|
HC BRONCH CMPTR ASST IMAGE ADD ON
|
Facility
|
IP
|
$258.03
|
|
| Hospital Charge Code |
75000007
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$232.23 |
| Rate for Payer: Aetna Commercial |
$219.33
|
| Rate for Payer: BCBS Trust/PPO |
$210.63
|
| Rate for Payer: BCN Commercial |
$199.41
|
| Rate for Payer: Cash Price |
$206.42
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.42
|
| Rate for Payer: Healthscope Commercial |
$232.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.33
|
| Rate for Payer: Nomi Health Commercial |
$211.58
|
| Rate for Payer: PHP Commercial |
$219.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.72
|
| Rate for Payer: Priority Health HMO/PPO |
$224.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.07
|
| Rate for Payer: UHC Core |
$215.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.52
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
IP
|
$3,103.68
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,017.39 |
| Max. Negotiated Rate |
$2,793.31 |
| Rate for Payer: Aetna Commercial |
$2,638.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,533.53
|
| Rate for Payer: BCN Commercial |
$2,398.52
|
| Rate for Payer: Cash Price |
$2,482.94
|
| Rate for Payer: Cofinity Commercial |
$2,669.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.94
|
| Rate for Payer: Healthscope Commercial |
$2,793.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,327.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.13
|
| Rate for Payer: Nomi Health Commercial |
$2,545.02
|
| Rate for Payer: PHP Commercial |
$2,638.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.39
|
| Rate for Payer: Priority Health HMO/PPO |
$2,700.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,079.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,731.24
|
| Rate for Payer: UHC Core |
$2,591.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,327.76
|
|
|
HC BRONCHIAL NAVIGATION
|
Facility
|
OP
|
$3,103.68
|
|
| Hospital Charge Code |
36000102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$737.12 |
| Max. Negotiated Rate |
$2,793.31 |
| Rate for Payer: Aetna Commercial |
$2,638.13
|
| Rate for Payer: Aetna Medicare |
$806.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$969.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$969.90
|
| Rate for Payer: BCBS Complete |
$1,241.47
|
| Rate for Payer: BCBS MAPPO |
$775.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,551.54
|
| Rate for Payer: BCN Commercial |
$2,413.11
|
| Rate for Payer: BCN Medicare Advantage |
$775.92
|
| Rate for Payer: Cash Price |
$2,482.94
|
| Rate for Payer: Cofinity Commercial |
$2,669.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,482.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.92
|
| Rate for Payer: Healthscope Commercial |
$2,793.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,327.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$892.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,638.13
|
| Rate for Payer: Nomi Health Commercial |
$2,545.02
|
| Rate for Payer: PACE Senior Care Partners |
$737.12
|
| Rate for Payer: PACE SWMI |
$775.92
|
| Rate for Payer: PHP Commercial |
$2,638.13
|
| Rate for Payer: PHP Medicare Advantage |
$775.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.39
|
| Rate for Payer: Priority Health HMO/PPO |
$2,700.20
|
| Rate for Payer: Priority Health Medicare |
$783.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,079.47
|
| Rate for Payer: Railroad Medicare Medicare |
$775.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,731.24
|
| Rate for Payer: UHC Core |
$2,591.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$775.92
|
| Rate for Payer: UHC Exchange |
$775.92
|
| Rate for Payer: UHC Medicare Advantage |
$775.92
|
| Rate for Payer: VA VA |
$775.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,327.76
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
OP
|
$273.76
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: Aetna Medicare |
$71.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.55
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$68.44
|
| Rate for Payer: BCBS Trust/PPO |
$225.06
|
| Rate for Payer: BCN Commercial |
$212.85
|
| Rate for Payer: BCN Medicare Advantage |
$68.44
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cofinity Commercial |
$235.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.44
|
| Rate for Payer: Healthscope Commercial |
$246.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.32
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.86
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: Nomi Health Commercial |
$224.48
|
| Rate for Payer: PACE Senior Care Partners |
$65.02
|
| Rate for Payer: PACE SWMI |
$68.44
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: PHP Medicare Advantage |
$68.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.94
|
| Rate for Payer: Priority Health HMO/PPO |
