|
HC BRUCELLA ANTIBODY CMPT
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.38
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC BRUCELLA ANTIBODY CONFIRMATION
|
Facility
|
OP
|
$53.04
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: Aetna Medicare |
$13.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.58
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS MAPPO |
$13.26
|
| Rate for Payer: BCBS Trust/PPO |
$43.60
|
| Rate for Payer: BCN Commercial |
$41.24
|
| Rate for Payer: BCN Medicare Advantage |
$13.26
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.78
|
| Rate for Payer: Mclaren Medicaid |
$6.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.92
|
| Rate for Payer: Meridian Medicaid |
$6.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Nomi Health Commercial |
$43.49
|
| Rate for Payer: PACE Senior Care Partners |
$12.60
|
| Rate for Payer: PACE SWMI |
$13.26
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: PHP Medicare Advantage |
$13.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health HMO/PPO |
$46.14
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.68
|
| Rate for Payer: UHC Core |
$44.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.26
|
| Rate for Payer: UHC Exchange |
$13.26
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
| Rate for Payer: UHCCP Medicaid |
$6.46
|
| Rate for Payer: VA VA |
$13.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.78
|
|
|
HC BRUCELLA ANTIBODY CONFIRMATION
|
Facility
|
IP
|
$53.04
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200237
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$47.74 |
| Rate for Payer: Aetna Commercial |
$45.08
|
| Rate for Payer: BCBS Trust/PPO |
$43.30
|
| Rate for Payer: BCN Commercial |
$40.99
|
| Rate for Payer: Cash Price |
$42.43
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.43
|
| Rate for Payer: Healthscope Commercial |
$47.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.08
|
| Rate for Payer: Nomi Health Commercial |
$43.49
|
| Rate for Payer: PHP Commercial |
$45.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.48
|
| Rate for Payer: Priority Health HMO/PPO |
$46.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.68
|
| Rate for Payer: UHC Core |
$44.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.78
|
|
|
HC BUDESONIDE INHALATION SOLUTION
|
Facility
|
IP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$26.42 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: BCBS Trust/PPO |
$23.96
|
| Rate for Payer: BCN Commercial |
$22.68
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Healthscope Commercial |
$26.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Nomi Health Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health HMO/PPO |
$25.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
HC BUDESONIDE INHALATION SOLUTION
|
Facility
|
OP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$26.42 |
| Rate for Payer: Aetna Commercial |
$24.95
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: BCBS MAPPO |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$24.13
|
| Rate for Payer: BCN Commercial |
$22.82
|
| Rate for Payer: BCN Medicare Advantage |
$7.34
|
| Rate for Payer: Cash Price |
$23.48
|
| Rate for Payer: Cofinity Commercial |
$25.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$26.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.95
|
| Rate for Payer: Nomi Health Commercial |
$24.07
|
| Rate for Payer: PACE Senior Care Partners |
$6.97
|
| Rate for Payer: PACE SWMI |
$7.34
|
| Rate for Payer: PHP Commercial |
$24.95
|
| Rate for Payer: PHP Medicare Advantage |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health HMO/PPO |
$25.53
|
| Rate for Payer: Priority Health Medicare |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.83
|
| Rate for Payer: UHC Core |
$24.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.34
|
| Rate for Payer: UHC Exchange |
$7.34
|
| Rate for Payer: UHC Medicare Advantage |
$7.34
|
| Rate for Payer: VA VA |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.01
|
|
|
HC BUNDLE OF HIS RECORDING
|
Facility
|
IP
|
$4,021.38
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,613.90 |
| Max. Negotiated Rate |
$3,619.24 |
| Rate for Payer: Aetna Commercial |
$3,418.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,282.65
|
| Rate for Payer: BCN Commercial |
$3,107.72
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cofinity Commercial |
$3,458.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,217.10
|
| Rate for Payer: Healthscope Commercial |
$3,619.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,016.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,418.17
|
| Rate for Payer: Nomi Health Commercial |
$3,297.53
|
| Rate for Payer: PHP Commercial |
$3,418.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,613.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,498.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,694.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,538.81
|
| Rate for Payer: UHC Core |
$3,357.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,016.04
|
|
|
HC BUNDLE OF HIS RECORDING
|
Facility
|
OP
|
$4,021.38
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
48100029
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$955.08 |
