|
HC ADDL DOSE TC99M NON HEU
|
Facility
|
OP
|
$55.71
|
|
|
Service Code
|
HCPCS Q9969
|
| Hospital Charge Code |
34300036
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$50.14 |
| Rate for Payer: Aetna Commercial |
$47.35
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.41
|
| Rate for Payer: BCBS Complete |
$10.31
|
| Rate for Payer: BCBS MAPPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$45.80
|
| Rate for Payer: BCN Commercial |
$45.80
|
| Rate for Payer: BCN Medicare Advantage |
$13.93
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$50.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.78
|
| Rate for Payer: Mclaren Medicaid |
$9.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.62
|
| Rate for Payer: Meridian Medicaid |
$10.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.35
|
| Rate for Payer: Nomi Health Commercial |
$45.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.78
|
| Rate for Payer: PACE Senior Care Partners |
$13.23
|
| Rate for Payer: PACE SWMI |
$13.93
|
| Rate for Payer: PHP Commercial |
$47.35
|
| Rate for Payer: PHP Medicare Advantage |
$13.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.47
|
| Rate for Payer: Priority Health Medicare |
$14.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.77
|
| Rate for Payer: Railroad Medicare Medicare |
$13.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.02
|
| Rate for Payer: UHC Core |
$46.52
|
| Rate for Payer: UHC Exchange |
$13.93
|
| Rate for Payer: UHC Medicaid |
$9.82
|
| Rate for Payer: UHC Medicare Advantage |
$13.93
|
| Rate for Payer: UHCCP Medicaid |
$9.82
|
| Rate for Payer: VA VA |
$13.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.78
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.16
|
| Rate for Payer: BCBS Complete |
$19.64
|
| Rate for Payer: BCBS MAPPO |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$26.53
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.53
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$18.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.86
|
| Rate for Payer: Meridian Medicaid |
$19.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.20
|
| Rate for Payer: PACE SWMI |
$26.53
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$26.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: Railroad Medicare Medicare |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: UHC Exchange |
$26.53
|
| Rate for Payer: UHC Medicaid |
$18.71
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: VA VA |
$26.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ADENOVIRUS ANTIBODY
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
30200219
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: BCBS Trust/PPO |
$87.64
|
| Rate for Payer: BCN Commercial |
$87.64
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
IP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.12 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: BCBS Trust/PPO |
$86.77
|
| Rate for Payer: BCN Commercial |
$86.77
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$86.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.45
|
| Rate for Payer: UHC Core |
$87.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.80
|
|
|
HC ADENOVIRUS PCR
|
Facility
|
OP
|
$105.06
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600279
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$94.55 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Medicare |
$27.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.83
|
| Rate for Payer: BCBS Complete |
$19.45
|
| Rate for Payer: BCBS MAPPO |
$26.27
|
| Rate for Payer: BCBS Trust/PPO |
$86.37
|
| Rate for Payer: BCN Commercial |
$86.37
|
| Rate for Payer: BCN Medicare Advantage |
$26.27
|
| Rate for Payer: Cash Price |
$84.05
|
| Rate for Payer: Cofinity Commercial |
$90.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.27
|
| Rate for Payer: Healthscope Commercial |
$94.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.80
|
| Rate for Payer: Mclaren Medicaid |
$18.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.58
|
| Rate for Payer: Meridian Medicaid |
$19.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.30
|
| Rate for Payer: Nomi Health Commercial |
$86.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.80
|
| Rate for Payer: PACE Senior Care Partners |
$24.95
|
| Rate for Payer: PACE SWMI |
$26.27
|
| Rate for Payer: PHP Commercial |
$89.30
|
| Rate for Payer: PHP Medicare Advantage |
$26.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.40
|
| Rate for Payer: Priority Health Medicare |
$26.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.12
|
| Rate for Payer: Railroad Medicare Medicare |
$26.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.45
|
| Rate for Payer: UHC Core |
$87.73
|
| Rate for Payer: UHC Exchange |
$26.27
|
| Rate for Payer: UHC Medicaid |
$18.52
|
| Rate for Payer: UHC Medicare Advantage |
$26.27
|
| Rate for Payer: UHCCP Medicaid |
$18.52
|
| Rate for Payer: VA VA |
$26.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.80
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
IP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.41
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.87
|
| Rate for Payer: UHC Core |
$22.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.35
|
|
|
HC ADHESIVE RELEASER 50 ML
|
Facility
|
OP
|
$27.13
|
|
|
Service Code
