|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: Aetna Medicare |
$34.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.25
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$33.00
|
| Rate for Payer: BCBS Trust/PPO |
$102.63
|
| Rate for Payer: BCN Commercial |
$102.63
|
| Rate for Payer: BCN Medicare Advantage |
$33.00
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.00
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PACE Senior Care Partners |
$31.35
|
| Rate for Payer: PACE SWMI |
$33.00
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Medicare |
$33.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: Railroad Medicare Medicare |
$33.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.00
|
| Rate for Payer: UHC Medicare Advantage |
$33.99
|
| Rate for Payer: VA VA |
$33.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna Commercial |
$112.20
|
| Rate for Payer: BCBS Trust/PPO |
$102.01
|
| Rate for Payer: BCN Commercial |
$102.01
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Healthscope Commercial |
$118.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.20
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.16
|
| Rate for Payer: UHC Core |
$110.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.00
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.78
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC COMPLEMENT C 3
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.31
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$28.25
|
| Rate for Payer: BCBS Trust/PPO |
$87.86
|
| Rate for Payer: BCN Commercial |
$87.86
|
| Rate for Payer: BCN Medicare Advantage |
$28.25
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.25
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Senior Care Partners |
$26.84
|
| Rate for Payer: PACE SWMI |
$28.25
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$28.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: Railroad Medicare Medicare |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.25
|
| Rate for Payer: UHC Medicare Advantage |
$29.10
|
| Rate for Payer: VA VA |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 3
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.33
|
| Rate for Payer: BCN Commercial |
$87.33
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.31
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$28.25
|
| Rate for Payer: BCBS Trust/PPO |
$87.86
|
| Rate for Payer: BCN Commercial |
$87.86
|
| Rate for Payer: BCN Medicare Advantage |
$28.25
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.25
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Senior Care Partners |
$26.84
|
| Rate for Payer: PACE SWMI |
$28.25
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$28.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: Railroad Medicare Medicare |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.25
|
| Rate for Payer: UHC Medicare Advantage |
$29.10
|
| Rate for Payer: VA VA |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.33
|
| Rate for Payer: BCN Commercial |
$87.33
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$9.30
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$55.51
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Mclaren Medicaid |
$8.86
|
| Rate for Payer: Meridian Medicaid |
$9.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$17.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.39
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$55.18
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.69
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$38.76
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$29.95
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$38.76
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$34.88 |
| Rate for Payer: Aetna Commercial |
$32.95
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.11
|
| Rate for Payer: BCBS Complete |
$15.75
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCBS Trust/PPO |
$30.14
|
| Rate for Payer: BCN Commercial |
$30.14
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cash Price |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$33.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$34.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.07
|
| Rate for Payer: Mclaren Medicaid |
$15.00
|
| Rate for Payer: Meridian Medicaid |
$15.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.95
|
| Rate for Payer: PACE Senior Care Partners |
$9.21
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Commercial |
$32.95
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.72
|
| Rate for Payer: Priority Health Medicare |
$9.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.11
|
| Rate for Payer: UHC Core |
$32.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.69
|
| Rate for Payer: UHC Medicare Advantage |
$9.98
|
| Rate for Payer: VA VA |
$9.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.07
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$389.48
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.54 |
| Max. Negotiated Rate |
$350.53 |
| Rate for Payer: Aetna Commercial |
$331.06
|
| Rate for Payer: BCBS Trust/PPO |
$300.99
|
| Rate for Payer: BCN Commercial |
$300.99
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Commercial |
$334.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Healthscope Commercial |
$350.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.06
|
| Rate for Payer: PHP Commercial |
$331.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.74
|
| Rate for Payer: UHC Core |
$325.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.11
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$389.48
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$350.53 |
| Rate for Payer: Aetna Commercial |
$331.06
|
| Rate for Payer: Aetna Medicare |
$101.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.71
|
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: BCBS MAPPO |
$97.37
|
| Rate for Payer: BCBS Trust/PPO |
$302.82
|
| Rate for Payer: BCN Commercial |
$302.82
|
| Rate for Payer: BCN Medicare Advantage |
$97.37
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cash Price |
$311.58
|
| Rate for Payer: Cofinity Commercial |
