|
HC BDIAL VWFX
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: Aetna Medicare |
$26.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.56
|
| Rate for Payer: BCBS Complete |
$23.43
|
| Rate for Payer: BCBS MAPPO |
$25.25
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$78.53
|
| Rate for Payer: BCN Medicare Advantage |
$25.25
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Mclaren Medicaid |
$22.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.51
|
| Rate for Payer: Meridian Medicaid |
$23.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: PACE Senior Care Partners |
$23.99
|
| Rate for Payer: PACE SWMI |
$25.25
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: PHP Medicare Advantage |
$25.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO |
$87.87
|
| Rate for Payer: Priority Health Medicare |
$25.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.67
|
| Rate for Payer: Railroad Medicare Medicare |
$25.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.88
|
| Rate for Payer: UHC Core |
$84.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.25
|
| Rate for Payer: UHC Exchange |
$25.25
|
| Rate for Payer: UHC Medicare Advantage |
$25.25
|
| Rate for Payer: UHCCP Medicaid |
$22.31
|
| Rate for Payer: VA VA |
$25.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
HC BDIAL VWFX
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 85397
|
| Hospital Charge Code |
30500093
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$85.85
|
| Rate for Payer: BCBS Trust/PPO |
$82.45
|
| Rate for Payer: BCN Commercial |
$78.05
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$86.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.80
|
| Rate for Payer: Healthscope Commercial |
$90.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.85
|
| Rate for Payer: Nomi Health Commercial |
$82.82
|
| Rate for Payer: PHP Commercial |
$85.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO |
$87.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.88
|
| Rate for Payer: UHC Core |
$84.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.75
|
|
|
HC BEDSIDE/SIMPLE SPIROMETRY
|
Facility
|
OP
|
$239.25
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$215.32 |
| Rate for Payer: Aetna Commercial |
$203.36
|
| Rate for Payer: Aetna Medicare |
$62.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.77
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$59.81
|
| Rate for Payer: BCBS Trust/PPO |
$196.69
|
| Rate for Payer: BCN Commercial |
$186.02
|
| Rate for Payer: BCN Medicare Advantage |
$59.81
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cofinity Commercial |
$205.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.81
|
| Rate for Payer: Healthscope Commercial |
$215.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.44
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.80
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.36
|
| Rate for Payer: Nomi Health Commercial |
$196.19
|
| Rate for Payer: PACE Senior Care Partners |
$56.82
|
| Rate for Payer: PACE SWMI |
$59.81
|
| Rate for Payer: PHP Commercial |
$203.36
|
| Rate for Payer: PHP Medicare Advantage |
$59.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.51
|
| Rate for Payer: Priority Health HMO/PPO |
$208.15
|
| Rate for Payer: Priority Health Medicare |
$60.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.30
|
| Rate for Payer: Railroad Medicare Medicare |
$59.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.54
|
| Rate for Payer: UHC Core |
$199.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.81
|
| Rate for Payer: UHC Exchange |
$59.81
|
| Rate for Payer: UHC Medicare Advantage |
$59.81
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$59.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.44
|
|
|
HC BEDSIDE/SIMPLE SPIROMETRY
|
Facility
|
IP
|
$239.25
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$155.51 |
| Max. Negotiated Rate |
$215.32 |
| Rate for Payer: Aetna Commercial |
$203.36
|
| Rate for Payer: BCBS Trust/PPO |
$195.30
|
| Rate for Payer: BCN Commercial |
$184.89
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cofinity Commercial |
$205.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.40
|
| Rate for Payer: Healthscope Commercial |
$215.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.36
|
| Rate for Payer: Nomi Health Commercial |
$196.19
|
| Rate for Payer: PHP Commercial |
$203.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.51
|
| Rate for Payer: Priority Health HMO/PPO |
$208.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.54
|
| Rate for Payer: UHC Core |
$199.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.44
|
|
|
HC BEDSIDE URINE PREG TEST
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$6.23
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC BEDSIDE URINE PREG TEST
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC BEECH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BEECH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200074
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BENCE JONES PROTEIN
|
Facility
|
OP
|
$169.12
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: Aetna Medicare |
$43.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.85
|
| Rate for Payer: BCBS Complete |
$22.28
|
| Rate for Payer: BCBS MAPPO |
$42.28
|
| Rate for Payer: BCBS Trust/PPO |
$139.03
|
| Rate for Payer: BCN Commercial |
$131.49
|
| Rate for Payer: BCN Medicare Advantage |
$42.28
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.28
