|
HC DRAINAGE SOFT TISSUE W IMAGE GUIDANCE
|
Facility
|
IP
|
$3,238.15
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
36100422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,253.75 |
| Max. Negotiated Rate |
$2,914.34 |
| Rate for Payer: Aetna Commercial |
$2,752.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.39
|
| Rate for Payer: BCN Commercial |
$2,674.39
|
| Rate for Payer: Cash Price |
$2,590.52
|
| Rate for Payer: Cofinity Commercial |
$2,784.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,590.52
|
| Rate for Payer: Healthscope Commercial |
$2,914.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,428.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,752.43
|
| Rate for Payer: Nomi Health Commercial |
$2,655.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,428.61
|
| Rate for Payer: PHP Commercial |
$2,752.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,817.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,253.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,849.57
|
| Rate for Payer: UHC Core |
$2,703.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,428.61
|
|
|
HC DRAINAGE TENDON SHEATH DIGIT AND/OR PALM EACH
|
Facility
|
OP
|
$9,998.00
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$8,998.20 |
| Rate for Payer: Aetna Commercial |
$8,498.30
|
| Rate for Payer: Aetna Medicare |
$2,599.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,124.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,124.38
|
| Rate for Payer: BCBS Complete |
$1,850.63
|
| Rate for Payer: BCBS MAPPO |
$2,499.50
|
| Rate for Payer: BCBS Trust/PPO |
$8,219.36
|
| Rate for Payer: BCN Commercial |
$8,219.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,499.50
|
| Rate for Payer: Cash Price |
$7,998.40
|
| Rate for Payer: Cash Price |
$7,998.40
|
| Rate for Payer: Cofinity Commercial |
$8,598.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,998.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,499.50
|
| Rate for Payer: Healthscope Commercial |
$8,998.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,498.50
|
| Rate for Payer: Mclaren Medicaid |
$1,762.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,624.47
|
| Rate for Payer: Meridian Medicaid |
$1,850.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,874.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,749.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,498.30
|
| Rate for Payer: Nomi Health Commercial |
$8,198.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,498.50
|
| Rate for Payer: PACE Senior Care Partners |
$2,374.53
|
| Rate for Payer: PACE SWMI |
$2,499.50
|
| Rate for Payer: PHP Commercial |
$8,498.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,499.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,762.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,698.26
|
| Rate for Payer: Priority Health Medicare |
$2,524.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,958.61
|
| Rate for Payer: Railroad Medicare Medicare |
$2,499.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,798.24
|
| Rate for Payer: UHC Core |
$8,348.33
|
| Rate for Payer: UHC Exchange |
$2,499.50
|
| Rate for Payer: UHC Medicaid |
$1,762.65
|
| Rate for Payer: UHC Medicare Advantage |
$2,499.50
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$2,499.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,498.50
|
|
|
HC DRAINAGE TENDON SHEATH DIGIT AND/OR PALM EACH
|
Facility
|
IP
|
$9,998.00
|
|
|
Service Code
|
CPT 26020
|
| Hospital Charge Code |
45000107
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,958.61 |
| Max. Negotiated Rate |
$8,998.20 |
| Rate for Payer: Aetna Commercial |
$8,498.30
|
| Rate for Payer: BCBS Trust/PPO |
$8,257.35
|
| Rate for Payer: BCN Commercial |
$8,257.35
|
| Rate for Payer: Cash Price |
$7,998.40
|
| Rate for Payer: Cofinity Commercial |
$8,598.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,998.40
|
| Rate for Payer: Healthscope Commercial |
$8,998.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,498.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,498.30
|
| Rate for Payer: Nomi Health Commercial |
$8,198.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,498.50
|
| Rate for Payer: PHP Commercial |
$8,498.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,698.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,958.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,798.24
|
| Rate for Payer: UHC Core |
$8,348.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,498.50
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
OP
|
$4,145.71
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$730.89 |
| Max. Negotiated Rate |
$3,731.14 |
| Rate for Payer: Aetna Commercial |
$3,523.85
|
| Rate for Payer: Aetna Medicare |
$1,077.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,295.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,295.53
|
| Rate for Payer: BCBS Complete |
$767.37
|
| Rate for Payer: BCBS MAPPO |
$1,036.43
