|
HC HEM/ONC CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$96.60
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEM/ONC CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500007
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$97.19
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$97.19
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.25
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.24
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.25
|
| Rate for Payer: UHC Medicare Advantage |
$32.19
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEM/ONC CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
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 HEM/ONC CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500005
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$349.88
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| 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: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| 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 Medicare |
$112.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$115.88
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEM/ONC CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEM/ONC CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500008
|
|
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 HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.10 |
| Max. Negotiated Rate |
$1,025.72 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: BCBS Trust/PPO |
$880.75
|
| Rate for Payer: BCN Commercial |
$880.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$991.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,002.93
|
| Rate for Payer: UHC Core |
$951.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.77
|
|
|
HC HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
76100187
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.68 |
| Max. Negotiated Rate |
$1,025.72 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: Aetna Medicare |
$296.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.15
|
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: BCBS MAPPO |
$284.92
|
| Rate for Payer: BCBS Trust/PPO |
$886.11
|
| Rate for Payer: BCN Commercial |
$886.11
|
| Rate for Payer: BCN Medicare Advantage |
$284.92
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.92
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.77
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Senior Care Partners |
$270.68
|
| Rate for Payer: PACE SWMI |
$284.92
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: PHP Medicare Advantage |
$284.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$991.53
|
| Rate for Payer: Priority Health Medicare |
$284.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.10
|
| Rate for Payer: Railroad Medicare Medicare |
$284.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,002.93
|
| Rate for Payer: UHC Core |
$951.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.92
|
| Rate for Payer: UHC Medicare Advantage |
$293.47
|
| Rate for Payer: VA VA |
$284.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.77
|
|
|
HC HEMOSIDERIN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.19
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS MAPPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Medicare Advantage |
$5.75
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.75
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Meridian Medicaid |
$3.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PACE Senior Care Partners |
$5.46
|
| Rate for Payer: PACE SWMI |
$5.75
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health Medicare |
$5.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.03
|
| Rate for Payer: Railroad Medicare Medicare |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$19.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$5.92
|
| Rate for Payer: VA VA |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
HC HEMOSIDERIN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
30100241
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$19.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
OP
|
$476.74
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$429.07 |
| Rate for Payer: Aetna Commercial |
$405.23
|
| Rate for Payer: Aetna Medicare |
$123.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.98
|
| Rate for Payer: BCBS Complete |
$190.70
|
| Rate for Payer: BCBS MAPPO |
$119.18
|
| Rate for Payer: BCBS Trust/PPO |
$370.67
|
| Rate for Payer: BCN Commercial |
$370.67
|
| Rate for Payer: BCN Medicare Advantage |
$119.18
|
| Rate for Payer: Cash Price |
$381.39
|
| Rate for Payer: Cofinity Commercial |
$410.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.18
|
| Rate for Payer: Healthscope Commercial |
$429.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.23
|
| Rate for Payer: PACE Senior Care Partners |
$113.23
|
| Rate for Payer: PACE SWMI |
$119.18
|
| Rate for Payer: PHP Commercial |
$405.23
|
| Rate for Payer: PHP Medicare Advantage |
$119.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.76
|
| Rate for Payer: Priority Health Medicare |
$119.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.76
|
| Rate for Payer: Railroad Medicare Medicare |
$119.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.53
|
| Rate for Payer: UHC Core |
$398.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.18
|
| Rate for Payer: UHC Medicare Advantage |
$122.76
|
| Rate for Payer: VA VA |
$119.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.56
|
|
|
HC HEMOSTASIS PATCH
|
Facility
|
IP
|
$476.74
|
|
| Hospital Charge Code |
27200153
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$290.76 |
| Max. Negotiated Rate |
$429.07 |
| Rate for Payer: Aetna Commercial |
$405.23
|
| Rate for Payer: BCBS Trust/PPO |
$368.42
|
| Rate for Payer: BCN Commercial |
$368.42
|
| Rate for Payer: Cash Price |
$381.39
|
| Rate for Payer: Cofinity Commercial |
$410.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.39
|
| Rate for Payer: Healthscope Commercial |
$429.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.23
|
| Rate for Payer: PHP Commercial |
$405.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.53
|
| Rate for Payer: UHC Core |
$398.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.56
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,267.23 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,139.89
|
| Rate for Payer: BCN Commercial |
$4,139.89
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,017.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,553.45
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,749.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,660.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,267.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,714.16
|
| Rate for Payer: UHC Core |
$4,473.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,017.75
|
|
|
HC HEMOSTATIC AGENT GI TOPICAL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1052
|
| Hospital Charge Code |
27800146
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.29 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna Commercial |
$4,553.45
|
| Rate for Payer: Aetna Medicare |
$1,392.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,674.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,674.06
|
| Rate for Payer: BCBS Complete |
$2,142.80
|
| Rate for Payer: BCBS MAPPO |
$1,339.25
|
| Rate for Payer: BCBS Trust/PPO |
$4,165.07
|
| Rate for Payer: BCN Commercial |