| Max. Negotiated Rate |
$5,644.40 |
| Rate for Payer: Aetna Commercial |
$3,418.17
|
| Rate for Payer: Aetna Medicare |
$1,045.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,256.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,256.68
|
| Rate for Payer: BCBS Complete |
$5,644.40
|
| Rate for Payer: BCBS MAPPO |
$1,005.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,305.98
|
| Rate for Payer: BCN Commercial |
$3,126.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.34
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cash Price |
$3,217.10
|
| Rate for Payer: Cofinity Commercial |
$3,458.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,217.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.34
|
| Rate for Payer: Healthscope Commercial |
$3,619.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,016.04
|
| Rate for Payer: Mclaren Medicaid |
$5,375.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.61
|
| Rate for Payer: Meridian Medicaid |
$5,644.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,156.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,418.17
|
| Rate for Payer: Nomi Health Commercial |
$3,297.53
|
| Rate for Payer: PACE Senior Care Partners |
$955.08
|
| Rate for Payer: PACE SWMI |
$1,005.34
|
| Rate for Payer: PHP Commercial |
$3,418.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,375.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,613.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3,498.60
|
| Rate for Payer: Priority Health Medicare |
$1,015.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,694.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,005.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,538.81
|
| Rate for Payer: UHC Core |
$3,357.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,005.34
|
| Rate for Payer: UHC Exchange |
$1,005.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.34
|
| Rate for Payer: UHCCP Medicaid |
$5,375.27
|
| Rate for Payer: VA VA |
$1,005.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,016.04
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
IP
|
$1.51
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.23
|
| Rate for Payer: BCN Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.21
|
| Rate for Payer: Healthscope Commercial |
$1.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.24
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.33
|
| Rate for Payer: UHC Core |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.13
|
|
|
HC BUPIVACAINE 0.5 MG
|
Facility
|
OP
|
$1.51
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25000016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.36 |
| Rate for Payer: Aetna Commercial |
$1.28
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.47
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$1.24
|
| Rate for Payer: BCN Commercial |
$1.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.38
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cofinity Commercial |
$1.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.38
|
| Rate for Payer: Healthscope Commercial |
$1.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.28
|
| Rate for Payer: Nomi Health Commercial |
$1.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.38
|
| Rate for Payer: PHP Commercial |
$1.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.98
|
| Rate for Payer: Priority Health HMO/PPO |
$1.31
|
| Rate for Payer: Priority Health Medicare |
$0.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.33
|
| Rate for Payer: UHC Core |
$1.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.38
|
| Rate for Payer: UHC Exchange |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.38
|
| Rate for Payer: VA VA |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.13
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
OP
|
$177.48
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.15 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Medicare |
$46.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.46
|
| Rate for Payer: BCBS Complete |
$70.99
|
| Rate for Payer: BCBS MAPPO |
$44.37
|
| Rate for Payer: BCBS Trust/PPO |
$145.91
|
| Rate for Payer: BCN Commercial |
$137.99
|
| Rate for Payer: BCN Medicare Advantage |
$44.37
|
| Rate for Payer: Cash Price |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.37
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.86
|
| Rate for Payer: Nomi Health Commercial |
$145.53
|
| Rate for Payer: PACE Senior Care Partners |
$42.15
|
| Rate for Payer: PACE SWMI |
$44.37
|
| Rate for Payer: PHP Commercial |
$150.86
|
| Rate for Payer: PHP Medicare Advantage |
$44.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.36
|
| Rate for Payer: Priority Health HMO/PPO |
$154.41
|
| Rate for Payer: Priority Health Medicare |
$44.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.18
|
| Rate for Payer: UHC Core |
$148.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.37
|
| Rate for Payer: UHC Exchange |
$44.37
|
| Rate for Payer: UHC Medicare Advantage |
$44.37
|
| Rate for Payer: VA VA |
$44.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.11
|
|
|
HC BUPRENORPHINE & MET QUANT, UR
|
Facility
|
IP
|
$177.48
|
|
|
Service Code
|
CPT 80348
|
| Hospital Charge Code |
30100598