|
| Rate for Payer: BCBS Trust/PPO |
$3,408.19
|
| Rate for Payer: BCN Commercial |
$3,408.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,036.43
|
| Rate for Payer: Cash Price |
$3,316.57
|
| Rate for Payer: Cofinity Commercial |
$3,565.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,316.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,036.43
|
| Rate for Payer: Healthscope Commercial |
$3,731.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,109.28
|
| Rate for Payer: Mclaren Medicaid |
$730.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,088.25
|
| Rate for Payer: Meridian Medicaid |
$767.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,191.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,140.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,523.85
|
| Rate for Payer: Nomi Health Commercial |
$3,399.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,109.28
|
| Rate for Payer: PACE Senior Care Partners |
$984.61
|
| Rate for Payer: PACE SWMI |
$1,036.43
|
| Rate for Payer: PHP Commercial |
$3,523.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,036.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$730.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,606.77
|
| Rate for Payer: Priority Health Medicare |
$1,046.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,885.41
|
| Rate for Payer: Railroad Medicare Medicare |
$1,036.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,648.22
|
| Rate for Payer: UHC Core |
$3,461.67
|
| Rate for Payer: UHC Exchange |
$1,036.43
|
| Rate for Payer: UHC Medicaid |
$730.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,036.43
|
| Rate for Payer: UHCCP Medicaid |
$730.89
|
| Rate for Payer: VA VA |
$1,036.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,109.28
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
IP
|
$4,145.71
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,885.41 |
| Max. Negotiated Rate |
$3,731.14 |
| Rate for Payer: Aetna Commercial |
$3,523.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,423.94
|
| Rate for Payer: BCN Commercial |
$3,423.94
|
| Rate for Payer: Cash Price |
$3,316.57
|
| Rate for Payer: Cofinity Commercial |
$3,565.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,316.57
|
| Rate for Payer: Healthscope Commercial |
$3,731.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,109.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,523.85
|
| Rate for Payer: Nomi Health Commercial |
$3,399.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,109.28
|
| Rate for Payer: PHP Commercial |
$3,523.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,606.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,885.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,648.22
|
| Rate for Payer: UHC Core |
$3,461.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,109.28
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
OP
|
$4,176.90
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.39 |
| Max. Negotiated Rate |
$3,759.21 |
| Rate for Payer: Aetna Commercial |
$3,550.36
|
| Rate for Payer: Aetna Commercial |
$5,325.55
|
| Rate for Payer: Aetna Medicare |
$1,628.99
|
| Rate for Payer: Aetna Medicare |
$1,085.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,957.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,305.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,305.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,957.92
|
| Rate for Payer: BCBS Complete |
$773.14
|
| Rate for Payer: BCBS Complete |
$1,159.72
|
| Rate for Payer: BCBS MAPPO |
$1,044.22
|
| Rate for Payer: BCBS MAPPO |
$1,566.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,433.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,150.74
|
| Rate for Payer: BCN Commercial |
$5,150.74
|
| Rate for Payer: BCN Commercial |
$3,433.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,566.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,044.22
|
| Rate for Payer: Cash Price |
$3,341.52
|
| Rate for Payer: Cash Price |
$5,012.28
|
| Rate for Payer: Cofinity Commercial |
$3,592.13
|
| Rate for Payer: Cofinity Commercial |
$5,388.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,012.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,341.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,566.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,044.22
|
| Rate for Payer: Healthscope Commercial |
$3,759.21
|
| Rate for Payer: Healthscope Commercial |
$5,638.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,699.01
|
| Rate for Payer: Mclaren Medicaid |
$1,104.58
|
| Rate for Payer: Mclaren Medicaid |
$736.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,644.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,096.44
|
| Rate for Payer: Meridian Medicaid |
$773.14
|
| Rate for Payer: Meridian Medicaid |
