|
HC COCAINE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000127
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.77
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.42
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.69
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.42
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$25.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.42
|
| Rate for Payer: UHC Exchange |
$25.42
|
| Rate for Payer: UHC Medicare Advantage |
$25.42
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC COCCIDIOIDES TOTAL AB BY CF&ID
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200244
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$8.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$8.29
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC COCCIDIOIDES TOTAL AB CMPT
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
30200246
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$8.71
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$8.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$8.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$8.29
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC COCKROACH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COCKROACH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COCONUT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COCONUT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200079
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC CODFISH IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC CODFISH IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200035
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC COGNITIVE EXAM
|
Facility
|
IP
|
$300.90
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$195.58 |
| Max. Negotiated Rate |
$270.81 |
| Rate for Payer: Aetna Commercial |
$255.76
|
| Rate for Payer: BCBS Trust/PPO |
$245.62
|
| Rate for Payer: BCN Commercial |
$232.54
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Healthscope Commercial |
$270.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: PHP Commercial |
$255.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.58
|
| Rate for Payer: Priority Health HMO/PPO |
$261.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.79
|
| Rate for Payer: UHC Core |
$251.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.68
|
|
|
HC COGNITIVE EXAM
|
Facility
|
OP
|
$300.90
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
43400002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$270.81 |
| Rate for Payer: Aetna Commercial |
$255.76
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.03
|
| Rate for Payer: BCBS Complete |
$120.36
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$247.37
|
| Rate for Payer: BCN Commercial |
$233.95
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$240.72
|
| Rate for Payer: Cofinity Commercial |
$258.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Healthscope Commercial |
$270.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.76
|
| Rate for Payer: Nomi Health Commercial |
$246.74
|
| Rate for Payer: PACE Senior Care Partners |
$71.46
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Commercial |
$255.76
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.58
|
| Rate for Payer: Priority Health HMO/PPO |
$261.78
|
| Rate for Payer: Priority Health Medicare |
$75.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.60
|
| Rate for Payer: Railroad Medicare Medicare |
$75.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.79
|
| Rate for Payer: UHC Core |
$251.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Exchange |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
| Rate for Payer: VA VA |
$75.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.68
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
IP
|
$113.49
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.77 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: BCBS Trust/PPO |
$92.64
|
| Rate for Payer: BCN Commercial |
$87.71
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$97.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$102.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.47
|
| Rate for Payer: Nomi Health Commercial |
$93.06
|
| Rate for Payer: PHP Commercial |
$96.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.77
|
| Rate for Payer: Priority Health HMO/PPO |
$98.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.87
|
| Rate for Payer: UHC Core |
$94.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.12
|
|
|
HC COGNITIVE FUNCTION, ADDL 15 MIN
|
Facility
|
OP
|
$113.49
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
43000023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.47
|
| Rate for Payer: BCBS Complete |
$45.40
|
| Rate for Payer: BCBS MAPPO |
$28.37
|
| Rate for Payer: BCBS Trust/PPO |
$93.30
|
| Rate for Payer: BCN Commercial |
$88.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.37
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$97.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.37
|
| Rate for Payer: Healthscope Commercial |
$102.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.47
|
| Rate for Payer: Nomi Health Commercial |
$93.06
|
| Rate for Payer: PACE Senior Care Partners |
$26.95
|
| Rate for Payer: PACE SWMI |
$28.37
|
| Rate for Payer: PHP Commercial |
$96.47
|
| Rate for Payer: PHP Medicare Advantage |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.77
|
| Rate for Payer: Priority Health HMO/PPO |
$98.74
|
| Rate for Payer: Priority Health Medicare |
$28.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.04
|
| Rate for Payer: Railroad Medicare Medicare |
$28.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.87
|
| Rate for Payer: UHC Core |
$94.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.37
|