$334.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.37
|
| Rate for Payer: Healthscope Commercial |
$350.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.11
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.06
|
| Rate for Payer: PACE Senior Care Partners |
$92.50
|
| Rate for Payer: PACE SWMI |
$97.37
|
| Rate for Payer: PHP Commercial |
$331.06
|
| Rate for Payer: PHP Medicare Advantage |
$97.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.85
|
| Rate for Payer: Priority Health Medicare |
$97.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.54
|
| Rate for Payer: Railroad Medicare Medicare |
$97.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.74
|
| Rate for Payer: UHC Core |
$325.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.37
|
| Rate for Payer: UHC Medicare Advantage |
$100.29
|
| Rate for Payer: VA VA |
$97.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.11
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$859.86
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.43 |
| Max. Negotiated Rate |
$773.87 |
| Rate for Payer: Aetna Commercial |
$730.88
|
| Rate for Payer: BCBS Trust/PPO |
$664.50
|
| Rate for Payer: BCN Commercial |
$664.50
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cofinity Commercial |
$739.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.89
|
| Rate for Payer: Healthscope Commercial |
$773.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.88
|
| Rate for Payer: PHP Commercial |
$730.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.68
|
| Rate for Payer: UHC Core |
$717.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.90
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$859.86
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.22 |
| Max. Negotiated Rate |
$773.87 |
| Rate for Payer: Aetna Commercial |
$730.88
|
| Rate for Payer: Aetna Medicare |
$223.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.71
|
| Rate for Payer: BCBS Complete |
$470.52
|
| Rate for Payer: BCBS MAPPO |
$214.96
|
| Rate for Payer: BCBS Trust/PPO |
$668.54
|
| Rate for Payer: BCN Commercial |
$668.54
|
| Rate for Payer: BCN Medicare Advantage |
$214.96
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cash Price |
$687.89
|
| Rate for Payer: Cofinity Commercial |
$739.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.96
|
| Rate for Payer: Healthscope Commercial |
$773.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.90
|
| Rate for Payer: Mclaren Medicaid |
$448.11
|
| Rate for Payer: Meridian Medicaid |
$470.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.88
|
| Rate for Payer: PACE Senior Care Partners |
$204.22
|
| Rate for Payer: PACE SWMI |
$214.96
|
| Rate for Payer: PHP Commercial |
$730.88
|
| Rate for Payer: PHP Medicare Advantage |
$214.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.08
|
| Rate for Payer: Priority Health Medicare |
$214.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.43
|
| Rate for Payer: Railroad Medicare Medicare |
$214.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$756.68
|
| Rate for Payer: UHC Core |
$717.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.96
|
| Rate for Payer: UHC Medicare Advantage |
$221.41
|
| Rate for Payer: VA VA |
$214.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.90
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$860.25
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.67 |
| Max. Negotiated Rate |
$774.22 |
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: BCBS Trust/PPO |
$664.80
|
| Rate for Payer: BCN Commercial |
$664.80
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$757.02
|
| Rate for Payer: UHC Core |
$718.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$860.25
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.31 |
| Max. Negotiated Rate |
$774.22 |
| Rate for Payer: Aetna Commercial |
$731.21
|
| Rate for Payer: Aetna Medicare |
$223.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.83
|
| Rate for Payer: BCBS Complete |
$470.52
|
| Rate for Payer: BCBS MAPPO |
$215.06
|
| Rate for Payer: BCBS Trust/PPO |
$668.84
|
| Rate for Payer: BCN Commercial |
$668.84
|
| Rate for Payer: BCN Medicare Advantage |
$215.06
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cash Price |
$688.20
|
| Rate for Payer: Cofinity Commercial |
$739.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.06
|
| Rate for Payer: Healthscope Commercial |
$774.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$645.19
|
| Rate for Payer: Mclaren Medicaid |
$448.11
|
| Rate for Payer: Meridian Medicaid |
$470.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$247.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$731.21
|
| Rate for Payer: PACE Senior Care Partners |
$204.31
|
| Rate for Payer: PACE SWMI |
$215.06
|
| Rate for Payer: PHP Commercial |
$731.21
|
| Rate for Payer: PHP Medicare Advantage |
$215.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.42
|
| Rate for Payer: Priority Health Medicare |
$215.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.67
|
| Rate for Payer: Railroad Medicare Medicare |
$215.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$757.02
|
| Rate for Payer: UHC Core |
$718.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.06
|
| Rate for Payer: UHC Medicare Advantage |
$221.51
|
| Rate for Payer: VA VA |
$215.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$645.19
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.87 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Aetna Commercial |
$675.75
|
| Rate for Payer: BCBS Trust/PPO |
$614.38
|
| Rate for Payer: BCN Commercial |
$614.38
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cofinity Commercial |
$683.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.00
|
| Rate for Payer: Healthscope Commercial |
$715.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$675.75
|
| Rate for Payer: PHP Commercial |
$675.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.60
|
| Rate for Payer: UHC Core |
$663.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.25
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Aetna Commercial |
$675.75
|
| Rate for Payer: Aetna Medicare |
