|
HC BILIARY DUCT BALLOON DILATATIO
|
Facility
|
IP
|
$1,855.62
|
|
| Hospital Charge Code |
36000011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,206.15 |
| Max. Negotiated Rate |
$1,670.06 |
| Rate for Payer: Aetna Commercial |
$1,577.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,514.74
|
| Rate for Payer: BCN Commercial |
$1,434.02
|
| Rate for Payer: Cash Price |
$1,484.50
|
| Rate for Payer: Cofinity Commercial |
$1,595.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,484.50
|
| Rate for Payer: Healthscope Commercial |
$1,670.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,391.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,577.28
|
| Rate for Payer: Nomi Health Commercial |
$1,521.61
|
| Rate for Payer: PHP Commercial |
$1,577.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,206.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,614.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,243.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,632.95
|
| Rate for Payer: UHC Core |
$1,549.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,391.71
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX REMV CALCULI
|
Facility
|
IP
|
$28,810.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
36100633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18,726.50 |
| Max. Negotiated Rate |
$25,929.00 |
| Rate for Payer: Aetna Commercial |
$24,488.50
|
| Rate for Payer: BCBS Trust/PPO |
$23,517.60
|
| Rate for Payer: BCN Commercial |
$22,264.37
|
| Rate for Payer: Cash Price |
$23,048.00
|
| Rate for Payer: Cofinity Commercial |
$24,776.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,048.00
|
| Rate for Payer: Healthscope Commercial |
$25,929.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,607.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,488.50
|
| Rate for Payer: Nomi Health Commercial |
$23,624.20
|
| Rate for Payer: PHP Commercial |
$24,488.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,726.50
|
| Rate for Payer: Priority Health HMO/PPO |
$25,064.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,302.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,352.80
|
| Rate for Payer: UHC Core |
$24,056.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,607.50
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX REMV CALCULI
|
Facility
|
OP
|
$28,810.00
|
|
|
Service Code
|
CPT 47554
|
| Hospital Charge Code |
36100633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,842.38 |
| Max. Negotiated Rate |
$25,929.00 |
| Rate for Payer: Aetna Commercial |
$24,488.50
|
| Rate for Payer: Aetna Medicare |
$7,490.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,003.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,003.12
|
| Rate for Payer: BCBS Complete |
$7,904.20
|
| Rate for Payer: BCBS MAPPO |
$7,202.50
|
| Rate for Payer: BCBS Trust/PPO |
$23,684.70
|
| Rate for Payer: BCN Commercial |
$22,399.78
|
| Rate for Payer: BCN Medicare Advantage |
$7,202.50
|
| Rate for Payer: Cash Price |
$23,048.00
|
| Rate for Payer: Cash Price |
$23,048.00
|
| Rate for Payer: Cofinity Commercial |
$24,776.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23,048.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,202.50
|
| Rate for Payer: Healthscope Commercial |
$25,929.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,607.50
|
| Rate for Payer: Mclaren Medicaid |
$7,527.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,562.62
|
| Rate for Payer: Meridian Medicaid |
$7,904.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,282.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,488.50
|
| Rate for Payer: Nomi Health Commercial |
$23,624.20
|
| Rate for Payer: PACE Senior Care Partners |
$6,842.38
|
| Rate for Payer: PACE SWMI |
$7,202.50
|
| Rate for Payer: PHP Commercial |
$24,488.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,202.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,527.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18,726.50
|
| Rate for Payer: Priority Health HMO/PPO |
$25,064.70
|
| Rate for Payer: Priority Health Medicare |
$7,274.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19,302.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7,202.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,352.80
|
| Rate for Payer: UHC Core |
$24,056.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,202.50
|
| Rate for Payer: UHC Exchange |
$7,202.50
|
| Rate for Payer: UHC Medicare Advantage |
$7,202.50
|
| Rate for Payer: UHCCP Medicaid |
$7,527.31
|
| Rate for Payer: VA VA |
$7,202.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,607.50
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX SING OR MULTI
|
Facility
|
OP
|
$21,200.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
36100632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,511.34 |
| Max. Negotiated Rate |
$19,080.00 |
| Rate for Payer: Aetna Commercial |
$18,020.00
|
| Rate for Payer: Aetna Medicare |
$5,512.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,625.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,625.00
|
| Rate for Payer: BCBS Complete |
$4,737.22
|
| Rate for Payer: BCBS MAPPO |
$5,300.00
|
| Rate for Payer: BCBS Trust/PPO |
$17,428.52
|
| Rate for Payer: BCN Commercial |
$16,483.00
|
| Rate for Payer: BCN Medicare Advantage |
$5,300.00
|
| Rate for Payer: Cash Price |
$16,960.00
|
| Rate for Payer: Cash Price |
$16,960.00
|
| Rate for Payer: Cofinity Commercial |
$18,232.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,960.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,300.00
|
| Rate for Payer: Healthscope Commercial |
$19,080.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,900.00
|
| Rate for Payer: Mclaren Medicaid |
$4,511.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,565.00
|
| Rate for Payer: Meridian Medicaid |
$4,737.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,095.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,020.00
|
| Rate for Payer: Nomi Health Commercial |
$17,384.00
|
| Rate for Payer: PACE Senior Care Partners |
$5,035.00
|
| Rate for Payer: PACE SWMI |
$5,300.00
|
| Rate for Payer: PHP Commercial |
$18,020.00
|
| Rate for Payer: PHP Medicare Advantage |
$5,300.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,511.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,780.00
|
| Rate for Payer: Priority Health HMO/PPO |
$18,444.00
|
| Rate for Payer: Priority Health Medicare |