| Rate for Payer: UHC Exchange |
$28.37
|
| Rate for Payer: UHC Medicare Advantage |
$28.37
|
| Rate for Payer: VA VA |
$28.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.12
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
IP
|
$115.76
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$104.18 |
| Rate for Payer: Aetna Commercial |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$94.49
|
| Rate for Payer: BCN Commercial |
$89.46
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Commercial |
$99.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Healthscope Commercial |
$104.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Nomi Health Commercial |
$94.92
|
| Rate for Payer: PHP Commercial |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.24
|
| Rate for Payer: Priority Health HMO/PPO |
$100.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.87
|
| Rate for Payer: UHC Core |
$96.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.82
|
|
|
HC COGNITIVE FUNCTION, INITIAL 15 MIN
|
Facility
|
OP
|
$115.76
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$104.18 |
| Rate for Payer: Aetna Commercial |
$98.40
|
| Rate for Payer: Aetna Medicare |
$30.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.18
|
| Rate for Payer: BCBS Complete |
$46.30
|
| Rate for Payer: BCBS MAPPO |
$28.94
|
| Rate for Payer: BCBS Trust/PPO |
$95.17
|
| Rate for Payer: BCN Commercial |
$90.00
|
| Rate for Payer: BCN Medicare Advantage |
$28.94
|
| Rate for Payer: Cash Price |
$92.61
|
| Rate for Payer: Cofinity Commercial |
$99.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$104.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.40
|
| Rate for Payer: Nomi Health Commercial |
$94.92
|
| Rate for Payer: PACE Senior Care Partners |
$27.49
|
| Rate for Payer: PACE SWMI |
$28.94
|
| Rate for Payer: PHP Commercial |
$98.40
|
| Rate for Payer: PHP Medicare Advantage |
$28.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.24
|
| Rate for Payer: Priority Health HMO/PPO |
$100.71
|
| Rate for Payer: Priority Health Medicare |
$29.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.56
|
| Rate for Payer: Railroad Medicare Medicare |
$28.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.87
|
| Rate for Payer: UHC Core |
$96.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.94
|
| Rate for Payer: UHC Exchange |
$28.94
|
| Rate for Payer: UHC Medicare Advantage |
$28.94
|
| Rate for Payer: VA VA |
$28.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.82
|
|
|
HC COLD AGGLUTININS
|
Facility
|
IP
|
$61.51
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.98 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Aetna Commercial |
$52.28
|
| Rate for Payer: BCBS Trust/PPO |
$50.21
|
| Rate for Payer: BCN Commercial |
$47.53
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$52.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.21
|
| Rate for Payer: Healthscope Commercial |
$55.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.28
|
| Rate for Payer: Nomi Health Commercial |
$50.44
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health HMO/PPO |
$53.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.13
|
| Rate for Payer: UHC Core |
$51.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.13
|
|
|
HC COLD AGGLUTININS
|
Facility
|
OP
|
$61.51
|
|
|
Service Code
|
CPT 86156
|
| Hospital Charge Code |
30200149
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$55.36 |
| Rate for Payer: Aetna Commercial |
$52.28
|
| Rate for Payer: Aetna Medicare |
$15.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.22
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS MAPPO |
$15.38
|
| Rate for Payer: BCBS Trust/PPO |
$50.57
|
| Rate for Payer: BCN Commercial |
$47.82
|
| Rate for Payer: BCN Medicare Advantage |
$15.38
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cash Price |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$52.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.38
|
| Rate for Payer: Healthscope Commercial |
$55.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.13
|
| Rate for Payer: Mclaren Medicaid |
$5.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.15
|
| Rate for Payer: Meridian Medicaid |
$6.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.28
|
| Rate for Payer: Nomi Health Commercial |
$50.44
|
| Rate for Payer: PACE Senior Care Partners |
$14.61
|
| Rate for Payer: PACE SWMI |
$15.38
|
| Rate for Payer: PHP Commercial |
$52.28
|
| Rate for Payer: PHP Medicare Advantage |
$15.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.98
|
| Rate for Payer: Priority Health HMO/PPO |
$53.51
|
| Rate for Payer: Priority Health Medicare |
$15.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.21
|
| Rate for Payer: Railroad Medicare Medicare |
$15.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.13
|
| Rate for Payer: UHC Core |
$51.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.38
|
| Rate for Payer: UHC Exchange |
$15.38
|
| Rate for Payer: UHC Medicare Advantage |
$15.38
|
| Rate for Payer: UHCCP Medicaid |
$5.83
|
| Rate for Payer: VA VA |
$15.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.13
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
OP
|
$545.16
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Aetna Medicare |
$141.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.36
|
| Rate for Payer: BCBS Complete |
$218.06
|
| Rate for Payer: BCBS MAPPO |
$136.29
|
| Rate for Payer: BCBS Trust/PPO |
$448.18
|
| Rate for Payer: BCN Commercial |
$423.86
|
| Rate for Payer: BCN Medicare Advantage |
$136.29
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.29
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: PACE Senior Care Partners |
$129.48
|
| Rate for Payer: PACE SWMI |
$136.29
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: PHP Medicare Advantage |