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.84
|
| Rate for Payer: Mclaren Medicaid |
$21.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.39
|
| Rate for Payer: Meridian Medicaid |
$22.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| Rate for Payer: PACE Senior Care Partners |
$40.17
|
| Rate for Payer: PACE SWMI |
$42.28
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: PHP Medicare Advantage |
$42.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health HMO/PPO |
$147.13
|
| Rate for Payer: Priority Health Medicare |
$42.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.31
|
| Rate for Payer: Railroad Medicare Medicare |
$42.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.83
|
| Rate for Payer: UHC Core |
$141.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.28
|
| Rate for Payer: UHC Exchange |
$42.28
|
| Rate for Payer: UHC Medicare Advantage |
$42.28
|
| Rate for Payer: UHCCP Medicaid |
$21.22
|
| Rate for Payer: VA VA |
$42.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.84
|
|
|
HC BENCE JONES PROTEIN
|
Facility
|
IP
|
$169.12
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
30200197
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.93 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Aetna Commercial |
$143.75
|
| Rate for Payer: BCBS Trust/PPO |
$138.05
|
| Rate for Payer: BCN Commercial |
$130.70
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$152.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.75
|
| Rate for Payer: Nomi Health Commercial |
$138.68
|
| Rate for Payer: PHP Commercial |
$143.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.93
|
| Rate for Payer: Priority Health HMO/PPO |
$147.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.83
|
| Rate for Payer: UHC Core |
$141.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.84
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$72.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.86
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$69.48
|
| Rate for Payer: BCBS Trust/PPO |
$228.49
|
| Rate for Payer: BCN Commercial |
$216.10
|
| Rate for Payer: BCN Medicare Advantage |
$69.48
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.48
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.96
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PACE Senior Care Partners |
$66.01
|
| Rate for Payer: PACE SWMI |
$69.48
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$69.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: Railroad Medicare Medicare |
$69.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.48
|
| Rate for Payer: UHC Exchange |
$69.48
|
| Rate for Payer: UHC Medicare Advantage |
$69.48
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$69.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENIGN HYPERKERATOTIC 2-4 LESIONS
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
76100039
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: BCBS Trust/PPO |
$226.88
|
| Rate for Payer: BCN Commercial |
$214.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$72.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.86
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$69.48
|
| Rate for Payer: BCBS Trust/PPO |
$228.49
|
| Rate for Payer: BCN Commercial |
$216.10
|
| Rate for Payer: BCN Medicare Advantage |
$69.48
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.48
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.96
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PACE Senior Care Partners |
$66.01
|
| Rate for Payer: PACE SWMI |
$69.48
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$69.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: Railroad Medicare Medicare |
$69.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.48
|
| Rate for Payer: UHC Exchange |
$69.48
|
| Rate for Payer: UHC Medicare Advantage |
$69.48
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$69.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENIGN HYPERKERATOTIC >4 LESIONS
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
76100040
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: BCBS Trust/PPO |
$226.88
|
| Rate for Payer: BCN Commercial |
$214.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
OP
|
$277.94
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: Aetna Medicare |
$72.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.86
|
| Rate for Payer: BCBS Complete |
$150.85
|
| Rate for Payer: BCBS MAPPO |
$69.48
|
| Rate for Payer: BCBS Trust/PPO |
$228.49
|
| Rate for Payer: BCN Commercial |
$216.10
|
| Rate for Payer: BCN Medicare Advantage |
$69.48
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.48
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Mclaren Medicaid |
$143.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.96
|
| Rate for Payer: Meridian Medicaid |
$150.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PACE Senior Care Partners |
$66.01
|
| Rate for Payer: PACE SWMI |
$69.48
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: PHP Medicare Advantage |
$69.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Medicare |
$70.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: Railroad Medicare Medicare |
$69.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.48
|
| Rate for Payer: UHC Exchange |
$69.48
|
| Rate for Payer: UHC Medicare Advantage |
$69.48
|
| Rate for Payer: UHCCP Medicaid |
$143.66
|
| Rate for Payer: VA VA |
$69.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENIGN HYPERKERATOTIC LESION
|
Facility
|
IP
|
$277.94