$5,353.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,204.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,300.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,656.00
|
| Rate for Payer: UHC Core |
$17,702.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,300.00
|
| Rate for Payer: UHC Exchange |
$5,300.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,300.00
|
| Rate for Payer: UHCCP Medicaid |
$4,511.34
|
| Rate for Payer: VA VA |
$5,300.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,900.00
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W BX SING OR MULTI
|
Facility
|
IP
|
$21,200.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
36100632
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,780.00 |
| Max. Negotiated Rate |
$19,080.00 |
| Rate for Payer: Aetna Commercial |
$18,020.00
|
| Rate for Payer: BCBS Trust/PPO |
$17,305.56
|
| Rate for Payer: BCN Commercial |
$16,383.36
|
| Rate for Payer: Cash Price |
$16,960.00
|
| Rate for Payer: Cofinity Commercial |
$18,232.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,960.00
|
| Rate for Payer: Healthscope Commercial |
$19,080.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,900.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,020.00
|
| Rate for Payer: Nomi Health Commercial |
$17,384.00
|
| Rate for Payer: PHP Commercial |
$18,020.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,780.00
|
| Rate for Payer: Priority Health HMO/PPO |
$18,444.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14,204.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,656.00
|
| Rate for Payer: UHC Core |
$17,702.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,900.00
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W DIL OF BIL STRICT WO STENT
|
Facility
|
OP
|
$9,700.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,303.75 |
| Max. Negotiated Rate |
$8,730.00 |
| Rate for Payer: Aetna Commercial |
$8,245.00
|
| Rate for Payer: Aetna Medicare |
$2,522.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,031.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,031.25
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$2,425.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,974.37
|
| Rate for Payer: BCN Commercial |
$7,541.75
|
| Rate for Payer: BCN Medicare Advantage |
$2,425.00
|
| Rate for Payer: Cash Price |
$7,760.00
|
| Rate for Payer: Cash Price |
$7,760.00
|
| Rate for Payer: Cofinity Commercial |
$8,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,760.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,425.00
|
| Rate for Payer: Healthscope Commercial |
$8,730.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,275.00
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,546.25
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,788.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,245.00
|
| Rate for Payer: Nomi Health Commercial |
$7,954.00
|
| Rate for Payer: PACE Senior Care Partners |
$2,303.75
|
| Rate for Payer: PACE SWMI |
$2,425.00
|
| Rate for Payer: PHP Commercial |
$8,245.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,425.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,305.00
|
| Rate for Payer: Priority Health HMO/PPO |
$8,439.00
|
| Rate for Payer: Priority Health Medicare |
$2,449.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,499.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,425.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,536.00
|
| Rate for Payer: UHC Core |
$8,099.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,425.00
|
| Rate for Payer: UHC Exchange |
$2,425.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,425.00
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$2,425.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,275.00
|
|
|
HC BILIARY ENDO PERC VIA T-TUBE/OTHER TRACT W DIL OF BIL STRICT WO STENT
|
Facility
|
IP
|
$9,700.00
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,305.00 |
| Max. Negotiated Rate |
$8,730.00 |
| Rate for Payer: Aetna Commercial |
$8,245.00
|
| Rate for Payer: BCBS Trust/PPO |
$7,918.11
|
| Rate for Payer: BCN Commercial |
$7,496.16
|
| Rate for Payer: Cash Price |
$7,760.00
|
| Rate for Payer: Cofinity Commercial |
$8,342.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,760.00
|
| Rate for Payer: Healthscope Commercial |
$8,730.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,275.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,245.00
|
| Rate for Payer: Nomi Health Commercial |
$7,954.00
|
| Rate for Payer: PHP Commercial |
$8,245.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,305.00
|
| Rate for Payer: Priority Health HMO/PPO |
$8,439.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,499.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,536.00
|
| Rate for Payer: UHC Core |
$8,099.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,275.00
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
30100118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC BILIRUBIN DIRECT
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
30100118
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.63
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
30100117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.63
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC BILIRUBIN TOTAL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
30100117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC BILIRUBIN TOTAL TRANSCUTANEOUS
|
Facility
|
IP
|
$47.48
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
30100694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: BCBS Trust/PPO |
$38.76
|
| Rate for Payer: BCN Commercial |
$36.69
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$40.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.98
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.36
|
| Rate for Payer: Nomi Health Commercial |
$38.93
|
| Rate for Payer: PHP Commercial |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.86
|
| Rate for Payer: Priority Health HMO/PPO |
$41.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.78
|
| Rate for Payer: UHC Core |
$39.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.61
|
|
|
HC BILIRUBIN TOTAL TRANSCUTANEOUS
|
Facility
|
OP
|
$47.48
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
30100694
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Aetna Commercial |
$40.36
|
| Rate for Payer: Aetna Medicare |