$238.17
|
| Rate for Payer: Priority Health Medicare |
$69.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.42
|
| Rate for Payer: Railroad Medicare Medicare |
$68.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.91
|
| Rate for Payer: UHC Core |
$228.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.44
|
| Rate for Payer: UHC Exchange |
$68.44
|
| Rate for Payer: UHC Medicare Advantage |
$68.44
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$68.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.32
|
|
|
HC BRONCHO HYGIENE INITIAL
|
Facility
|
IP
|
$273.76
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
41000010
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$177.94 |
| Max. Negotiated Rate |
$246.38 |
| Rate for Payer: Aetna Commercial |
$232.70
|
| Rate for Payer: BCBS Trust/PPO |
$223.47
|
| Rate for Payer: BCN Commercial |
$211.56
|
| Rate for Payer: Cash Price |
$219.01
|
| Rate for Payer: Cofinity Commercial |
$235.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.01
|
| Rate for Payer: Healthscope Commercial |
$246.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: Nomi Health Commercial |
$224.48
|
| Rate for Payer: PHP Commercial |
$232.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.94
|
| Rate for Payer: Priority Health HMO/PPO |
$238.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.91
|
| Rate for Payer: UHC Core |
$228.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.32
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
IP
|
$263.12
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$171.03 |
| Max. Negotiated Rate |
$236.81 |
| Rate for Payer: Aetna Commercial |
$223.65
|
| Rate for Payer: BCBS Trust/PPO |
$214.78
|
| Rate for Payer: BCN Commercial |
$203.34
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.50
|
| Rate for Payer: Healthscope Commercial |
$236.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.65
|
| Rate for Payer: Nomi Health Commercial |
$215.76
|
| Rate for Payer: PHP Commercial |
$223.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.03
|
| Rate for Payer: Priority Health HMO/PPO |
$228.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.55
|
| Rate for Payer: UHC Core |
$219.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.34
|
|
|
HC BRONCHO HYGIENE SUBS
|
Facility
|
OP
|
$263.12
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
41000011
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$62.49 |
| Max. Negotiated Rate |
$236.81 |
| Rate for Payer: Aetna Commercial |
$223.65
|
| Rate for Payer: Aetna Medicare |
$68.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.22
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$65.78
|
| Rate for Payer: BCBS Trust/PPO |
$216.31
|
| Rate for Payer: BCN Commercial |
$204.58
|
| Rate for Payer: BCN Medicare Advantage |
$65.78
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cofinity Commercial |
$226.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.78
|
| Rate for Payer: Healthscope Commercial |
$236.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.34
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.07
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.65
|
| Rate for Payer: Nomi Health Commercial |
$215.76
|
| Rate for Payer: PACE Senior Care Partners |
$62.49
|
| Rate for Payer: PACE SWMI |
$65.78
|
| Rate for Payer: PHP Commercial |
$223.65
|
| Rate for Payer: PHP Medicare Advantage |
$65.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.03
|
| Rate for Payer: Priority Health HMO/PPO |
$228.91
|
| Rate for Payer: Priority Health Medicare |
$66.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.29
|
| Rate for Payer: Railroad Medicare Medicare |
$65.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.55
|
| Rate for Payer: UHC Core |
$219.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.78
|
| Rate for Payer: UHC Exchange |
$65.78
|
| Rate for Payer: UHC Medicare Advantage |
$65.78
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$65.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.34
|
|
|
HC BRONCHOSCOPY
|
Facility
|
IP
|
$2,564.80
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,667.12 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.65
|
| Rate for Payer: BCN Commercial |
$1,982.08
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,923.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: Nomi Health Commercial |
$2,103.14
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,231.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,718.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,257.02
|
| Rate for Payer: UHC Core |
$2,141.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,923.60
|
|
|
HC BRONCHOSCOPY
|
Facility
|
OP
|
$2,564.80
|
|
| Hospital Charge Code |
36000014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$609.14 |
| Max. Negotiated Rate |
$2,308.32 |
| Rate for Payer: Aetna Commercial |
$2,180.08