|
HCPCS A4455
|
| Hospital Charge Code |
27000626
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna Commercial |
$23.06
|
| Rate for Payer: Aetna Medicare |
$7.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.48
|
| Rate for Payer: BCBS Complete |
$5.02
|
| Rate for Payer: BCBS MAPPO |
$6.78
|
| Rate for Payer: BCBS Trust/PPO |
$22.30
|
| Rate for Payer: BCN Commercial |
$22.30
|
| Rate for Payer: BCN Medicare Advantage |
$6.78
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$23.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.78
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.35
|
| Rate for Payer: Mclaren Medicaid |
$4.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.12
|
| Rate for Payer: Meridian Medicaid |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.06
|
| Rate for Payer: Nomi Health Commercial |
$22.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.35
|
| Rate for Payer: PACE Senior Care Partners |
$6.44
|
| Rate for Payer: PACE SWMI |
$6.78
|
| Rate for Payer: PHP Commercial |
$23.06
|
| Rate for Payer: PHP Medicare Advantage |
$6.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.60
|
| Rate for Payer: Priority Health Medicare |
$6.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.88
|
| Rate for Payer: Railroad Medicare Medicare |
$6.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.87
|
| Rate for Payer: UHC Core |
$22.65
|
| Rate for Payer: UHC Exchange |
$6.78
|
| Rate for Payer: UHC Medicaid |
$4.78
|
| Rate for Payer: UHC Medicare Advantage |
$6.78
|
| Rate for Payer: UHCCP Medicaid |
$4.78
|
| Rate for Payer: VA VA |
$6.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.35
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
IP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,656.77 |
| Max. Negotiated Rate |
$6,021.68 |
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,525.90
|
| Rate for Payer: BCN Commercial |
$5,525.90
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$5,486.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,820.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,656.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,887.87
|
| Rate for Payer: UHC Core |
$5,586.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.07
|
|
|
HC ADJT TIS REARRGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQ CM
|
Facility
|
OP
|
$6,690.76
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
76100556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,179.58 |
| Max. Negotiated Rate |
$6,021.68 |
| Rate for Payer: Aetna Commercial |
$5,687.15
|
| Rate for Payer: Aetna Medicare |
$1,739.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,090.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,090.86
|
| Rate for Payer: BCBS Complete |
$1,238.46
|
| Rate for Payer: BCBS MAPPO |
$1,672.69
|
| Rate for Payer: BCBS Trust/PPO |
$5,500.47
|
| Rate for Payer: BCN Commercial |
$5,500.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,672.69
|
| Rate for Payer: Cash Price |
$5,352.61
|
| Rate for Payer: Cofinity Commercial |
$5,754.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,352.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,672.69
|
| Rate for Payer: Healthscope Commercial |
$6,021.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,018.07
|
| Rate for Payer: Mclaren Medicaid |
$1,179.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,756.32
|
| Rate for Payer: Meridian Medicaid |
$1,238.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,923.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,839.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,687.15
|
| Rate for Payer: Nomi Health Commercial |
$5,486.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,018.07
|
| Rate for Payer: PACE Senior Care Partners |
$1,589.06
|
| Rate for Payer: PACE SWMI |
$1,672.69
|
| Rate for Payer: PHP Commercial |
$5,687.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,672.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,179.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,820.96
|
| Rate for Payer: Priority Health Medicare |
$1,689.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,656.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,672.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,887.87
|
| Rate for Payer: UHC Core |
$5,586.78
|
| Rate for Payer: UHC Exchange |
$1,672.69
|
| Rate for Payer: UHC Medicaid |
$1,179.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,672.69
|
| Rate for Payer: UHCCP Medicaid |
$1,179.58
|
| Rate for Payer: VA VA |
$1,672.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,018.07
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,383.65 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.89
|
| Rate for Payer: BCN Commercial |
$1,641.89
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Nomi Health Commercial |
$1,630.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,729.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,383.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,749.44
|
| Rate for Payer: UHC Core |
$1,659.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.00
|
|
|
HC ADJT TIS TRNSFR/REARRGMT DEFEC EA ADDL 30 SQ CM
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
76100553
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.48 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Aetna Commercial |