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
76100041
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$250.15 |
| Rate for Payer: Aetna Commercial |
$236.25
|
| Rate for Payer: BCBS Trust/PPO |
$226.88
|
| Rate for Payer: BCN Commercial |
$214.79
|
| Rate for Payer: Cash Price |
$222.35
|
| Rate for Payer: Cofinity Commercial |
$239.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.35
|
| Rate for Payer: Healthscope Commercial |
$250.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.25
|
| Rate for Payer: Nomi Health Commercial |
$227.91
|
| Rate for Payer: PHP Commercial |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.66
|
| Rate for Payer: Priority Health HMO/PPO |
$241.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.59
|
| Rate for Payer: UHC Core |
$232.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.46
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Exchange |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: VA VA |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC BENZO CONFIRMATION CMPT 1
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 80347
|
| Hospital Charge Code |
30000164
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.14
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$8.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.20
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS MAPPO |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$26.83
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: BCN Medicare Advantage |
$8.16
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.16
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Nomi Health Commercial |
$26.76
|
| Rate for Payer: PACE Senior Care Partners |
$7.75
|
| Rate for Payer: PACE SWMI |
$8.16
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: PHP Medicare Advantage |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health HMO/PPO |
$28.40
|
| Rate for Payer: Priority Health Medicare |
$8.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.72
|
| Rate for Payer: UHC Core |
$27.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.16
|
| Rate for Payer: UHC Exchange |
$8.16
|
| Rate for Payer: UHC Medicare Advantage |
$8.16
|
| Rate for Payer: VA VA |
$8.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC BENZO CONFIRMATION CMPT 2
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 80368
|
| Hospital Charge Code |
30000165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: BCBS Trust/PPO |
$26.64
|
| Rate for Payer: BCN Commercial |
$25.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Nomi Health Commercial |
$26.76
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.22
|
| Rate for Payer: Priority Health HMO/PPO |
$28.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.72
|
| Rate for Payer: UHC Core |
$27.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.48
|
|
|
HC BENZO CONFIRMATION, U
|
Facility
|
OP
|
$30.64
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Medicare |
$7.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.57
|
| Rate for Payer: BCBS Complete |
$12.26
|
| Rate for Payer: BCBS MAPPO |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.19
|
| Rate for Payer: BCN Commercial |
$23.82
|
| Rate for Payer: BCN Medicare Advantage |
$7.66
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.66
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: Nomi Health Commercial |
$25.12
|
| Rate for Payer: PACE Senior Care Partners |
$7.28
|
| Rate for Payer: PACE SWMI |
$7.66
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: PHP Medicare Advantage |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.92
|
| Rate for Payer: Priority Health HMO/PPO |
$26.66
|
| Rate for Payer: Priority Health Medicare |
$7.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.53
|
| Rate for Payer: Railroad Medicare Medicare |
$7.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$25.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.66
|
| Rate for Payer: UHC Exchange |
$7.66
|
| Rate for Payer: UHC Medicare Advantage |
$7.66
|
| Rate for Payer: VA VA |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.98
|
|
|
HC BENZO CONFIRMATION, U
|
Facility
|
IP
|
$30.64
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
30000163
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.92 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: BCBS Trust/PPO |
$25.01
|
| Rate for Payer: BCN Commercial |
$23.68
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: Nomi Health Commercial |
$25.12
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.92
|
| Rate for Payer: Priority Health HMO/PPO |
$26.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$25.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.98
|
|
|
HC BENZODIAZAPINE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.77
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.41
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.69
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.41
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$25.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.41
|
| Rate for Payer: UHC Exchange |
$25.41
|
| Rate for Payer: UHC Medicare Advantage |
$25.41
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC BENZODIAZAPINE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCN Commercial |
$78.56
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.25
|
|
|
HC BENZODIAZEPINE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
30100594
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