|
| Rate for Payer: Aetna Medicare |
$666.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$801.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$801.50
|
| Rate for Payer: BCBS Complete |
$1,025.92
|
| Rate for Payer: BCBS MAPPO |
$641.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.52
|
| Rate for Payer: BCN Commercial |
$1,994.13
|
| Rate for Payer: BCN Medicare Advantage |
$641.20
|
| Rate for Payer: Cash Price |
$2,051.84
|
| Rate for Payer: Cofinity Commercial |
$2,205.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,051.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.20
|
| Rate for Payer: Healthscope Commercial |
$2,308.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,923.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$737.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,180.08
|
| Rate for Payer: Nomi Health Commercial |
$2,103.14
|
| Rate for Payer: PACE Senior Care Partners |
$609.14
|
| Rate for Payer: PACE SWMI |
$641.20
|
| Rate for Payer: PHP Commercial |
$2,180.08
|
| Rate for Payer: PHP Medicare Advantage |
$641.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,667.12
|
| Rate for Payer: Priority Health HMO/PPO |
$2,231.38
|
| Rate for Payer: Priority Health Medicare |
$647.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,718.42
|
| Rate for Payer: Railroad Medicare Medicare |
$641.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,257.02
|
| Rate for Payer: UHC Core |
$2,141.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.20
|
| Rate for Payer: UHC Exchange |
$641.20
|
| Rate for Payer: UHC Medicare Advantage |
$641.20
|
| Rate for Payer: VA VA |
$641.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,923.60
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
OP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$754.78 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: Aetna Medicare |
$826.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$993.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$993.13
|
| Rate for Payer: BCBS Complete |
$1,271.21
|
| Rate for Payer: BCBS MAPPO |
$794.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,612.65
|
| Rate for Payer: BCN Commercial |
$2,470.91
|
| Rate for Payer: BCN Medicare Advantage |
$794.50
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$794.50
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,383.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$834.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$913.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: Nomi Health Commercial |
$2,605.98
|
| Rate for Payer: PACE Senior Care Partners |
$754.78
|
| Rate for Payer: PACE SWMI |
$794.50
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: PHP Medicare Advantage |
$794.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health HMO/PPO |
$2,764.88
|
| Rate for Payer: Priority Health Medicare |
$802.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,129.27
|
| Rate for Payer: Railroad Medicare Medicare |
$794.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,796.66
|
| Rate for Payer: UHC Core |
$2,653.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$794.50
|
| Rate for Payer: UHC Exchange |
$794.50
|
| Rate for Payer: UHC Medicare Advantage |
$794.50
|
| Rate for Payer: VA VA |
$794.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,383.51
|
|
|
HC BRONCHOSCOPY W EBUS EXAM
|
Facility
|
IP
|
$3,178.02
|
|
| Hospital Charge Code |
36000015
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,065.71 |
| Max. Negotiated Rate |
$2,860.22 |
| Rate for Payer: Aetna Commercial |
$2,701.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,594.22
|
| Rate for Payer: BCN Commercial |
$2,455.97
|
| Rate for Payer: Cash Price |
$2,542.42
|
| Rate for Payer: Cofinity Commercial |
$2,733.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,542.42
|
| Rate for Payer: Healthscope Commercial |
$2,860.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,383.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,701.32
|
| Rate for Payer: Nomi Health Commercial |
$2,605.98
|
| Rate for Payer: PHP Commercial |
$2,701.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,065.71
|
| Rate for Payer: Priority Health HMO/PPO |
$2,764.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,129.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,796.66
|
| Rate for Payer: UHC Core |
$2,653.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,383.51
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
OP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$637.81 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: Aetna Medicare |
$184.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.46
|
| Rate for Payer: BCBS Complete |
$236.41
|
| Rate for Payer: BCBS MAPPO |
$177.17
|
| Rate for Payer: BCBS Trust/PPO |
$582.61
|
| Rate for Payer: BCN Commercial |
$551.00
|
| Rate for Payer: BCN Medicare Advantage |