$1,689.80
|
| Rate for Payer: Aetna Medicare |
$516.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$621.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$621.25
|
| Rate for Payer: BCBS Complete |
$367.98
|
| Rate for Payer: BCBS MAPPO |
$497.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,634.33
|
| Rate for Payer: BCN Commercial |
$1,634.33
|
| Rate for Payer: BCN Medicare Advantage |
$497.00
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$1,709.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,590.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$497.00
|
| Rate for Payer: Healthscope Commercial |
$1,789.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,491.00
|
| Rate for Payer: Mclaren Medicaid |
$350.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.85
|
| Rate for Payer: Meridian Medicaid |
$367.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$546.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,689.80
|
| Rate for Payer: Nomi Health Commercial |
$1,630.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PACE Senior Care Partners |
$472.15
|
| Rate for Payer: PACE SWMI |
$497.00
|
| Rate for Payer: PHP Commercial |
$1,689.80
|
| Rate for Payer: PHP Medicare Advantage |
$497.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,729.56
|
| Rate for Payer: Priority Health Medicare |
$501.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,383.65
|
| Rate for Payer: Railroad Medicare Medicare |
$497.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,749.44
|
| Rate for Payer: UHC Core |
$1,659.98
|
| Rate for Payer: UHC Exchange |
$497.00
|
| Rate for Payer: UHC Medicaid |
$350.48
|
| Rate for Payer: UHC Medicare Advantage |
$497.00
|
| Rate for Payer: UHCCP Medicaid |
$350.48
|
| Rate for Payer: VA VA |
$497.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,491.00
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
IP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,446.48 |
| Max. Negotiated Rate |
$3,163.55 |
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,903.09
|
| Rate for Payer: BCN Commercial |
$2,903.09
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,636.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,058.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,446.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,093.25
|
| Rate for Payer: UHC Core |
$2,935.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,636.30
|
|
|
HC ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Facility
|
OP
|
$3,515.06
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
76100552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.71 |
| Max. Negotiated Rate |
$3,163.55 |
| Rate for Payer: Aetna Commercial |
$2,987.80
|
| Rate for Payer: Aetna Medicare |
$913.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,098.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,098.46
|
| Rate for Payer: BCBS Complete |
$650.64
|
| Rate for Payer: BCBS MAPPO |
$878.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,889.73
|
| Rate for Payer: BCN Commercial |
$2,889.73
|
| Rate for Payer: BCN Medicare Advantage |
$878.76
|
| Rate for Payer: Cash Price |
$2,812.05
|
| Rate for Payer: Cofinity Commercial |
$3,022.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,812.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$878.76
|
| Rate for Payer: Healthscope Commercial |
$3,163.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,636.30
|
| Rate for Payer: Mclaren Medicaid |
$619.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.70
|
| Rate for Payer: Meridian Medicaid |
$650.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,010.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$966.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,987.80
|
| Rate for Payer: Nomi Health Commercial |
$2,882.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,636.30
|
| Rate for Payer: PACE Senior Care Partners |
$834.83
|
| Rate for Payer: PACE SWMI |
$878.76
|
| Rate for Payer: PHP Commercial |
$2,987.80
|
| Rate for Payer: PHP Medicare Advantage |
$878.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,058.10
|
| Rate for Payer: Priority Health Medicare |
$887.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,446.48
|
| Rate for Payer: Railroad Medicare Medicare |
$878.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,093.25
|
| Rate for Payer: UHC Core |
$2,935.08
|
| Rate for Payer: UHC Exchange |
$878.76
|
| Rate for Payer: UHC Medicaid |
$619.71
|
| Rate for Payer: UHC Medicare Advantage |
$878.76
|
| Rate for Payer: UHCCP Medicaid |
$619.71
|
| Rate for Payer: VA VA |
$878.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,636.30
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$27.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.50
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$85.50
|
| Rate for Payer: BCN Commercial |
$85.50
|
| Rate for Payer: BCN Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$83.20
|
| 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 |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.30
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Senior Care Partners |
$24.70
|
| Rate for Payer: PACE SWMI |
$26.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: PHP Medicare Advantage |
$26.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.48
|
