|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.31
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: BCBS Trust/PPO |
$176.71
|
| Rate for Payer: BCN Commercial |
$176.71
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Healthscope Commercial |
$205.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: PHP Commercial |
$194.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.22
|
| Rate for Payer: UHC Core |
$190.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
OP
|
$228.66
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$205.79 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Aetna Medicare |
$59.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.46
|
| Rate for Payer: BCBS Complete |
$91.46
|
| Rate for Payer: BCBS MAPPO |
$57.16
|
| Rate for Payer: BCBS Trust/PPO |
$177.78
|
| Rate for Payer: BCN Commercial |
$177.78
|
| Rate for Payer: BCN Medicare Advantage |
$57.16
|
| Rate for Payer: Cash Price |
$182.93
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.16
|
| Rate for Payer: Healthscope Commercial |
$205.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.36
|
| Rate for Payer: PACE Senior Care Partners |
$54.31
|
| Rate for Payer: PACE SWMI |
$57.16
|
| Rate for Payer: PHP Commercial |
$194.36
|
| Rate for Payer: PHP Medicare Advantage |
$57.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.93
|
| Rate for Payer: Priority Health Medicare |
$57.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.46
|
| Rate for Payer: Railroad Medicare Medicare |
$57.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.22
|
| Rate for Payer: UHC Core |
$190.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.16
|
| Rate for Payer: UHC Medicare Advantage |
$58.88
|
| Rate for Payer: VA VA |
$57.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Medicare |
$65.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.75
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$195.93
|
| Rate for Payer: BCN Commercial |
$195.93
|
| Rate for Payer: BCN Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.00
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PACE Senior Care Partners |
$59.85
|
| Rate for Payer: PACE SWMI |
$63.00
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: PHP Medicare Advantage |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Medicare |
$63.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| Rate for Payer: Railroad Medicare Medicare |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.00
|
| Rate for Payer: UHC Medicare Advantage |
$64.89
|
| Rate for Payer: VA VA |
$63.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$252.00
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: BCBS Trust/PPO |
$194.75
|
| Rate for Payer: BCN Commercial |
$194.75
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$216.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$226.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: PHP Commercial |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.76
|
| Rate for Payer: UHC Core |
$210.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.00
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.88 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.62
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$163.28
|
| Rate for Payer: BCN Commercial |
$163.28
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: PACE Senior Care Partners |
$49.88
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.70
|
| Rate for Payer: Priority Health Medicare |
$52.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.08
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.50
|
| Rate for Payer: UHC Medicare Advantage |
$54.08
|
| Rate for Payer: VA VA |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$162.29
|
| Rate for Payer: BCN Commercial |
$162.29
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$225.62 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: Aetna Medicare |
$247.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.88
|
| Rate for Payer: BCBS Complete |
$380.00
|
| Rate for Payer: BCBS MAPPO |
$237.50
|
| Rate for Payer: BCBS Trust/PPO |
$738.62
|
| Rate for Payer: BCN Commercial |
$738.62
|
| Rate for Payer: BCN Medicare Advantage |
$237.50
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.50
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PACE Senior Care Partners |
$225.62
|
| Rate for Payer: PACE SWMI |
$237.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: PHP Medicare Advantage |
$237.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.50
|
| Rate for Payer: Priority Health Medicare |
$237.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.40
|
| Rate for Payer: Railroad Medicare Medicare |
$237.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$836.00
|
| Rate for Payer: UHC Core |
$793.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.50
|
| Rate for Payer: UHC Medicare Advantage |
$244.62
|
| Rate for Payer: VA VA |
$237.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$950.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$579.40 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna Commercial |
$807.50
|
| Rate for Payer: BCBS Trust/PPO |
$734.16
|
| Rate for Payer: BCN Commercial |
$734.16
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$760.00
|
| Rate for Payer: Healthscope Commercial |
$855.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$712.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$807.50
|
| Rate for Payer: PHP Commercial |
$807.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$836.00
|
| Rate for Payer: UHC Core |
$793.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$712.50
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$400.66
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: Aetna Medicare |
$104.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.21
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$100.16
|
| Rate for Payer: BCBS Trust/PPO |
$311.51
|
| Rate for Payer: BCN Commercial |
$311.51
|
| Rate for Payer: BCN Medicare Advantage |
$100.16
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.16
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PACE Senior Care Partners |
$95.16
|
| Rate for Payer: PACE SWMI |
$100.16
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: PHP Medicare Advantage |
$100.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.57
|
| Rate for Payer: Priority Health Medicare |
$100.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: Railroad Medicare Medicare |
$100.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.58
|
| Rate for Payer: UHC Core |
$334.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.16
|
| Rate for Payer: UHC Medicare Advantage |
$103.17
|
| Rate for Payer: VA VA |
$100.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$400.66