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: BCBS Trust/PPO |
$144.88
|
| Rate for Payer: BCN Commercial |
$137.16
|
| Rate for Payer: Cash Price |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.98
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.86
|
| Rate for Payer: Nomi Health Commercial |
$145.53
|
| Rate for Payer: PHP Commercial |
$150.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.36
|
| Rate for Payer: Priority Health HMO/PPO |
$154.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.18
|
| Rate for Payer: UHC Core |
$148.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.11
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC BUPRENORPHINE SCRN URN
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30000116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC BURN CARE LARGE
|
Facility
|
OP
|
$691.65
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$622.48 |
| Rate for Payer: Aetna Commercial |
$587.90
|
| Rate for Payer: Aetna Medicare |
$179.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.14
|
| Rate for Payer: BCBS Complete |
$297.19
|
| Rate for Payer: BCBS MAPPO |
$172.91
|
| Rate for Payer: BCBS Trust/PPO |
$568.61
|
| Rate for Payer: BCN Commercial |
$537.76
|
| Rate for Payer: BCN Medicare Advantage |
$172.91
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cofinity Commercial |
$594.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.91
|
| Rate for Payer: Healthscope Commercial |
$622.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Mclaren Medicaid |
$283.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.56
|
| Rate for Payer: Meridian Medicaid |
$297.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.90
|
| Rate for Payer: Nomi Health Commercial |
$567.15
|
| Rate for Payer: PACE Senior Care Partners |
$164.27
|
| Rate for Payer: PACE SWMI |
$172.91
|
| Rate for Payer: PHP Commercial |
$587.90
|
| Rate for Payer: PHP Medicare Advantage |
$172.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.57
|
| Rate for Payer: Priority Health HMO/PPO |
$601.74
|
| Rate for Payer: Priority Health Medicare |
$174.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.41
|
| Rate for Payer: Railroad Medicare Medicare |
$172.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.65
|
| Rate for Payer: UHC Core |
$577.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.91
|
| Rate for Payer: UHC Exchange |
$172.91
|
| Rate for Payer: UHC Medicare Advantage |
$172.91
|
| Rate for Payer: UHCCP Medicaid |
$283.02
|
| Rate for Payer: VA VA |
$172.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC BURN CARE LARGE
|
Facility
|
IP
|
$691.65
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
36100007
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$449.57 |
| Max. Negotiated Rate |
$622.48 |
| Rate for Payer: Aetna Commercial |
$587.90
|
| Rate for Payer: BCBS Trust/PPO |
$564.59
|
| Rate for Payer: BCN Commercial |
$534.51
|
| Rate for Payer: Cash Price |
$553.32
|
| Rate for Payer: Cofinity Commercial |
$594.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$553.32
|
| Rate for Payer: Healthscope Commercial |
$622.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$518.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.90
|
| Rate for Payer: Nomi Health Commercial |
$567.15
|
| Rate for Payer: PHP Commercial |
$587.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.57
|
| Rate for Payer: Priority Health HMO/PPO |
$601.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$463.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$608.65
|
| Rate for Payer: UHC Core |
$577.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$518.74
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
IP
|
$531.94
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$345.76 |
| Max. Negotiated Rate |
$478.75 |
| Rate for Payer: Aetna Commercial |
$452.15
|
| Rate for Payer: BCBS Trust/PPO |
$434.22
|
| Rate for Payer: BCN Commercial |
$411.08
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cofinity Commercial |
$457.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.55
|
| Rate for Payer: Healthscope Commercial |
$478.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.15
|
| Rate for Payer: Nomi Health Commercial |
$436.19
|
| Rate for Payer: PHP Commercial |
$452.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.76
|
| Rate for Payer: Priority Health HMO/PPO |
$462.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.11
|
| Rate for Payer: UHC Core |
$444.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.96
|
|
|
HC BURN CARE MEDIUM
|
Facility
|
OP
|
$531.94
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
36100006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$478.75 |
| Rate for Payer: Aetna Commercial |
$452.15
|
| Rate for Payer: Aetna Medicare |
$138.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$166.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$166.23
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$132.98
|
| Rate for Payer: BCBS Trust/PPO |
$437.31
|
| Rate for Payer: BCN Commercial |
$413.58
|
| Rate for Payer: BCN Medicare Advantage |
$132.98
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cash Price |
$425.55
|
| Rate for Payer: Cofinity Commercial |
$457.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.98
|
| Rate for Payer: Healthscope Commercial |