| Rate for Payer: Priority Health Medicare |
$26.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.52
|
| Rate for Payer: UHC Core |
$86.84
|
| Rate for Payer: UHC Exchange |
$26.00
|
| Rate for Payer: UHC Medicaid |
$18.34
|
| Rate for Payer: UHC Medicare Advantage |
$26.00
|
| Rate for Payer: UHCCP Medicaid |
$18.34
|
| Rate for Payer: VA VA |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC ADL TRAINING EA 15 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: BCBS Trust/PPO |
$85.89
|
| Rate for Payer: BCN Commercial |
$85.89
|
| Rate for Payer: Cash Price |
$83.20
|
| 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: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.52
|
| Rate for Payer: UHC Core |
$86.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.43 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: BCBS Trust/PPO |
$199.87
|
| Rate for Payer: BCN Commercial |
$199.87
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.96
|
| Rate for Payer: UHC Core |
$202.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
HC ADMIN DEVELOPMENTAL TEST EA ADDL 30 MIN
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
51000132
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$62.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.62
|
| Rate for Payer: BCBS Complete |
$44.79
|
| Rate for Payer: BCBS MAPPO |
$60.50
|
| Rate for Payer: BCBS Trust/PPO |
$198.95
|
| Rate for Payer: BCN Commercial |
$198.95
|
| Rate for Payer: BCN Medicare Advantage |
$60.50
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Mclaren Medicaid |
$42.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.52
|
| Rate for Payer: Meridian Medicaid |
$44.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PACE Senior Care Partners |
$57.48
|
| Rate for Payer: PACE SWMI |
$60.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$60.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$210.54
|
| Rate for Payer: Priority Health Medicare |
$61.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.43
|
| Rate for Payer: Railroad Medicare Medicare |
$60.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.96
|
| Rate for Payer: UHC Core |
$202.07
|
| Rate for Payer: UHC Exchange |
$60.50
|
| Rate for Payer: UHC Medicaid |
$42.66
|
| Rate for Payer: UHC Medicare Advantage |
$60.50
|
| Rate for Payer: UHCCP Medicaid |
$42.66
|
| Rate for Payer: VA VA |
$60.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Aetna Commercial |
$410.55
|
| Rate for Payer: Aetna Medicare |
$125.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$150.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$150.94
|
| Rate for Payer: BCBS Complete |
$89.40
|
| Rate for Payer: BCBS MAPPO |
$120.75
|
| Rate for Payer: BCBS Trust/PPO |
$397.07
|
| Rate for Payer: BCN Commercial |
$397.07
|
| Rate for Payer: BCN Medicare Advantage |
$120.75
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$415.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.75
|
| Rate for Payer: Healthscope Commercial |
$434.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.25
|
| Rate for Payer: Mclaren Medicaid |
$85.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.79
|
| Rate for Payer: Meridian Medicaid |
$89.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$132.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$396.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PACE Senior Care Partners |
$114.71
|
| Rate for Payer: PACE SWMI |
$120.75
|
| Rate for Payer: PHP Commercial |
$410.55
|
| Rate for Payer: PHP Medicare Advantage |
$120.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$420.21
|
| Rate for Payer: Priority Health Medicare |
$121.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.17
|
| Rate for Payer: Railroad Medicare Medicare |
$120.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.04
|
| Rate for Payer: UHC Core |
$403.31
|
| Rate for Payer: UHC Exchange |
$120.75
|
| Rate for Payer: UHC Medicaid |
$85.15
|
| Rate for Payer: UHC Medicare Advantage |
$120.75
|
| Rate for Payer: UHCCP Medicaid |
$85.15
|
| Rate for Payer: VA VA |
$120.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.25
|
|
|
HC ADMIN DEVELOPMENTAL TEST FIRST HOUR
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
51000131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$336.17 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Aetna Commercial |
$410.55
|
| Rate for Payer: BCBS Trust/PPO |
$398.91
|
| Rate for Payer: BCN Commercial |
$398.91
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$415.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$386.40
|
| Rate for Payer: Healthscope Commercial |
$434.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.55
|
| Rate for Payer: Nomi Health Commercial |
$396.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PHP Commercial |
$410.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$420.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.04
|
| Rate for Payer: UHC Core |
$403.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.25
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
IP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$415.64 |
| Max. Negotiated Rate |
$537.47 |
| Rate for Payer: Aetna Commercial |
$507.61
|
| Rate for Payer: BCBS Trust/PPO |
$493.22
|
| Rate for Payer: BCN Commercial |
$493.22
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Commercial |