$4,165.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,339.25
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Cofinity Commercial |
$4,607.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,285.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,339.25
|
| Rate for Payer: Healthscope Commercial |
$4,821.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,017.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,406.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,540.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,553.45
|
| Rate for Payer: PACE Senior Care Partners |
$1,272.29
|
| Rate for Payer: PACE SWMI |
$1,339.25
|
| Rate for Payer: PHP Commercial |
$4,553.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,339.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,749.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,660.59
|
| Rate for Payer: Priority Health Medicare |
$1,339.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,267.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,339.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,714.16
|
| Rate for Payer: UHC Core |
$4,473.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,339.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,379.43
|
| Rate for Payer: VA VA |
$1,339.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,017.75
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$118.96
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC HEP A & HEP B VACC ADULT IM
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
63600193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.31 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$118.24
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.05
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC HEPARIN ANTI-XA
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
30500083
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$9.66
|
| Rate for Payer: Meridian Medicaid |
$10.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
IP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$27.69 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: BCBS Trust/PPO |
$35.09
|
| Rate for Payer: BCN Commercial |
$35.09
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.95
|
| Rate for Payer: UHC Core |
$37.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.05
|
|
|
HC HEPARIN NEUTRALIZATION
|
Facility
|
OP
|
$45.40
|
|
|
Service Code
|
CPT 85525
|
| Hospital Charge Code |
30500050
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: Aetna Commercial |
$38.59
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.19
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS MAPPO |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$35.30
|
| Rate for Payer: BCN Commercial |
$35.30
|
| Rate for Payer: BCN Medicare Advantage |
$11.35
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cash Price |
$36.32
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.35
|
| Rate for Payer: Healthscope Commercial |
$40.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.05
|
| Rate for Payer: Mclaren Medicaid |
$8.74
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.59
|
| Rate for Payer: PACE Senior Care Partners |
$10.78
|
| Rate for Payer: PACE SWMI |
$11.35
|
| Rate for Payer: PHP Commercial |
$38.59
|
| Rate for Payer: PHP Medicare Advantage |
$11.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.50
|
| Rate for Payer: Priority Health Medicare |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.95
|
| Rate for Payer: UHC Core |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.35
|
| Rate for Payer: UHC Medicare Advantage |
$11.69
|
| Rate for Payer: VA VA |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.05
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$146.19 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: BCBS Trust/PPO |
$185.24
|
| Rate for Payer: BCN Commercial |
$185.24
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
HC HEPARIN PF4 AB HIT
|
Facility
|
OP
|
$239.70
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200392
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna Medicare |
$62.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.91
|
| Rate for Payer: BCBS Complete |
$14.23
|
| Rate for Payer: BCBS MAPPO |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$186.37
|
| Rate for Payer: BCN Commercial |
$186.37
|
| Rate for Payer: BCN Medicare Advantage |
$59.92
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.92
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Mclaren Medicaid |
$13.56
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PACE Senior Care Partners |
$56.93
|
| Rate for Payer: PACE SWMI |
$59.92
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: PHP Medicare Advantage |
$59.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.54
|
| Rate for Payer: Priority Health Medicare |
$59.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.19
|
| Rate for Payer: Railroad Medicare Medicare |
$59.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.94
|
| Rate for Payer: UHC Core |
$200.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.92
|
| Rate for Payer: UHC Medicare Advantage |
$61.72
|
| Rate for Payer: VA VA |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
30100018
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$6.03
|
| Rate for Payer: Meridian Medicaid |
$6.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC HEPATIC VENOGRAPHY WO HEMODYNAMIC EVAL
|
Facility
|
OP
|
$3,481.61
|
|
|
Service Code
|
CPT 75891
|
| Hospital Charge Code |
32000323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$826.88 |
| Max. Negotiated Rate |
$3,133.45 |
| Rate for Payer: Aetna Commercial |
$2,959.37
|
| Rate for Payer: Aetna Medicare |
$905.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,088.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,088.00
|
| Rate for Payer: BCBS Complete |
$2,195.52
|
| Rate for Payer: BCBS MAPPO |
$870.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,706.95
|
| Rate for Payer: BCN Commercial |
$2,706.95
|
| Rate for Payer: BCN Medicare Advantage |
$870.40
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cash Price |
$2,785.29
|
| Rate for Payer: Cofinity Commercial |
$2,994.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,785.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.40
|
| Rate for Payer: Healthscope Commercial |
$3,133.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,611.21
|
| Rate for Payer: Mclaren Medicaid |
$2,090.97
|
| Rate for Payer: Meridian Medicaid |
$2,195.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$913.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,000.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,959.37
|
| Rate for Payer: PACE Senior Care Partners |
$826.88
|
| Rate for Payer: PACE SWMI |
$870.40
|
| Rate for Payer: PHP Commercial |
$2,959.37
|
| Rate for Payer: PHP Medicare Advantage |
$870.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,090.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,437.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,029.00
|
| Rate for Payer: Priority Health Medicare |
$870.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,123.43
|
| Rate for Payer: Railroad Medicare Medicare |
$870.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,063.82
|
| Rate for Payer: UHC Core |
$2,907.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.40
|
| Rate for Payer: UHC Medicare Advantage |
$896.51
|
| Rate for Payer: VA VA |
$870.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,611.21
|
|
