: BCN Medicare Advantage |
$11.90
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$42.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.47
|
| Rate for Payer: Nomi Health Commercial |
$39.04
|
| Rate for Payer: PACE Senior Care Partners |
$11.31
|
| Rate for Payer: PACE SWMI |
$11.90
|
| Rate for Payer: PHP Commercial |
$40.47
|
| Rate for Payer: PHP Medicare Advantage |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.95
|
| Rate for Payer: Priority Health HMO/PPO |
$41.42
|
| Rate for Payer: Priority Health Medicare |
$12.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.90
|
| Rate for Payer: UHC Core |
$39.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.90
|
| Rate for Payer: UHC Exchange |
$11.90
|
| Rate for Payer: UHC Medicare Advantage |
$11.90
|
| Rate for Payer: VA VA |
$11.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.71
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna Medicare |
$61.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.80
|
| Rate for Payer: BCBS Complete |
$94.47
|
| Rate for Payer: BCBS MAPPO |
$59.04
|
| Rate for Payer: BCBS Trust/PPO |
$194.16
|
| Rate for Payer: BCN Commercial |
$183.62
|
| Rate for Payer: BCN Medicare Advantage |
$59.04
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.04
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: PACE Senior Care Partners |
$56.09
|
| Rate for Payer: PACE SWMI |
$59.04
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: PHP Medicare Advantage |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health HMO/PPO |
$205.47
|
| Rate for Payer: Priority Health Medicare |
$59.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.23
|
| Rate for Payer: Railroad Medicare Medicare |
$59.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.83
|
| Rate for Payer: UHC Core |
$197.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.04
|
| Rate for Payer: UHC Exchange |
$59.04
|
| Rate for Payer: UHC Medicare Advantage |
$59.04
|
| Rate for Payer: VA VA |
$59.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.13
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$236.17
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$153.51 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: BCBS Trust/PPO |
$192.79
|
| Rate for Payer: BCN Commercial |
$182.51
|
| Rate for Payer: Cash Price |
$188.94
|
| Rate for Payer: Cofinity Commercial |
$203.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.94
|
| Rate for Payer: Healthscope Commercial |
$212.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.66
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.51
|
| Rate for Payer: Priority Health HMO/PPO |
$205.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.83
|
| Rate for Payer: UHC Core |
$197.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.13
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: Aetna Medicare |
$65.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.22
|
| Rate for Payer: BCBS Complete |
$100.12
|
| Rate for Payer: BCBS MAPPO |
$62.57
|
| Rate for Payer: BCBS Trust/PPO |
$205.76
|
| Rate for Payer: BCN Commercial |
$194.60
|
| Rate for Payer: BCN Medicare Advantage |
$62.57
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.57
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: PACE Senior Care Partners |
$59.44
|
| Rate for Payer: PACE SWMI |
$62.57
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: PHP Medicare Advantage |
$62.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$63.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.69
|
| Rate for Payer: Railroad Medicare Medicare |
$62.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.26
|
| Rate for Payer: UHC Core |
$208.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.57
|
| Rate for Payer: UHC Exchange |
$62.57
|
| Rate for Payer: UHC Medicare Advantage |
$62.57
|
| Rate for Payer: VA VA |
$62.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.72
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$250.29
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$162.69 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$212.75
|
| Rate for Payer: BCBS Trust/PPO |
$204.31
|
| Rate for Payer: BCN Commercial |
$193.42
|
| Rate for Payer: Cash Price |
$200.23
|
| Rate for Payer: Cofinity Commercial |
$215.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.23
|
| Rate for Payer: Healthscope Commercial |
$225.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.75
|
| Rate for Payer: Nomi Health Commercial |
$205.24
|
| Rate for Payer: PHP Commercial |
$212.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health HMO/PPO |
$217.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.26
|
| Rate for Payer: UHC Core |
$208.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.72
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.14
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$16.26
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Mclaren Medicaid |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: Meridian Medicaid |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Exchange |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$15.49
|
| Rate for Payer: VA VA |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: Aetna Medicare |
$30.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.07
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS MAPPO |
$29.65
|
| Rate for Payer: BCBS Trust/PPO |
$97.51
|
| Rate for Payer: BCN Commercial |
$92.22
|
| Rate for Payer: BCN Medicare Advantage |
$29.65
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cash Price |
$94.89
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.65
|
| Rate for Payer: Healthscope Commercial |
$106.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.96
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.14
|
| Rate for Payer: Meridian Medicaid |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: PACE Senior Care Partners |
$28.17
|
| Rate for Payer: PACE SWMI |
$29.65
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: PHP Medicare Advantage |
$29.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health HMO/PPO |
$103.19
|
| Rate for Payer: Priority Health Medicare |
$29.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.47
|
| Rate for Payer: Railroad Medicare Medicare |
$29.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.38
|
| Rate for Payer: UHC Core |
$99.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.65
|
| Rate for Payer: UHC Exchange |
$29.65
|
| Rate for Payer: UHC Medicare Advantage |
$29.65
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: VA VA |
$29.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.96
|
|