$513.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Healthscope Commercial |
$537.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Nomi Health Commercial |
$489.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: PHP Commercial |
$507.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$519.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$415.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.53
|
| Rate for Payer: UHC Core |
$498.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.89
|
|
|
HC ADMIN INTRAPULMONARY SURFACTANT
|
Facility
|
OP
|
$597.19
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
46000034
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$537.47 |
| Rate for Payer: Aetna Commercial |
$507.61
|
| Rate for Payer: Aetna Medicare |
$155.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.62
|
| Rate for Payer: BCBS Complete |
$110.54
|
| Rate for Payer: BCBS MAPPO |
$149.30
|
| Rate for Payer: BCBS Trust/PPO |
$490.95
|
| Rate for Payer: BCN Commercial |
$490.95
|
| Rate for Payer: BCN Medicare Advantage |
$149.30
|
| Rate for Payer: Cash Price |
$477.75
|
| Rate for Payer: Cofinity Commercial |
$513.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.30
|
| Rate for Payer: Healthscope Commercial |
$537.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.89
|
| Rate for Payer: Mclaren Medicaid |
$105.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.76
|
| Rate for Payer: Meridian Medicaid |
$110.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$164.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.61
|
| Rate for Payer: Nomi Health Commercial |
$489.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.89
|
| Rate for Payer: PACE Senior Care Partners |
$141.83
|
| Rate for Payer: PACE SWMI |
$149.30
|
| Rate for Payer: PHP Commercial |
$507.61
|
| Rate for Payer: PHP Medicare Advantage |
$149.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$519.56
|
| Rate for Payer: Priority Health Medicare |
$150.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$415.64
|
| Rate for Payer: Railroad Medicare Medicare |
$149.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.53
|
| Rate for Payer: UHC Core |
$498.65
|
| Rate for Payer: UHC Exchange |
$149.30
|
| Rate for Payer: UHC Medicaid |
$105.28
|
| Rate for Payer: UHC Medicare Advantage |
$149.30
|
| Rate for Payer: UHCCP Medicaid |
$105.28
|
| Rate for Payer: VA VA |
$149.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.89
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.76
|
| Rate for Payer: BCBS Complete |
$18.81
|
| Rate for Payer: BCBS MAPPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$83.56
|
| Rate for Payer: BCN Commercial |
$83.56
|
| Rate for Payer: BCN Medicare Advantage |
$25.41
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Mclaren Medicaid |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.68
|
| Rate for Payer: Meridian Medicaid |
$18.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.41
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: PHP Medicare Advantage |
$25.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Medicare |
$25.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$25.41
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: VA VA |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
|
HC ADMIN RSV MONOC ANTB IM INJ
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
77100066
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: BCBS Trust/PPO |
$83.94
|
| Rate for Payer: BCN Commercial |
$83.94
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
IP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: BCBS Trust/PPO |
$83.94
|
| Rate for Payer: BCN Commercial |
$83.94
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
|
HC ADMIN RSV MONOC ANTB IM W/COUNSELING
|
Facility
|
OP
|
$101.64
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
77100065
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$91.48 |
| Rate for Payer: Aetna Commercial |
$86.39
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.76
|
| Rate for Payer: BCBS Complete |
$18.81
|
| Rate for Payer: BCBS MAPPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$83.56
|
| Rate for Payer: BCN Commercial |
$83.56
|
| Rate for Payer: BCN Medicare Advantage |
$25.41
|
| Rate for Payer: Cash Price |
$81.31
|
| Rate for Payer: Cofinity Commercial |
$87.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$91.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.23
|
| Rate for Payer: Mclaren Medicaid |
$17.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.68
|
| Rate for Payer: Meridian Medicaid |
$18.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.39
|
| Rate for Payer: Nomi Health Commercial |
$83.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.23
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.41
|
| Rate for Payer: PHP Commercial |
$86.39
|
| Rate for Payer: PHP Medicare Advantage |
$25.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.43
|
| Rate for Payer: Priority Health Medicare |
$25.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.44
|
| Rate for Payer: UHC Core |
$84.87
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicaid |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$25.41
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: VA VA |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.23
|
|