$478.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.96
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.63
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.15
|
| Rate for Payer: Nomi Health Commercial |
$436.19
|
| Rate for Payer: PACE Senior Care Partners |
$126.34
|
| Rate for Payer: PACE SWMI |
$132.98
|
| Rate for Payer: PHP Commercial |
$452.15
|
| Rate for Payer: PHP Medicare Advantage |
$132.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.76
|
| Rate for Payer: Priority Health HMO/PPO |
$462.79
|
| Rate for Payer: Priority Health Medicare |
$134.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.40
|
| Rate for Payer: Railroad Medicare Medicare |
$132.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.11
|
| Rate for Payer: UHC Core |
$444.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.98
|
| Rate for Payer: UHC Exchange |
$132.98
|
| Rate for Payer: UHC Medicare Advantage |
$132.98
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$132.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.96
|
|
|
HC BURN CARE SMALL
|
Facility
|
IP
|
$365.20
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.38 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Aetna Commercial |
$310.42
|
| Rate for Payer: BCBS Trust/PPO |
$298.11
|
| Rate for Payer: BCN Commercial |
$282.23
|
| Rate for Payer: Cash Price |
$292.16
|
| Rate for Payer: Cofinity Commercial |
$314.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.16
|
| Rate for Payer: Healthscope Commercial |
$328.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.42
|
| Rate for Payer: Nomi Health Commercial |
$299.46
|
| Rate for Payer: PHP Commercial |
$310.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.38
|
| Rate for Payer: Priority Health HMO/PPO |
$317.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.38
|
| Rate for Payer: UHC Core |
$304.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.90
|
|
|
HC BURN CARE SMALL
|
Facility
|
OP
|
$365.20
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
36100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.74 |
| Max. Negotiated Rate |
$328.68 |
| Rate for Payer: Aetna Commercial |
$310.42
|
| Rate for Payer: Aetna Medicare |
$94.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.12
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$91.30
|
| Rate for Payer: BCBS Trust/PPO |
$300.23
|
| Rate for Payer: BCN Commercial |
$283.94
|
| Rate for Payer: BCN Medicare Advantage |
$91.30
|
| Rate for Payer: Cash Price |
$292.16
|
| Rate for Payer: Cash Price |
$292.16
|
| Rate for Payer: Cofinity Commercial |
$314.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.30
|
| Rate for Payer: Healthscope Commercial |
$328.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.90
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.86
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.42
|
| Rate for Payer: Nomi Health Commercial |
$299.46
|
| Rate for Payer: PACE Senior Care Partners |
$86.74
|
| Rate for Payer: PACE SWMI |
$91.30
|
| Rate for Payer: PHP Commercial |
$310.42
|
| Rate for Payer: PHP Medicare Advantage |
$91.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.38
|
| Rate for Payer: Priority Health HMO/PPO |
$317.72
|
| Rate for Payer: Priority Health Medicare |
$92.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.68
|
| Rate for Payer: Railroad Medicare Medicare |
$91.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.38
|
| Rate for Payer: UHC Core |
$304.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.30
|
| Rate for Payer: UHC Exchange |
$91.30
|
| Rate for Payer: UHC Medicare Advantage |
$91.30
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.90
|
|
|
HC BURN R&B
|
Facility
|
IP
|
$7,438.86
|
|
| Hospital Charge Code |
20700001
|
|
Hospital Revenue Code
|
207
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$6,694.97 |
| Rate for Payer: Aetna Commercial |
$6,323.03
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,072.34
|
| Rate for Payer: BCN Commercial |
$5,748.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$5,951.09
|
| Rate for Payer: Cash Price |
$5,951.09
|
| Rate for Payer: Cofinity Commercial |
$6,397.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,951.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$6,694.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,579.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,323.03
|
| Rate for Payer: Nomi Health Commercial |
$6,099.87
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$6,323.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,835.26
|
| Rate for Payer: Priority Health HMO/PPO |
$6,471.81
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,984.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,546.20
|
| Rate for Payer: UHC Core |
$6,211.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,579.14
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
IP
|
$223.87
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$190.29
|
| Rate for Payer: BCBS Trust/PPO |
$182.75
|
| Rate for Payer: BCN Commercial |
$173.01
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cofinity Commercial |
$192.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.10
|
| Rate for Payer: Healthscope Commercial |
$201.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.29
