|
HC FACTOR VIII ASSAY
|
Facility
|
IP
|
$172.50
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna American Axle |
$112.12
|
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: Priority Health SBD |
$108.67
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.38
|
|
|
HC FACTOR VIII ASSAY
|
Facility
|
OP
|
$172.50
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500018
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna American Axle |
$112.12
|
| Rate for Payer: Aetna Commercial |
$146.62
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.12
|
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cofinity Advantage |
$120.75
|
| Rate for Payer: Cofinity Commercial |
$148.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$155.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.38
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.62
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.38
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$146.62
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$108.67
|
| Rate for Payer: Priority Health Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC Core |
$26.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$63.83
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.38
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: Priority Health Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC Core |
$26.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$38.48
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC FACTOR VIII INHIBITOR EVALUATION
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 85240
|
| Hospital Charge Code |
30500019
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna American Axle |
$67.60
|
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Advantage |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health SBD |
$65.52
|
| Rate for Payer: UMR Bronson Commercial |
$45.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC FACTOR X ASSAY
|
Facility
|
OP
|
$111.42
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna American Axle |
$72.42
|
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.56
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$70.19
|
| Rate for Payer: Priority Health Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC Core |
$26.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$41.23
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.56
|
|
|
HC FACTOR X ASSAY
|
Facility
|
IP
|
$111.42
|
|
|
Service Code
|
CPT 85260
|
| Hospital Charge Code |
30500031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$49.02 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna American Axle |
$72.42
|
| Rate for Payer: Aetna Commercial |
$94.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.42
|
| Rate for Payer: Cash Price |
$89.14
|
| Rate for Payer: Cofinity Advantage |
$77.99
|
| Rate for Payer: Cofinity Commercial |
$95.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.14
|
| Rate for Payer: Healthscope Commercial |
$100.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.56
|
| Rate for Payer: PHP Commercial |
$94.71
|
| Rate for Payer: Priority Health SBD |
$70.19
|
| Rate for Payer: UMR Bronson Commercial |
$49.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.56
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$17.90
|
| Rate for Payer: Mclaren Medicare |
$17.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: Meridian Medicaid |
$18.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$26.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$17.00
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: Priority Health Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC Core |
$26.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.90
|
| Rate for Payer: UHC Exchange |
$26.85
|
| Rate for Payer: UHC Medicaid |
$9.36
|
| Rate for Payer: UHCCP Medicaid |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: VA VA |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR XI ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85270
|
| Hospital Charge Code |
30500032
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| 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 |
$10.63
|
| Rate for Payer: BCBS MAPPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$22.36
|
| Rate for Payer: BCN Commercial |
$22.36
|
| Rate for Payer: BCN Medicare Advantage |
$19.35
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$19.35
|
| Rate for Payer: Mclaren Medicare |
$19.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$29.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PACE Medicare |
$18.38
|
| Rate for Payer: PACE SWMI |
$19.35
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$19.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.35
|
| Rate for Payer: Priority Health Medicare |
$19.35
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: Priority Health Tiered Network |
$15.48
|
| Rate for Payer: Railroad Medicare Medicare |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.03
|
| Rate for Payer: UHC Core |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19.35
|
| Rate for Payer: UHC Exchange |
$29.03
|
| Rate for Payer: UHC Medicaid |
$10.12
|
| Rate for Payer: UHCCP Medicaid |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$40.42
|
| Rate for Payer: VA VA |
$19.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR XII ASSAY
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 85280
|
| Hospital Charge Code |
30500033
