|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$165.80
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.95 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna American Axle |
$107.77
|
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health SBD |
$104.45
|
| Rate for Payer: UMR Bronson Commercial |
$72.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.35
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$165.80
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$149.22 |
| Rate for Payer: Aetna American Axle |
$107.77
|
| Rate for Payer: Aetna Commercial |
$140.93
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cash Price |
$132.64
|
| Rate for Payer: Cofinity Commercial |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.35
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.93
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$140.93
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$104.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: UMR Bronson Commercial |
$61.35
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.35
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$99.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna American Axle |
$64.97
|
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: UMR Bronson Commercial |
$43.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$99.96
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$89.96 |
| Rate for Payer: Aetna American Axle |
$64.97
|
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cash Price |
$79.97
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Cofinity Commercial |
$85.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$89.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.97
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.97
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$84.97
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$62.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: UMR Bronson Commercial |
$36.99
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.97
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: UMR Bronson Commercial |
$39.63
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.38
|
| Rate for Payer: BCBS Complete |
$10.28
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$9.79
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Medicaid |
$10.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.48
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Exchange |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: UMR Bronson Commercial |
$46.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna American Axle |
$68.25
|
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Cofinity Commercial |
$73.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$66.15
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$31.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.35
|
| Rate for Payer: UHC Exchange |
$19.35
|
| Rate for Payer: UHC Medicare Advantage |
$19.93
|
| Rate for Payer: UMR Bronson Commercial |
$38.85
|
| Rate for Payer: VA VA |
$19.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna American Axle |
$115.70
|
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.70
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health SBD |
$112.14
|
| Rate for Payer: UMR Bronson Commercial |
$78.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna American Axle |
$115.70
|
| Rate for Payer: Aetna Commercial |
$151.30
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$124.60
|
| Rate for Payer: Cofinity Commercial |
$153.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$160.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.50
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.30
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$151.30
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$112.14
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$26.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$65.86
|
| Rate for Payer: VA VA |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.50
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: UMR Bronson Commercial |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna American Axle |
$73.45
|
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.70
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$8.94
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$9.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.94
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$16.75
|
| Rate for Payer: Priority Health SBD |
$71.19
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$26.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.34
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$41.81
|
| Rate for Payer: VA VA |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$89.66
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$446.15 |
| Rate for Payer: Aetna American Axle |
$58.28
|
| Rate for Payer: Aetna Commercial |
$76.21
|
| Rate for Payer: Aetna Medicare |
$147.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.15
|
| Rate for Payer: BCBS Complete |
$81.40
|
| Rate for Payer: BCBS MAPPO |
$141.72
|
| Rate for Payer: BCBS Trust/PPO |
$58.64
|
| Rate for Payer: BCN Medicare Advantage |
$141.72
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$62.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.72
|
| Rate for Payer: Healthscope Commercial |
$80.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.24
|
| Rate for Payer: Mclaren Medicaid |
$77.52
|
| Rate for Payer: Mclaren Medicare |
$141.72
|
| Rate for Payer: Meridian Medicaid |
$81.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.21
|
| Rate for Payer: PACE Medicare |
$134.63
|
| Rate for Payer: PACE SWMI |
$141.72
|
| Rate for Payer: PHP Commercial |
$76.21
|
| Rate for Payer: PHP Medicare Advantage |
$141.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.15
|
| Rate for Payer: Priority Health Medicare |
$141.72
|
| Rate for Payer: Priority Health Narrow Network |
$356.92
|
| Rate for Payer: Priority Health SBD |
$56.49
|
| Rate for Payer: Railroad Medicare Medicare |
$141.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.72
|
| Rate for Payer: UHC Exchange |
$95.61
|
| Rate for Payer: UHC Medicare Advantage |
$145.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.17
|
| Rate for Payer: VA VA |
$141.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.24
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$89.66
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$80.69 |
| Rate for Payer: Aetna American Axle |
$58.28
|
| Rate for Payer: Aetna Commercial |
$76.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.28
|
| Rate for Payer: Cash Price |
$71.73
|
| Rate for Payer: Cofinity Commercial |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$62.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.73
|
| Rate for Payer: Healthscope Commercial |
$80.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.21
|
| Rate for Payer: PHP Commercial |
$76.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.76
|
| Rate for Payer: Priority Health SBD |
$56.49
|
| Rate for Payer: UMR Bronson Commercial |
$39.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.24
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,251.46
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,870.64 |
| Max. Negotiated Rate |
$3,826.31 |
| Rate for Payer: Aetna American Axle |
$2,763.45
|
| Rate for Payer: Aetna Commercial |
$3,613.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.45
|
| Rate for Payer: Cash Price |
$3,401.17
|
| Rate for Payer: Cofinity Commercial |
$2,976.02
|
| Rate for Payer: Cofinity Commercial |
$3,656.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,401.17
|
| Rate for Payer: Healthscope Commercial |
$3,826.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,188.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,613.74
|
| Rate for Payer: PHP Commercial |
$3,613.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,976.02
|
| Rate for Payer: Priority Health SBD |
$2,678.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,870.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,188.60
