|
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
|
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 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 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 |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.92
|
| 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 |
$8.92
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| 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 |
$8.92
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.92
|
| 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 |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.92
|
| Rate for Payer: UHC Exchange |
$8.92
|
| Rate for Payer: UHC Medicare Advantage |
$8.92
|
| Rate for Payer: UHCCP Medicaid |
$15.49
|
| Rate for Payer: VA VA |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
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 |
$26.78
|
| 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 |
$26.78
|
|
|
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
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$118.61
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$106.75 |
| Rate for Payer: Aetna Commercial |
$100.82
|
| Rate for Payer: BCBS Trust/PPO |
$96.82
|
| Rate for Payer: BCN Commercial |
$91.66
|
| 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: Healthscope Commercial |
$106.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.82
|
| Rate for Payer: Nomi Health Commercial |
$97.26
|
| Rate for Payer: PHP Commercial |
$100.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.10
|
| Rate for Payer: Priority Health HMO/PPO |
$103.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.38
|
| Rate for Payer: UHC Core |
$99.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.96
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$27.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.84
|
| Rate for Payer: BCBS Complete |
$16.26
|
| Rate for Payer: BCBS MAPPO |
$26.27
|
| Rate for Payer: BCBS Trust/PPO |
$86.39
|
| Rate for Payer: BCN Commercial |
$81.70
|
| Rate for Payer: BCN Medicare Advantage |
$26.27
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.27
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.81
|
| Rate for Payer: Mclaren Medicaid |
$15.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.58
|
| Rate for Payer: Meridian Medicaid |
$16.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PACE Senior Care Partners |
$24.96
|
| Rate for Payer: PACE SWMI |
$26.27
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$26.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO |
$91.42
|
| Rate for Payer: Priority Health Medicare |
$26.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.40
|
| Rate for Payer: Railroad Medicare Medicare |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.47
|
| Rate for Payer: UHC Core |
$87.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.27
|
| Rate for Payer: UHC Exchange |
$26.27
|
| Rate for Payer: UHC Medicare Advantage |
$26.27
|
| Rate for Payer: UHCCP Medicaid |
$15.49
|
| Rate for Payer: VA VA |
$26.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.81
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$105.08
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$94.57 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: BCBS Trust/PPO |
$85.78
|
| Rate for Payer: BCN Commercial |
$81.21
|
| Rate for Payer: Cash Price |
$84.06
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.06
|
| Rate for Payer: Healthscope Commercial |
$94.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.32
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: PHP Commercial |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.30
|
| Rate for Payer: Priority Health HMO/PPO |
$91.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.47
|
| Rate for Payer: UHC Core |
$87.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.81
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: BCBS Trust/PPO |
$69.11
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.11 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$22.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.46
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS MAPPO |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$69.60
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: BCN Medicare Advantage |
$21.16
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.50
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.22
|
| Rate for Payer: Meridian Medicaid |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Senior Care Partners |
$20.11
|
| Rate for Payer: PACE SWMI |
$21.16
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Medicare |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Railroad Medicare Medicare |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.16
|
| Rate for Payer: UHC Exchange |
$21.16
|
| Rate for Payer: UHC Medicare Advantage |
$21.16
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: VA VA |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.50
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$69.17 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.02
|
| Rate for Payer: BCBS Complete |
$35.67
|
| Rate for Payer: BCBS MAPPO |
$19.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.19
|
| Rate for Payer: BCN Commercial |
$59.76
|
| Rate for Payer: BCN Medicare Advantage |
$19.22
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$66.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.64
|
| Rate for Payer: Mclaren Medicaid |
$33.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.18
|
| Rate for Payer: Meridian Medicaid |
$35.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: Nomi Health Commercial |
$63.03
|