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$48.07 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna American Axle |
$71.01
|
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.01
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Advantage |
$76.47
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.93
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health SBD |
$68.82
|
| Rate for Payer: UMR Bronson Commercial |
$48.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
OP
|
$185.19
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$166.67 |
| Rate for Payer: Aetna American Axle |
$120.37
|
| Rate for Payer: Aetna Commercial |
$157.41
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.90
|
| Rate for Payer: BCN Commercial |
$18.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cofinity Advantage |
$129.63
|
| Rate for Payer: Cofinity Commercial |
$159.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$166.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.89
|
| Rate for Payer: Mclaren Medicaid |
$16.34
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.41
|
| Rate for Payer: Nomi Health Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.89
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$157.41
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.34
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$116.67
|
| Rate for Payer: Priority Health Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.51
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$24.51
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$68.52
|
| Rate for Payer: VA VA |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.89
|
|
|
HC FACTOR XIII, FUNCTIONAL
|
Facility
|
IP
|
$185.19
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500086
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$166.67 |
| Rate for Payer: Aetna American Axle |
$120.37
|
| Rate for Payer: Aetna Commercial |
$157.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.37
|
| Rate for Payer: Cash Price |
$148.15
|
| Rate for Payer: Cofinity Advantage |
$129.63
|
| Rate for Payer: Cofinity Commercial |
$159.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.15
|
| Rate for Payer: Healthscope Commercial |
$166.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.89
|
| Rate for Payer: PHP Commercial |
$157.41
|
| Rate for Payer: Priority Health SBD |
$116.67
|
| Rate for Payer: UMR Bronson Commercial |
$81.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.89
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna American Axle |
$76.42
|
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: UMR Bronson Commercial |
$51.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC FACTOR XIII QUAL
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 85290
|
| Hospital Charge Code |
30500034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna American Axle |
$76.42
|
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$16.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.43
|
| Rate for Payer: BCBS Complete |
$8.97
|
| Rate for Payer: BCBS MAPPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$18.90
|
| Rate for Payer: BCN Commercial |
$18.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.34
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Advantage |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Mclaren Medicaid |
$16.34
|
| Rate for Payer: Mclaren Medicare |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.16
|
| Rate for Payer: Meridian Medicaid |
$17.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Medicare |
$15.52
|
| Rate for Payer: PACE SWMI |
$16.34
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$16.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.34
|
| Rate for Payer: Priority Health Medicare |
$16.34
|
| Rate for Payer: Priority Health SBD |
$74.07
|
| Rate for Payer: Priority Health Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.51
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.34
|
| Rate for Payer: UHC Exchange |
$24.51
|
| Rate for Payer: UHC Medicaid |
$8.55
|
| Rate for Payer: UHCCP Medicaid |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$43.50
|
| Rate for Payer: VA VA |
$16.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
OP
|
$93.28
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$571.94 |
| Rate for Payer: Aetna American Axle |
$60.63
|
| Rate for Payer: Aetna Commercial |
$79.29
|
| Rate for Payer: Aetna Medicare |
$183.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.07
|
| Rate for Payer: BCBS Complete |
$97.13
|
| Rate for Payer: BCBS MAPPO |
$176.86
|
| Rate for Payer: BCBS Trust/PPO |
$50.71
|
| Rate for Payer: BCN Commercial |
$50.71
|
| Rate for Payer: BCN Medicare Advantage |
$176.86
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cofinity Advantage |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.86
|
| Rate for Payer: Healthscope Commercial |
$83.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.96
|
| Rate for Payer: Mclaren Medicaid |
$176.86
|
| Rate for Payer: Mclaren Medicare |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.70
|
| Rate for Payer: Meridian Medicaid |
$185.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.29
|
| Rate for Payer: Nomi Health Commercial |
$530.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.96
|
| Rate for Payer: PACE Medicare |
$168.02
|
| Rate for Payer: PACE SWMI |
$176.86
|
| Rate for Payer: PHP Commercial |
$79.29
|
| Rate for Payer: PHP Medicare Advantage |