$12.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.84
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$11.87
|
| Rate for Payer: BCBS Trust/PPO |
$39.03
|
| Rate for Payer: BCN Commercial |
$36.92
|
| Rate for Payer: BCN Medicare Advantage |
$11.87
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cash Price |
$37.98
|
| Rate for Payer: Cofinity Commercial |
$40.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.87
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.61
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.46
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.36
|
| Rate for Payer: Nomi Health Commercial |
$38.93
|
| Rate for Payer: PACE Senior Care Partners |
$11.28
|
| Rate for Payer: PACE SWMI |
$11.87
|
| Rate for Payer: PHP Commercial |
$40.36
|
| Rate for Payer: PHP Medicare Advantage |
$11.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.86
|
| Rate for Payer: Priority Health HMO/PPO |
$41.31
|
| Rate for Payer: Priority Health Medicare |
$11.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.81
|
| Rate for Payer: Railroad Medicare Medicare |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.78
|
| Rate for Payer: UHC Core |
$39.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.87
|
| Rate for Payer: UHC Exchange |
$11.87
|
| Rate for Payer: UHC Medicare Advantage |
$11.87
|
| Rate for Payer: UHCCP Medicaid |
$3.63
|
| Rate for Payer: VA VA |
$11.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.61
|
|
|
HC BILL ONLY URINE DRUG SCR8 AUTO
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000141
|
|
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 BILL ONLY URINE DRUG SCR8 AUTO
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000141
|
|
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 BILL ONLY URINE DRUG SCR8 MAN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC BILL ONLY URINE DRUG SCR8 MAN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000135
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$11.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.45
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.45
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC BILL ONLY URINE DRUG SCR AUTO
|
Facility
|
OP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$91.75 |
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: Aetna Medicare |
$26.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.86
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$83.81
|
| Rate for Payer: BCN Commercial |
$79.27
|
| Rate for Payer: BCN Medicare Advantage |
$25.49
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.46
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.76
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: PACE Senior Care Partners |
$24.21
|
| Rate for Payer: PACE SWMI |
$25.49
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: PHP Medicare Advantage |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.70
|
| Rate for Payer: Priority Health Medicare |
$25.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: Railroad Medicare Medicare |
$25.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.49
|
| Rate for Payer: UHC Exchange |
$25.49
|
| Rate for Payer: UHC Medicare Advantage |
$25.49
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.46
|
|
|
HC BILL ONLY URINE DRUG SCR AUTO
|
Facility
|
IP
|
$101.95
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000142
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$91.75 |
| Rate for Payer: Aetna Commercial |
$86.66
|
| Rate for Payer: BCBS Trust/PPO |
$83.22
|
| Rate for Payer: BCN Commercial |
$78.79
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cofinity Commercial |
$87.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.56
|
| Rate for Payer: Healthscope Commercial |
$91.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.66
|
| Rate for Payer: Nomi Health Commercial |
$83.60
|
| Rate for Payer: PHP Commercial |
$86.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.27
|
| Rate for Payer: Priority Health HMO/PPO |
$88.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.72
|
| Rate for Payer: UHC Core |
$85.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.46
|
|
|
HC BILL ONLY URINE DRUG SCR MAN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC BILL ONLY URINE DRUG SCR MAN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$11.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.45
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.45
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: BCBS Trust/PPO |
$133.22
|
| Rate for Payer: BCN Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
47000003
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$65.28
|
| Rate for Payer: BCBS MAPPO |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$134.17
|
| Rate for Payer: BCN Commercial |
$126.89
|
| Rate for Payer: BCN Medicare Advantage |
$40.80
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PACE Senior Care Partners |
$38.76
|
| Rate for Payer: PACE SWMI |
$40.80
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Medicare |
$41.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: Railroad Medicare Medicare |
$40.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.80
|
| Rate for Payer: UHC Exchange |
$40.80
|
| Rate for Payer: UHC Medicare Advantage |
$40.80
|
| Rate for Payer: VA VA |
$40.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC BIOELECT IMPEDANCE ANALYSIS (BIA) WHOLE BODY
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 0358T
|
| Hospital Charge Code |
92000032
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.08
|
| Rate for Payer: BCBS Complete |
$18.59
|
| Rate for Payer: BCBS MAPPO |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$25.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PACE Senior Care Partners |
$7.66
|
| Rate for Payer: PACE SWMI |
$8.06
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$8.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.06
|
| Rate for Payer: UHC Exchange |
$8.06
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC BIOELECT IMPEDANCE ANALYSIS (BIA) WHOLE BODY
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 0358T
|
| Hospital Charge Code |
92000032
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$26.33
|
| Rate for Payer: BCN Commercial |
$24.92
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.96
|
| Rate for Payer: Priority Health HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