| Rate for Payer: PACE Senior Care Partners |
$18.25
|
| Rate for Payer: PACE SWMI |
$19.22
|
| Rate for Payer: PHP Commercial |
$65.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: Priority Health HMO/PPO |
$66.87
|
| Rate for Payer: Priority Health Medicare |
$19.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.50
|
| Rate for Payer: Railroad Medicare Medicare |
$19.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.64
|
| Rate for Payer: UHC Core |
$64.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.22
|
| Rate for Payer: UHC Exchange |
$19.22
|
| Rate for Payer: UHC Medicare Advantage |
$19.22
|
| Rate for Payer: UHCCP Medicaid |
$33.97
|
| Rate for Payer: VA VA |
$19.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.64
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$76.86
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$69.17 |
| Rate for Payer: Aetna Commercial |
$65.33
|
| Rate for Payer: BCBS Trust/PPO |
$62.74
|
| Rate for Payer: BCN Commercial |
$59.40
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cofinity Commercial |
$66.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.49
|
| Rate for Payer: Healthscope Commercial |
$69.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.33
|
| Rate for Payer: Nomi Health Commercial |
$63.03
|
| Rate for Payer: PHP Commercial |
$65.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.96
|
| Rate for Payer: Priority Health HMO/PPO |
$66.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.64
|
| Rate for Payer: UHC Core |
$64.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.64
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.29
|
| Rate for Payer: BCBS Complete |
$28.64
|
| Rate for Payer: BCBS MAPPO |
$15.43
|
| Rate for Payer: BCBS Trust/PPO |
$50.74
|
| Rate for Payer: BCN Commercial |
$47.99
|
| Rate for Payer: BCN Medicare Advantage |
$15.43
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.43
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.29
|
| Rate for Payer: Mclaren Medicaid |
$27.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.20
|
| Rate for Payer: Meridian Medicaid |
$28.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: Nomi Health Commercial |
$50.61
|
| Rate for Payer: PACE Senior Care Partners |
$14.66
|
| Rate for Payer: PACE SWMI |
$15.43
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: PHP Medicare Advantage |
$15.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health HMO/PPO |
$53.70
|
| Rate for Payer: Priority Health Medicare |
$15.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.35
|
| Rate for Payer: Railroad Medicare Medicare |
$15.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.31
|
| Rate for Payer: UHC Core |
$51.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.43
|
| Rate for Payer: UHC Exchange |
$15.43
|
| Rate for Payer: UHC Medicare Advantage |
$15.43
|
| Rate for Payer: UHCCP Medicaid |
$27.28
|
| Rate for Payer: VA VA |
$15.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.29
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$61.72
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$55.55 |
| Rate for Payer: Aetna Commercial |
$52.46
|
| Rate for Payer: BCBS Trust/PPO |
$50.38
|
| Rate for Payer: BCN Commercial |
$47.70
|
| Rate for Payer: Cash Price |
$49.38
|
| Rate for Payer: Cofinity Commercial |
$53.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.38
|
| Rate for Payer: Healthscope Commercial |
$55.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.46
|
| Rate for Payer: Nomi Health Commercial |
$50.61
|
| Rate for Payer: PHP Commercial |
$52.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.12
|
| Rate for Payer: Priority Health HMO/PPO |
$53.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.31
|
| Rate for Payer: UHC Core |
$51.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.29
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,570.54
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$720.70 |
| Max. Negotiated Rate |
$3,213.49 |
| Rate for Payer: Aetna Commercial |
$3,034.96
|
| Rate for Payer: Aetna Medicare |
$928.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,115.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,115.79
|
| Rate for Payer: BCBS Complete |
$756.79
|
| Rate for Payer: BCBS MAPPO |
$892.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,935.34
|
| Rate for Payer: BCN Commercial |
$2,776.09
|
| Rate for Payer: BCN Medicare Advantage |
$892.64
|
| Rate for Payer: Cash Price |
$2,856.43
|
| Rate for Payer: Cash Price |
$2,856.43
|
| Rate for Payer: Cofinity Commercial |
$3,070.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$892.64
|
| Rate for Payer: Healthscope Commercial |
$3,213.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.90
|
| Rate for Payer: Mclaren Medicaid |
$720.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.27
|
| Rate for Payer: Meridian Medicaid |
$756.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,026.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.96
|
| Rate for Payer: Nomi Health Commercial |
$2,927.84
|
| Rate for Payer: PACE Senior Care Partners |
$848.00
|
| Rate for Payer: PACE SWMI |
$892.64
|
| Rate for Payer: PHP Commercial |
$3,034.96
|
| Rate for Payer: PHP Medicare Advantage |
$892.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3,106.37
|
| Rate for Payer: Priority Health Medicare |
$901.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,392.26
|
| Rate for Payer: Railroad Medicare Medicare |
$892.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,142.08
|
| Rate for Payer: UHC Core |
$2,981.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$892.64
|
| Rate for Payer: UHC Exchange |
$892.64
|
| Rate for Payer: UHC Medicare Advantage |
$892.64
|
| Rate for Payer: UHCCP Medicaid |