$176.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$571.94
|
| Rate for Payer: Priority Health Medicare |
$176.86
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: Priority Health Tiered Network |
$457.55
|
| Rate for Payer: Railroad Medicare Medicare |
$176.86
|
| Rate for Payer: UHC Medicaid |
$92.50
|
| Rate for Payer: UHCCP Medicaid |
$92.50
|
| Rate for Payer: UMR Bronson Commercial |
$34.51
|
| Rate for Payer: VA VA |
$176.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.96
|
|
|
HC FAMILY PSYCHTHRPY 50 MIN W/O PATIENT
|
Facility
|
IP
|
$93.28
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
91600001
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$83.95 |
| Rate for Payer: Aetna American Axle |
$60.63
|
| Rate for Payer: Aetna Commercial |
$79.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.63
|
| Rate for Payer: Cash Price |
$74.62
|
| Rate for Payer: Cofinity Advantage |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$80.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.62
|
| Rate for Payer: Healthscope Commercial |
$83.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.96
|
| Rate for Payer: PHP Commercial |
$79.29
|
| Rate for Payer: Priority Health SBD |
$58.77
|
| Rate for Payer: UMR Bronson Commercial |
$41.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.96
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
OP
|
$4,423.22
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,636.59 |
| Max. Negotiated Rate |
$3,980.90 |
| Rate for Payer: Aetna American Axle |
$2,875.09
|
| Rate for Payer: Aetna Commercial |
$3,759.74
|
| Rate for Payer: Aetna Medicare |
$2,211.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,875.09
|
| Rate for Payer: BCBS Complete |
$1,769.29
|
| Rate for Payer: Cash Price |
$3,538.58
|
| Rate for Payer: Cofinity Advantage |
$3,096.25
|
| Rate for Payer: Cofinity Commercial |
$3,803.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,538.58
|
| Rate for Payer: Healthscope Commercial |
$3,980.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,096.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,317.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,538.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,759.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,317.41
|
| Rate for Payer: PHP Commercial |
$3,759.74
|
| Rate for Payer: Priority Health SBD |
$2,786.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,636.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,317.41
|
|
|
HC FASCIECTOMY PLANTAR FASCIA PARTIAL
|
Facility
|
IP
|
$4,423.22
|
|
| Hospital Charge Code |
36000100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,946.22 |
| Max. Negotiated Rate |
$3,980.90 |
| Rate for Payer: Aetna American Axle |
$2,875.09
|
| Rate for Payer: Aetna Commercial |
$3,759.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,875.09
|
| Rate for Payer: Cash Price |
$3,538.58
|
| Rate for Payer: Cofinity Advantage |
$3,096.25
|
| Rate for Payer: Cofinity Commercial |
$3,803.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,538.58
|
| Rate for Payer: Healthscope Commercial |
$3,980.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,096.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,317.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,759.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,317.41
|
| Rate for Payer: PHP Commercial |
$3,759.74
|
| Rate for Payer: Priority Health SBD |
$2,786.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,946.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,317.41
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
OP
|
$8,901.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna American Axle |
$5,785.65
|
| Rate for Payer: Aetna Commercial |
$7,565.85
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,785.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,786.96
|
| Rate for Payer: BCN Commercial |
$2,786.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cofinity Advantage |
$6,230.70
|
| Rate for Payer: Cofinity Commercial |
$7,654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,120.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$8,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,230.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,675.75
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,565.85
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,675.75
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$7,565.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$5,607.63
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: UMR Bronson Commercial |
$3,293.37
|
| Rate for Payer: VA VA |
$3,260.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,675.75
|
|
|
HC FASCIOTOMY FOOT AND OR TOE
|
Facility
|
IP
|
$8,901.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
36000099
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,916.44 |
| Max. Negotiated Rate |
$8,010.90 |
| Rate for Payer: Aetna American Axle |
$5,785.65
|
| Rate for Payer: Aetna Commercial |
$7,565.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,785.65
|
| Rate for Payer: Cash Price |
$7,120.80
|
| Rate for Payer: Cofinity Advantage |
$6,230.70
|
| Rate for Payer: Cofinity Commercial |
$7,654.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,120.80
|
| Rate for Payer: Healthscope Commercial |
$8,010.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,230.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,675.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,565.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,675.75
