|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
IP
|
$87.72
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: BCBS Trust/PPO |
$67.79
|
| Rate for Payer: BCN Commercial |
$67.79
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC CMV BY PCR CSF & BODY FLUIDS
|
Facility
|
OP
|
$87.72
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
30600151
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$78.95 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$68.20
|
| Rate for Payer: BCN Commercial |
$68.20
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Commercial |
$75.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.79
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.56
|
| Rate for Payer: PACE Senior Care Partners |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$74.56
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.32
|
| Rate for Payer: Priority Health Medicare |
$21.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.50
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.19
|
| Rate for Payer: UHC Core |
$73.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.59
|
| Rate for Payer: VA VA |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.79
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$103.68 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: BCBS Trust/PPO |
$131.38
|
| Rate for Payer: BCN Commercial |
$131.38
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$146.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.00
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.50
|
| Rate for Payer: PHP Commercial |
$144.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.60
|
| Rate for Payer: UHC Core |
$141.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.50
|
|
|
HC CMV DNA PCR QUANTITATIVE
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
30600152
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.62 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: Aetna Medicare |
$44.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.12
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$132.18
|
| Rate for Payer: BCN Commercial |
$132.18
|
| Rate for Payer: BCN Medicare Advantage |
$42.50
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$146.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$153.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.50
|
| Rate for Payer: Mclaren Medicaid |
$31.62
|
| Rate for Payer: Meridian Medicaid |
$33.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.50
|
| Rate for Payer: PACE Senior Care Partners |
$40.38
|
| Rate for Payer: PACE SWMI |
$42.50
|
| Rate for Payer: PHP Commercial |
$144.50
|
| Rate for Payer: PHP Medicare Advantage |
$42.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.90
|
| Rate for Payer: Priority Health Medicare |
$42.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.68
|
| Rate for Payer: Railroad Medicare Medicare |
$42.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.60
|
| Rate for Payer: UHC Core |
$141.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.50
|
| Rate for Payer: UHC Medicare Advantage |
$43.78
|
| Rate for Payer: VA VA |
$42.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.50
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.88
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Mclaren Medicaid |
$11.42
|
| Rate for Payer: Meridian Medicaid |
$12.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC COAGULATION INTERPRETATION
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 85390
|
| Hospital Charge Code |
30500075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$75.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$63.86
|
| Rate for Payer: BCBS Trust/PPO |
$58.06
|
| Rate for Payer: BCN Commercial |
$58.06
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$64.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.86
|
| Rate for Payer: PHP Commercial |
$63.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.11
|
| Rate for Payer: UHC Core |
$62.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.35
|
|
|
HC COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$75.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30000166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$67.62 |
| Rate for Payer: Aetna Commercial |
$63.86
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.48
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$18.78
|
| Rate for Payer: BCBS Trust/PPO |
$58.41
|
| Rate for Payer: BCN Commercial |
$58.41
|
| Rate for Payer: BCN Medicare Advantage |
$18.78
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cash Price |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$64.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.78
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.35
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.86
|
| Rate for Payer: PACE Senior Care Partners |
$17.84
|
| Rate for Payer: PACE SWMI |
$18.78
|
| Rate for Payer: PHP Commercial |
$63.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.36
|
| Rate for Payer: Priority Health Medicare |
$18.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.11
|
| Rate for Payer: UHC Core |
$62.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.78
|
| Rate for Payer: UHC Medicare Advantage |
$19.35
|
| Rate for Payer: VA VA |
$18.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.35
|
|
|
HC COBALT SERUM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
30100639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: Aetna Medicare |
$22.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.19
|
| Rate for Payer: BCBS Complete |
$17.02
|
| Rate for Payer: BCBS MAPPO |
$21.75
|
| Rate for Payer: BCBS Trust/PPO |
$67.64
|
| Rate for Payer: BCN Commercial |
$67.64
|
| Rate for Payer: BCN Medicare Advantage |
$21.75
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Mclaren Medicaid |
$16.21
|
| Rate for Payer: Meridian Medicaid |
$17.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PACE Senior Care Partners |
$20.66
|
| Rate for Payer: PACE SWMI |
$21.75
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: PHP Medicare Advantage |
$21.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Medicare |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: Railroad Medicare Medicare |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.75
|
| Rate for Payer: UHC Medicare Advantage |
$22.40
|
| Rate for Payer: VA VA |
$21.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC COBALT SERUM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
30100639
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Aetna Commercial |
$73.95
|
| Rate for Payer: BCBS Trust/PPO |
$67.23
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.60
|
| Rate for Payer: Healthscope Commercial |
$78.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.95
|
| Rate for Payer: PHP Commercial |
$73.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.56
|
| Rate for Payer: UHC Core |
$72.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.25
|
|
|
HC COCAINE CONFIRMATION URINE
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
30100597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$48.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COCAINE CONFIRMATION URINE
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
30100597
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.91
|
| Rate for Payer: BCN Commercial |
$47.91
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC COCAINE CONFIRM MECONIUM
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
30100573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.31 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$29.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.94
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$28.75
|
| Rate for Payer: BCBS Trust/PPO |
$89.41
|
| Rate for Payer: BCN Commercial |
$89.41
|
| Rate for Payer: BCN Medicare Advantage |
$28.75
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.75
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PACE Senior Care Partners |
$27.31
|
| Rate for Payer: PACE SWMI |
$28.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: PHP Medicare Advantage |
$28.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Medicare |
$28.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.14
|
| Rate for Payer: Railroad Medicare Medicare |
$28.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.20
|
| Rate for Payer: UHC Core |
$96.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.75
|
| Rate for Payer: UHC Medicare Advantage |
$29.61
|
| Rate for Payer: VA VA |
$28.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC COCAINE CONFIRM MECONIUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
30100573
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.14 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: BCBS Trust/PPO |
$88.87
|
| Rate for Payer: BCN Commercial |
$88.87
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$98.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.00
|
| Rate for Payer: Healthscope Commercial |
$103.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.75
|
| Rate for Payer: PHP Commercial |
$97.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.20
|
| Rate for Payer: UHC Core |
$96.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.25
|
|
|
HC COCAINE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.81
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$74.17
|
| Rate for Payer: BCN Commercial |
$74.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.66
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$24.57
|
| Rate for Payer: VA VA |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC COCAINE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.73
|
| Rate for Payer: BCN Commercial |
$73.73
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Meridian Medicaid |
$8.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$8.46
|
| Rate for Payer: Meridian Medicaid |
$8.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC COCKROACH IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC COCKROACH IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC COCONUT IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC COCONUT IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC CODFISH IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