$136.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.35
|
| Rate for Payer: Priority Health HMO/PPO |
$474.29
|
| Rate for Payer: Priority Health Medicare |
$137.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.26
|
| Rate for Payer: Railroad Medicare Medicare |
$136.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.74
|
| Rate for Payer: UHC Core |
$455.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.29
|
| Rate for Payer: UHC Exchange |
$136.29
|
| Rate for Payer: UHC Medicare Advantage |
$136.29
|
| Rate for Payer: VA VA |
$136.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.87
|
|
|
HC COLD SNARE POLYPECTOMY
|
Facility
|
IP
|
$545.16
|
|
| Hospital Charge Code |
36000018
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$354.35 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: BCBS Trust/PPO |
$445.01
|
| Rate for Payer: BCN Commercial |
$421.30
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.35
|
| Rate for Payer: Priority Health HMO/PPO |
$474.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.74
|
| Rate for Payer: UHC Core |
$455.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.87
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
IP
|
$1,880.98
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,222.64 |
| Max. Negotiated Rate |
$1,692.88 |
| Rate for Payer: Aetna Commercial |
$1,598.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.44
|
| Rate for Payer: BCN Commercial |
$1,453.62
|
| Rate for Payer: Cash Price |
$1,504.78
|
| Rate for Payer: Cofinity Commercial |
$1,617.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.78
|
| Rate for Payer: Healthscope Commercial |
$1,692.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,410.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.83
|
| Rate for Payer: Nomi Health Commercial |
$1,542.40
|
| Rate for Payer: PHP Commercial |
$1,598.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,636.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,260.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,655.26
|
| Rate for Payer: UHC Core |
$1,570.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,410.74
|
|
|
HC COLLAGEN IMPLANT
|
Facility
|
OP
|
$1,880.98
|
|
|
Service Code
|
HCPCS L8603
|
| Hospital Charge Code |
27800005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.73 |
| Max. Negotiated Rate |
$1,692.88 |
| Rate for Payer: Aetna Commercial |
$1,598.83
|
| Rate for Payer: Aetna Medicare |
$489.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$587.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$587.81
|
| Rate for Payer: BCBS Complete |
$752.39
|
| Rate for Payer: BCBS MAPPO |
$470.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.35
|
| Rate for Payer: BCN Commercial |
$1,462.46
|
| Rate for Payer: BCN Medicare Advantage |
$470.24
|
| Rate for Payer: Cash Price |
$1,504.78
|
| Rate for Payer: Cofinity Commercial |
$1,617.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,504.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.24
|
| Rate for Payer: Healthscope Commercial |
$1,692.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,410.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$540.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.83
|
| Rate for Payer: Nomi Health Commercial |
$1,542.40
|
| Rate for Payer: PACE Senior Care Partners |
$446.73
|
| Rate for Payer: PACE SWMI |
$470.24
|
| Rate for Payer: PHP Commercial |
$1,598.83
|
| Rate for Payer: PHP Medicare Advantage |
$470.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.64
|
| Rate for Payer: Priority Health HMO/PPO |
$1,636.45
|
| Rate for Payer: Priority Health Medicare |
$474.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,260.26
|
| Rate for Payer: Railroad Medicare Medicare |
$470.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,655.26
|
| Rate for Payer: UHC Core |
$1,570.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.24
|
| Rate for Payer: UHC Exchange |
$470.24
|
| Rate for Payer: UHC Medicare Advantage |
$470.24
|
| Rate for Payer: VA VA |
$470.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,410.74
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
IP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Aetna Commercial |
$7.43
|
| Rate for Payer: BCBS Trust/PPO |
$7.13
|
| Rate for Payer: BCN Commercial |
$6.75
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$7.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health HMO/PPO |
$7.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.69
|
| Rate for Payer: UHC Core |
$7.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.56
|
|
|
HC COLL CAPILLARY BLOOD SPECIMEN
|
Facility
|
OP
|
$8.74
|
|
|
Service Code
|
CPT 36416
|
| Hospital Charge Code |
30000077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$7.87 |
| Rate for Payer: Aetna Commercial |
$7.43
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.73
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: BCBS MAPPO |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: BCN Medicare Advantage |
$2.18
|
| Rate for Payer: Cash Price |
$6.99
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$7.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.43
|
| Rate for Payer: Nomi Health Commercial |
$7.17
|
| Rate for Payer: PACE Senior Care Partners |
$2.08
|
| Rate for Payer: PACE SWMI |
$2.18
|
| Rate for Payer: PHP Commercial |
$7.43
|
| Rate for Payer: PHP Medicare Advantage |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health HMO/PPO |
$7.60
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.69
|
| Rate for Payer: UHC Core |
$7.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.18
|
| Rate for Payer: UHC Exchange |
$2.18
|
| Rate for Payer: UHC Medicare Advantage |
$2.18
|
| Rate for Payer: VA VA |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.56
|
|