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.36 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna Commercial |
$340.56
|
| Rate for Payer: BCBS Trust/PPO |
$309.63
|
| Rate for Payer: BCN Commercial |
$309.63
|
| Rate for Payer: Cash Price |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$344.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.53
|
| Rate for Payer: Healthscope Commercial |
$360.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.56
|
| Rate for Payer: PHP Commercial |
$340.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$348.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$244.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.58
|
| Rate for Payer: UHC Core |
$334.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.50
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.96
|
| Rate for Payer: BCN Commercial |
$23.96
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.28
|
| Rate for Payer: UHC Core |
$25.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna Medicare |
$8.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.69
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$24.10
|
| Rate for Payer: BCN Commercial |
$24.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.75
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Mclaren Medicaid |
$1.75
|
| Rate for Payer: Meridian Medicaid |
$1.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PACE Senior Care Partners |
$7.36
|
| Rate for Payer: PACE SWMI |
$7.75
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.97
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.28
|
| Rate for Payer: UHC Core |
$25.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.75
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: VA VA |
$7.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$26.94
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.82
|
| Rate for Payer: BCN Commercial |
$20.82
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.90
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.71
|
| Rate for Payer: UHC Core |
$22.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$26.94
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.42
|
| Rate for Payer: BCBS Complete |
$13.99
|
| Rate for Payer: BCBS MAPPO |
$6.74
|
| Rate for Payer: BCBS Trust/PPO |
$20.95
|
| Rate for Payer: BCN Commercial |
$20.95
|
| Rate for Payer: BCN Medicare Advantage |
$6.74
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$24.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.20
|
| Rate for Payer: Mclaren Medicaid |
$13.33
|
| Rate for Payer: Meridian Medicaid |
$13.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.90
|
| Rate for Payer: PACE Senior Care Partners |
$6.40
|
| Rate for Payer: PACE SWMI |
$6.74
|
| Rate for Payer: PHP Commercial |
$22.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.44
|
| Rate for Payer: Priority Health Medicare |
$6.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.71
|
| Rate for Payer: UHC Core |
$22.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.74
|
| Rate for Payer: UHC Medicare Advantage |
$6.94
|
| Rate for Payer: VA VA |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.20
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: BCBS Trust/PPO |
$73.57
|
| Rate for Payer: BCN Commercial |
$73.57
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.75
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: BCN Medicare Advantage |
$23.80
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Mclaren Medicaid |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Senior Care Partners |
$22.61
|
| Rate for Payer: PACE SWMI |
$23.80
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: PHP Medicare Advantage |
$23.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Medicare |
$23.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: Railroad Medicare Medicare |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.51
|
| Rate for Payer: VA VA |
$23.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$37.74
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: Aetna Medicare |
$9.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.79
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Mclaren Medicaid |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PACE Senior Care Partners |
$8.96
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$37.74
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$33.97 |
| Rate for Payer: Aetna Commercial |
$32.08
|
| Rate for Payer: BCBS Trust/PPO |
$29.17
|
| Rate for Payer: BCN Commercial |
$29.17
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$32.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.19
|
| Rate for Payer: Healthscope Commercial |
$33.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.08
|
| Rate for Payer: PHP Commercial |
$32.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.21
|
| Rate for Payer: UHC Core |
$31.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.30
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: BCBS Trust/PPO |
$73.57
|
| Rate for Payer: BCN Commercial |
$73.57
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$95.20
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$85.68 |
| Rate for Payer: Aetna Commercial |
$80.92
|
| Rate for Payer: Aetna Medicare |
$24.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.75
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS MAPPO |
$23.80
|
| Rate for Payer: BCBS Trust/PPO |
$74.02
|
| Rate for Payer: BCN Commercial |
$74.02
|
| Rate for Payer: BCN Medicare Advantage |
$23.80
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cash Price |
$76.16
|
| Rate for Payer: Cofinity Commercial |
$81.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.80
|
| Rate for Payer: Healthscope Commercial |
$85.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.40
|
| Rate for Payer: Mclaren Medicaid |
$9.50
|
| Rate for Payer: Meridian Medicaid |
$9.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.92
|
| Rate for Payer: PACE Senior Care Partners |
$22.61
|
| Rate for Payer: PACE SWMI |
$23.80
|
| Rate for Payer: PHP Commercial |
$80.92
|
| Rate for Payer: PHP Medicare Advantage |
$23.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.82
|
| Rate for Payer: Priority Health Medicare |
$23.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.06
|
| Rate for Payer: Railroad Medicare Medicare |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.78
|
| Rate for Payer: UHC Core |
$79.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.51
|
| Rate for Payer: VA VA |
$23.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.40
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$233.25
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.25
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$182.97 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$231.84
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