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,251.46
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,573.04 |
| Max. Negotiated Rate |
$3,826.31 |
| Rate for Payer: Aetna American Axle |
$2,763.45
|
| Rate for Payer: Aetna Commercial |
$3,613.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,763.45
|
| Rate for Payer: BCBS Complete |
$1,700.58
|
| Rate for Payer: Cash Price |
$3,401.17
|
| Rate for Payer: Cofinity Commercial |
$2,976.02
|
| Rate for Payer: Cofinity Commercial |
$3,656.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,401.17
|
| Rate for Payer: Healthscope Commercial |
$3,826.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,976.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,188.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,613.74
|
| Rate for Payer: PHP Commercial |
$3,613.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,976.02
|
| Rate for Payer: Priority Health SBD |
$2,678.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,573.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,188.60
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,555.36
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$5,560.98
|
| Rate for Payer: Aetna Commercial |
$7,272.06
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,560.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,199.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cofinity Commercial |
$7,357.61
|
| Rate for Payer: Cofinity Commercial |
$5,988.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,844.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$7,699.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,988.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,416.52
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,272.06
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$7,272.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,988.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Priority Health SBD |
$5,389.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.92
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$291.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$3,165.48
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,416.52
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
IP
|
$8,555.36
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.36 |
| Max. Negotiated Rate |
$7,699.82 |
| Rate for Payer: Aetna American Axle |
$5,560.98
|
| Rate for Payer: Aetna Commercial |
$7,272.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,560.98
|
| Rate for Payer: Cash Price |
$6,844.29
|
| Rate for Payer: Cofinity Commercial |
$5,988.75
|
| Rate for Payer: Cofinity Commercial |
$7,357.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,844.29
|
| Rate for Payer: Healthscope Commercial |
$7,699.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,988.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,416.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,272.06
|
| Rate for Payer: PHP Commercial |
$7,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,988.75
|
| Rate for Payer: Priority Health SBD |
$5,389.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,764.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,416.52
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
OP
|
$151.08
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$135.97 |
| Rate for Payer: Aetna American Axle |
$98.20
|
| Rate for Payer: Aetna Commercial |
$128.42
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$135.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.31
|
| Rate for Payer: Mclaren Medicaid |
$10.27
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Medicaid |
$10.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.42
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$128.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$14.61
|
| Rate for Payer: Priority Health SBD |
$95.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.52
|
| Rate for Payer: UHC Core |
$21.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Exchange |
$18.77
|
| Rate for Payer: UHC Medicare Advantage |
$19.33
|
| Rate for Payer: UMR Bronson Commercial |
$55.90
|
| Rate for Payer: VA VA |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.31
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
IP
|
$151.08
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.48 |
| Max. Negotiated Rate |
$135.97 |
| Rate for Payer: Aetna American Axle |
$98.20
|
| Rate for Payer: Aetna Commercial |
$128.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.20
|
| Rate for Payer: Cash Price |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$105.76
|
| Rate for Payer: Cofinity Commercial |
$129.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.86
|
| Rate for Payer: Healthscope Commercial |
$135.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.42
|
| Rate for Payer: PHP Commercial |
$128.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.76
|
| Rate for Payer: Priority Health SBD |
$95.18
|
| Rate for Payer: UMR Bronson Commercial |
$66.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.31
|
|
|
HC FDG PER DOSE
|
Facility
|
OP
|
$762.71
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$237.13 |
| Max. Negotiated Rate |
$686.44 |
| Rate for Payer: Aetna American Axle |
$495.76
|
| Rate for Payer: Aetna Commercial |
$648.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: BCBS Complete |
$305.08
|
| Rate for Payer: BCBS Trust/PPO |
$237.13
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cofinity Commercial |
$533.90
|
| Rate for Payer: Cofinity Commercial |
$655.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.17
|
| Rate for Payer: Healthscope Commercial |
$686.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.30
|
| Rate for Payer: PHP Commercial |
$648.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.90
|
| Rate for Payer: Priority Health SBD |
$480.51
|
| Rate for Payer: UMR Bronson Commercial |
$282.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.03
|
|
|
HC FDG PER DOSE
|
Facility
|
IP
|
$762.71
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$335.59 |
| Max. Negotiated Rate |
$686.44 |
| Rate for Payer: Aetna American Axle |
$495.76
|
| Rate for Payer: Aetna Commercial |
$648.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: Cash Price |
$610.17
|
| Rate for Payer: Cofinity Commercial |
$533.90
|
| Rate for Payer: Cofinity Commercial |
$655.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$610.17
|
| Rate for Payer: Healthscope Commercial |
$686.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$533.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$648.30
|
| Rate for Payer: PHP Commercial |
$648.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.90
|
| Rate for Payer: Priority Health SBD |
$480.51
|
| Rate for Payer: UMR Bronson Commercial |
$335.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.03
|
|
|
HC FECAL FAT QUALITATIVE
|
Facility
|
OP
|
$33.55
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
30100198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$30.20 |
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna Commercial |
$28.52
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$2.93
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$4.59
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cash Price |
$26.84
|
| Rate for Payer: Cofinity Commercial |
$28.85
|
| Rate for Payer: Cofinity Commercial |
$23.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.16
|
| Rate for Payer: Mclaren Medicaid |
$2.79
|
| Rate for Payer: Mclaren Medicare |
$5.10
|
| Rate for Payer: Meridian Medicaid |
$2.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.52
|
| Rate for Payer: PACE Medicare |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$28.52
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.99
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow Network |
$5.59
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.12
|
| Rate for Payer: UHC Core |
$8.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Exchange |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.41
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.16
|
|