|
| Rate for Payer: PHP Commercial |
$7,565.85
|
| Rate for Payer: Priority Health SBD |
$5,607.63
|
| Rate for Payer: UMR Bronson Commercial |
$3,916.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,675.75
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
OP
|
$157.18
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$141.46 |
| Rate for Payer: Aetna American Axle |
$102.17
|
| Rate for Payer: Aetna Commercial |
$133.60
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.17
|
| 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 |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$21.70
|
| Rate for Payer: BCN Commercial |
$21.70
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cofinity Advantage |
$110.03
|
| Rate for Payer: Cofinity Commercial |
$135.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$141.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.89
|
| Rate for Payer: Mclaren Medicaid |
$18.77
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$19.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.60
|
| Rate for Payer: Nomi Health Commercial |
$28.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.89
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$133.60
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18.77
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health SBD |
$99.02
|
| Rate for Payer: Priority Health Tiered Network |
$15.02
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.16
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18.77
|
| Rate for Payer: UHC Exchange |
$28.16
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: UMR Bronson Commercial |
$58.16
|
| Rate for Payer: VA VA |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.89
|
|
|
HC FATTY ACID PROFILE, ESSENTIAL, S
|
Facility
|
IP
|
$157.18
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100745
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.16 |
| Max. Negotiated Rate |
$141.46 |
| Rate for Payer: Aetna American Axle |
$102.17
|
| Rate for Payer: Aetna Commercial |
$133.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.17
|
| Rate for Payer: Cash Price |
$125.74
|
| Rate for Payer: Cofinity Advantage |
$110.03
|
| Rate for Payer: Cofinity Commercial |
$135.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.74
|
| Rate for Payer: Healthscope Commercial |
$141.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.89
|
| Rate for Payer: PHP Commercial |
$133.60
|
| Rate for Payer: Priority Health SBD |
$99.02
|
| Rate for Payer: UMR Bronson Commercial |
$69.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.89
|
|
|
HC FDG PER DOSE
|
Facility
|
IP
|
$793.52
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$349.15 |
| Max. Negotiated Rate |
$714.17 |
| Rate for Payer: Aetna American Axle |
$515.79
|
| Rate for Payer: Aetna Commercial |
$674.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.79
|
| Rate for Payer: Cash Price |
$634.82
|
| Rate for Payer: Cofinity Advantage |
$555.46
|
| Rate for Payer: Cofinity Commercial |
$682.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.82
|
| Rate for Payer: Healthscope Commercial |
$714.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$595.14
|
| Rate for Payer: PHP Commercial |
$674.49
|
| Rate for Payer: Priority Health SBD |
$499.92
|
| Rate for Payer: UMR Bronson Commercial |
$349.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.14
|
|
|
HC FDG PER DOSE
|
Facility
|
OP
|
$793.52
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
34300006
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$714.17 |
| Rate for Payer: Aetna American Axle |
$515.79
|
| Rate for Payer: Aetna Commercial |
$674.49
|
| Rate for Payer: Aetna Medicare |
$396.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.79
|
| Rate for Payer: BCBS Complete |
$317.41
|
| Rate for Payer: BCBS Trust/PPO |
$304.81
|
| Rate for Payer: BCN Commercial |
$304.81
|
| Rate for Payer: Cash Price |
$634.82
|
| Rate for Payer: Cash Price |
$634.82
|
| Rate for Payer: Cofinity Advantage |
$555.46
|
| Rate for Payer: Cofinity Commercial |
$682.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.82
|
| Rate for Payer: Healthscope Commercial |
$714.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$555.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$595.14
|
| Rate for Payer: PHP Commercial |
$674.49
|
| Rate for Payer: Priority Health SBD |
$499.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.50
|
| Rate for Payer: UHC Core |
$711.50
|
| Rate for Payer: UHC Exchange |
$711.50
|
| Rate for Payer: UMR Bronson Commercial |
$293.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.14
|
|
|
HC FECAL FAT QUALITATIVE
|
Facility
|
IP
|
$34.90
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
30100198
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$31.41 |
| Rate for Payer: Aetna American Axle |
$22.68
|
| Rate for Payer: Aetna Commercial |
$29.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.68
|
| Rate for Payer: Cash Price |
$27.92
|
| Rate for Payer: Cofinity Advantage |
$24.43
|
| Rate for Payer: Cofinity Commercial |
$30.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.92
|
| Rate for Payer: Healthscope Commercial |
$31.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.18
|
| Rate for Payer: PHP Commercial |
$29.66
|
| Rate for Payer: Priority Health SBD |
$21.99
|
| Rate for Payer: UMR Bronson Commercial |
$15.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.18
|
|