$177.17
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.17
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.51
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.03
|
| Rate for Payer: Meridian Medicaid |
$236.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.38
|
| Rate for Payer: Nomi Health Commercial |
$581.12
|
| Rate for Payer: PACE Senior Care Partners |
$168.31
|
| Rate for Payer: PACE SWMI |
$177.17
|
| Rate for Payer: PHP Commercial |
$602.38
|
| Rate for Payer: PHP Medicare Advantage |
$177.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.64
|
| Rate for Payer: Priority Health HMO/PPO |
$616.55
|
| Rate for Payer: Priority Health Medicare |
$178.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.82
|
| Rate for Payer: Railroad Medicare Medicare |
$177.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.64
|
| Rate for Payer: UHC Core |
$591.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.17
|
| Rate for Payer: UHC Exchange |
$177.17
|
| Rate for Payer: UHC Medicare Advantage |
$177.17
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: VA VA |
$177.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.51
|
|
|
HC BRONCHOSPASM PROVOCATION (METHACHOLINE CHALLENGE)
|
Facility
|
IP
|
$708.68
|
|
|
Service Code
|
CPT 94070
|
| Hospital Charge Code |
46000003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$460.64 |
| Max. Negotiated Rate |
$637.81 |
| Rate for Payer: Aetna Commercial |
$602.38
|
| Rate for Payer: BCBS Trust/PPO |
$578.50
|
| Rate for Payer: BCN Commercial |
$547.67
|
| Rate for Payer: Cash Price |
$566.94
|
| Rate for Payer: Cofinity Commercial |
$609.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.94
|
| Rate for Payer: Healthscope Commercial |
$637.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.38
|
| Rate for Payer: Nomi Health Commercial |
$581.12
|
| Rate for Payer: PHP Commercial |
$602.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$460.64
|
| Rate for Payer: Priority Health HMO/PPO |
$616.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$474.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.64
|
| Rate for Payer: UHC Core |
$591.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.51
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.95
|
| Rate for Payer: BCN Commercial |
$56.75
|
| 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: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC BRUCELLA ANTIBODY
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200236
|
|
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 CMPT
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
30200238
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.95
|
| Rate for Payer: BCN Commercial |
$56.75
|
| 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: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
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 |
$16.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.57
|
| 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
|
OP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$26.41 |
| 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 |
$26.41
|
| 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 BUDESONIDE INHALATION SOLUTION
|
Facility
|
IP
|
$29.35
|
|
| Hospital Charge Code |
63700005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$26.41 |
| 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 |
$26.41
|
| 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 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 |
$3,016.03
|
| 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 |
$3,016.03
|
|
|
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 |
$5,760.89 |
| 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 |
$5,760.89
|
| Rate for Payer: BCBS MAPPO |
$1,005.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,305.98
|
| Rate for Payer: BCN Commercial |
$3,126.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.35
|
| 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 |
$1,005.35
|
| Rate for Payer: Healthscope Commercial |
$3,619.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,016.03
|
| Rate for Payer: Mclaren Medicaid |
$5,486.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,055.61
|
| Rate for Payer: Meridian Medicaid |
$5,760.89
|
| 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 |
$1,005.35
|
| Rate for Payer: PHP Commercial |
$3,418.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,486.20
|
| 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 |
$1,005.35
|
| 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 |
$1,005.35
|
| Rate for Payer: UHC Exchange |
$1,005.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,005.35
|
| Rate for Payer: UHCCP Medicaid |
$5,486.20
|
| Rate for Payer: VA VA |
$1,005.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,016.03
|
|
|
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
|
|