|
| Rate for Payer: Nomi Health Commercial |
$183.57
|
| Rate for Payer: PHP Commercial |
$190.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.52
|
| Rate for Payer: Priority Health HMO/PPO |
$194.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.01
|
| Rate for Payer: UHC Core |
$186.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.90
|
|
|
HC BX VULVA PERINEUM ADDL LESION
|
Facility
|
OP
|
$223.87
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
76100202
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.17 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$190.29
|
| Rate for Payer: Aetna Medicare |
$58.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.96
|
| Rate for Payer: BCBS Complete |
$89.55
|
| Rate for Payer: BCBS MAPPO |
$55.97
|
| Rate for Payer: BCBS Trust/PPO |
$184.04
|
| Rate for Payer: BCN Commercial |
$174.06
|
| Rate for Payer: BCN Medicare Advantage |
$55.97
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cofinity Commercial |
$192.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.97
|
| Rate for Payer: Healthscope Commercial |
$201.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.29
|
| Rate for Payer: Nomi Health Commercial |
$183.57
|
| Rate for Payer: PACE Senior Care Partners |
$53.17
|
| Rate for Payer: PACE SWMI |
$55.97
|
| Rate for Payer: PHP Commercial |
$190.29
|
| Rate for Payer: PHP Medicare Advantage |
$55.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.52
|
| Rate for Payer: Priority Health HMO/PPO |
$194.77
|
| Rate for Payer: Priority Health Medicare |
$56.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.99
|
| Rate for Payer: Railroad Medicare Medicare |
$55.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.01
|
| Rate for Payer: UHC Core |
$186.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.97
|
| Rate for Payer: UHC Exchange |
$55.97
|
| Rate for Payer: UHC Medicare Advantage |
$55.97
|
| Rate for Payer: VA VA |
$55.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.90
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.73
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS MAPPO |
$18.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.44
|
| Rate for Payer: BCN Commercial |
$59.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.99
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Mclaren Medicaid |
$8.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.94
|
| Rate for Payer: Meridian Medicaid |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PACE Senior Care Partners |
$18.04
|
| Rate for Payer: PACE SWMI |
$18.99
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Medicare |
$19.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: Railroad Medicare Medicare |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.99
|
| Rate for Payer: UHC Exchange |
$18.99
|
| Rate for Payer: UHC Medicare Advantage |
$18.99
|
| Rate for Payer: UHCCP Medicaid |
$8.68
|
| Rate for Payer: VA VA |
$18.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC C1 ESTERASE INHIBITOR FUNCTION
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
CPT 86161
|
| Hospital Charge Code |
30200153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.37 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: BCBS Trust/PPO |
$62.00
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Nomi Health Commercial |
$62.28
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.37
|
| Rate for Payer: Priority Health HMO/PPO |
$66.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.84
|
| Rate for Payer: UHC Core |
$63.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HC C1 ESTERASE INHIBITOR QUANTITATIVE
|
Facility
|
OP
|
$74.51
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100257
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$67.06 |
| Rate for Payer: Aetna Commercial |
$63.33
|
| Rate for Payer: Aetna Medicare |
$19.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.28
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$18.63
|
| Rate for Payer: BCBS Trust/PPO |
$61.25
|
| Rate for Payer: BCN Commercial |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$18.63
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cash Price |
$59.61
|
| Rate for Payer: Cofinity Commercial |
$64.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$67.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.88
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.56
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.33
|
| Rate for Payer: Nomi Health Commercial |
$61.10
|
| Rate for Payer: PACE Senior Care Partners |
$17.70
|
| Rate for Payer: PACE SWMI |
$18.63
|
| Rate for Payer: PHP Commercial |
$63.33
|
| Rate for Payer: PHP Medicare Advantage |
$18.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.43
|
| Rate for Payer: Priority Health HMO/PPO |
$64.82
|
| Rate for Payer: Priority Health Medicare |
$18.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.92
|
| Rate for Payer: Railroad Medicare Medicare |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.57
|
| Rate for Payer: UHC Core |
$62.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.63
|
| Rate for Payer: UHC Exchange |
$18.63
|
| Rate for Payer: UHC Medicare Advantage |
$18.63
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.88
|
|