$720.70
|
| Rate for Payer: VA VA |
$892.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.90
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,570.54
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,320.85 |
| Max. Negotiated Rate |
$3,213.49 |
| Rate for Payer: Aetna Commercial |
$3,034.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.63
|
| Rate for Payer: BCN Commercial |
$2,759.31
|
| Rate for Payer: Cash Price |
$2,856.43
|
| Rate for Payer: Cofinity Commercial |
$3,070.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.43
|
| Rate for Payer: Healthscope Commercial |
$3,213.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.96
|
| Rate for Payer: Nomi Health Commercial |
$2,927.84
|
| Rate for Payer: PHP Commercial |
$3,034.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3,106.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,392.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,142.08
|
| Rate for Payer: UHC Core |
$2,981.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.90
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$411.68
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$267.59 |
| Max. Negotiated Rate |
$370.51 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: BCBS Trust/PPO |
$336.05
|
| Rate for Payer: BCN Commercial |
$318.15
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Nomi Health Commercial |
$337.58
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health HMO/PPO |
$358.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.28
|
| Rate for Payer: UHC Core |
$343.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$411.68
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$370.51 |
| Rate for Payer: Aetna Commercial |
$349.93
|
| Rate for Payer: Aetna Medicare |
$107.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$128.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$128.65
|
| Rate for Payer: BCBS Complete |
$164.67
|
| Rate for Payer: BCBS MAPPO |
$102.92
|
| Rate for Payer: BCBS Trust/PPO |
$338.44
|
| Rate for Payer: BCN Commercial |
$320.08
|
| Rate for Payer: BCN Medicare Advantage |
$102.92
|
| Rate for Payer: Cash Price |
$329.34
|
| Rate for Payer: Cofinity Commercial |
$354.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.92
|
| Rate for Payer: Healthscope Commercial |
$370.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.93
|
| Rate for Payer: Nomi Health Commercial |
$337.58
|
| Rate for Payer: PACE Senior Care Partners |
$97.77
|
| Rate for Payer: PACE SWMI |
$102.92
|
| Rate for Payer: PHP Commercial |
$349.93
|
| Rate for Payer: PHP Medicare Advantage |
$102.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.59
|
| Rate for Payer: Priority Health HMO/PPO |
$358.16
|
| Rate for Payer: Priority Health Medicare |
$103.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.83
|
| Rate for Payer: Railroad Medicare Medicare |
$102.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.28
|
| Rate for Payer: UHC Core |
$343.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.92
|
| Rate for Payer: UHC Exchange |
$102.92
|
| Rate for Payer: UHC Medicare Advantage |
$102.92
|
| Rate for Payer: VA VA |
$102.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.76
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$316.14
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$205.49 |
| Max. Negotiated Rate |
$284.53 |
| Rate for Payer: Aetna Commercial |
$268.72
|
| Rate for Payer: BCBS Trust/PPO |
$258.07
|
| Rate for Payer: BCN Commercial |
$244.31
|
| Rate for Payer: Cash Price |
$252.91
|
| Rate for Payer: Cofinity Commercial |
$271.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.91
|
| Rate for Payer: Healthscope Commercial |
$284.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.72
|
| Rate for Payer: Nomi Health Commercial |
$259.23
|
| Rate for Payer: PHP Commercial |
$268.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.49
|
| Rate for Payer: Priority Health HMO/PPO |
$275.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.20
|
| Rate for Payer: UHC Core |
$263.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.10
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$316.14
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$284.53 |
| Rate for Payer: Aetna Commercial |
$268.72
|
| Rate for Payer: Aetna Medicare |
$82.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.79
|
| Rate for Payer: BCBS Complete |
$126.46
|
| Rate for Payer: BCBS MAPPO |
$79.04
|
| Rate for Payer: BCBS Trust/PPO |
$259.90
|
| Rate for Payer: BCN Commercial |
$245.80
|
| Rate for Payer: BCN Medicare Advantage |
$79.04
|
| Rate for Payer: Cash Price |
$252.91
|
| Rate for Payer: Cofinity Commercial |
$271.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.04
|
| Rate for Payer: Healthscope Commercial |
$284.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.72
|
| Rate for Payer: Nomi Health Commercial |
$259.23
|
| Rate for Payer: PACE Senior Care Partners |
$75.08
|
| Rate for Payer: PACE SWMI |
$79.04
|
| Rate for Payer: PHP Commercial |
$268.72
|
| Rate for Payer: PHP Medicare Advantage |
$79.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.49
|
| Rate for Payer: Priority Health HMO/PPO |
$275.04
|
| Rate for Payer: Priority Health Medicare |
$79.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.81
|
| Rate for Payer: Railroad Medicare Medicare |
$79.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.20
|
| Rate for Payer: UHC Core |
$263.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.04
|
| Rate for Payer: UHC Exchange |
$79.04
|
| Rate for Payer: UHC Medicare Advantage |
$79.04
|
| Rate for Payer: VA VA |
$79.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.10
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