$206.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.44
|
| Rate for Payer: BCBS Complete |
$108.53
|
| Rate for Payer: BCBS MAPPO |
$198.75
|
| Rate for Payer: BCBS Trust/PPO |
$618.11
|
| Rate for Payer: BCN Commercial |
$618.11
|
| Rate for Payer: BCN Medicare Advantage |
$198.75
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cofinity Commercial |
$683.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.75
|
| Rate for Payer: Healthscope Commercial |
$715.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.25
|
| Rate for Payer: Mclaren Medicaid |
$103.36
|
| Rate for Payer: Meridian Medicaid |
$108.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$208.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$675.75
|
| Rate for Payer: PACE Senior Care Partners |
$188.81
|
| Rate for Payer: PACE SWMI |
$198.75
|
| Rate for Payer: PHP Commercial |
$675.75
|
| Rate for Payer: PHP Medicare Advantage |
$198.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.65
|
| Rate for Payer: Priority Health Medicare |
$198.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$484.87
|
| Rate for Payer: Railroad Medicare Medicare |
$198.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.60
|
| Rate for Payer: UHC Core |
$663.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.75
|
| Rate for Payer: UHC Medicare Advantage |
$204.71
|
| Rate for Payer: VA VA |
$198.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.25
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$228.81
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.55 |
| Max. Negotiated Rate |
$205.93 |
| Rate for Payer: Aetna Commercial |
$194.49
|
| Rate for Payer: BCBS Trust/PPO |
$176.82
|
| Rate for Payer: BCN Commercial |
$176.82
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cofinity Commercial |
$196.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.05
|
| Rate for Payer: Healthscope Commercial |
$205.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.49
|
| Rate for Payer: PHP Commercial |
$194.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.35
|
| Rate for Payer: UHC Core |
$191.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.61
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$228.81
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.34 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$194.49
|
| Rate for Payer: Aetna Medicare |
$59.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.50
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$177.90
|
| Rate for Payer: BCN Commercial |
$177.90
|
| Rate for Payer: BCN Medicare Advantage |
$57.20
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cash Price |
$183.05
|
| Rate for Payer: Cofinity Commercial |
$196.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.20
|
| Rate for Payer: Healthscope Commercial |
$205.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.61
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.49
|
| Rate for Payer: PACE Senior Care Partners |
$54.34
|
| Rate for Payer: PACE SWMI |
$57.20
|
| Rate for Payer: PHP Commercial |
$194.49
|
| Rate for Payer: PHP Medicare Advantage |
$57.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.06
|
| Rate for Payer: Priority Health Medicare |
$57.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.55
|
| Rate for Payer: Railroad Medicare Medicare |
$57.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.35
|
| Rate for Payer: UHC Core |
$191.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.20
|
| Rate for Payer: UHC Medicare Advantage |
$58.92
|
| Rate for Payer: VA VA |
$57.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.61
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$38.40
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.42 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: BCBS Trust/PPO |
$29.68
|
| Rate for Payer: BCN Commercial |
$29.68
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.72
|
| Rate for Payer: Healthscope Commercial |
$34.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.64
|
| Rate for Payer: PHP Commercial |
$32.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.79
|
| Rate for Payer: UHC Core |
$32.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.80
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
OP
|
$38.40
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$34.56 |
| Rate for Payer: Aetna Commercial |
$32.64
|
| Rate for Payer: Aetna Medicare |
$9.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS MAPPO |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$29.86
|
| Rate for Payer: BCN Commercial |
$29.86
|
| Rate for Payer: BCN Medicare Advantage |
$9.60
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cash Price |
$30.72
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$34.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.80
|
| Rate for Payer: Mclaren Medicaid |
$7.79
|
| Rate for Payer: Meridian Medicaid |
$8.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.64
|
| Rate for Payer: PACE Senior Care Partners |
$9.12
|
| Rate for Payer: PACE SWMI |
$9.60
|
| Rate for Payer: PHP Commercial |
$32.64
|
| Rate for Payer: PHP Medicare Advantage |
$9.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.41
|
| Rate for Payer: Priority Health Medicare |
$9.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.79
|
| Rate for Payer: UHC Core |
$32.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.60
|
| Rate for Payer: UHC Medicare Advantage |
$9.89
|
| Rate for Payer: VA VA |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.80
|
|
|
HC COMPONENT POOLING
|
Facility
|
IP
|
$121.70
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
39000027
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.22 |
| Max. Negotiated Rate |
$109.53 |
| Rate for Payer: Aetna Commercial |
$103.44
|
| Rate for Payer: BCBS Trust/PPO |
$94.05
|
| Rate for Payer: BCN Commercial |
$94.05
|
| Rate for Payer: Cash Price |
$97.36
|
| Rate for Payer: Cofinity Commercial |
$104.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.36
|
| Rate for Payer: Healthscope Commercial |
$109.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.44
|
| Rate for Payer: PHP Commercial |
$103.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.28
|
|