$1,159.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,801.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,200.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,722.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,148.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,325.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,550.36
|
| Rate for Payer: Nomi Health Commercial |
$5,137.59
|
| Rate for Payer: Nomi Health Commercial |
$3,425.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,132.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,699.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,488.02
|
| Rate for Payer: PACE Senior Care Partners |
$992.01
|
| Rate for Payer: PACE SWMI |
$1,566.34
|
| Rate for Payer: PACE SWMI |
$1,044.22
|
| Rate for Payer: PHP Commercial |
$3,550.36
|
| Rate for Payer: PHP Commercial |
$5,325.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,044.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,566.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,104.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,450.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,633.90
|
| Rate for Payer: Priority Health Medicare |
$1,582.00
|
| Rate for Payer: Priority Health Medicare |
$1,054.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,907.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,360.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,044.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,566.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,675.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,513.51
|
| Rate for Payer: UHC Core |
$5,231.57
|
| Rate for Payer: UHC Core |
$3,487.71
|
| Rate for Payer: UHC Exchange |
$1,566.34
|
| Rate for Payer: UHC Exchange |
$1,044.22
|
| Rate for Payer: UHC Medicaid |
$1,104.58
|
| Rate for Payer: UHC Medicaid |
$736.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,044.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,566.34
|
| Rate for Payer: UHCCP Medicaid |
$736.39
|
| Rate for Payer: UHCCP Medicaid |
$1,104.58
|
| Rate for Payer: VA VA |
$1,044.22
|
| Rate for Payer: VA VA |
$1,566.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,699.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,132.68
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
IP
|
$4,176.90
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,907.12 |
| Max. Negotiated Rate |
$3,759.21 |
| Rate for Payer: Aetna Commercial |
$3,550.36
|
| Rate for Payer: Aetna Commercial |
$5,325.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,449.70
|
| Rate for Payer: BCBS Trust/PPO |
$5,174.55
|
| Rate for Payer: BCN Commercial |
$3,449.70
|
| Rate for Payer: BCN Commercial |
$5,174.55
|
| Rate for Payer: Cash Price |
$3,341.52
|
| Rate for Payer: Cash Price |
$5,012.28
|
| Rate for Payer: Cofinity Commercial |
$5,388.20
|
| Rate for Payer: Cofinity Commercial |
$3,592.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,012.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,341.52
|
| Rate for Payer: Healthscope Commercial |
$3,759.21
|
| Rate for Payer: Healthscope Commercial |
$5,638.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,132.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,699.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,550.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,325.55
|
| Rate for Payer: Nomi Health Commercial |
$3,425.06
|
| Rate for Payer: Nomi Health Commercial |
$5,137.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,132.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,699.01
|
| Rate for Payer: PHP Commercial |
$5,325.55
|
| Rate for Payer: PHP Commercial |
$3,550.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,450.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,633.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,907.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,360.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,675.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,513.51
|
| Rate for Payer: UHC Core |
$3,487.71
|
| Rate for Payer: UHC Core |
$5,231.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,132.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,699.01
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
IP
|
$1,485.16
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,033.67 |
| Max. Negotiated Rate |
$1,336.64 |
| Rate for Payer: Aetna Commercial |
$1,262.39
|
| Rate for Payer: Aetna Commercial |
$841.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,226.59
|
| Rate for Payer: BCBS Trust/PPO |
$817.72
|
| Rate for Payer: BCN Commercial |
$1,226.59
|
| Rate for Payer: BCN Commercial |
$817.72
|
| Rate for Payer: Cash Price |
$1,188.13
|
| Rate for Payer: Cash Price |
$792.08
|
| Rate for Payer: Cofinity Commercial |
$851.49
|
| Rate for Payer: Cofinity Commercial |
$1,277.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.13
|
| Rate for Payer: Healthscope Commercial |
$1,336.64
|
| Rate for Payer: Healthscope Commercial |
$891.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.59
|
| Rate for Payer: Nomi Health Commercial |
$1,217.83
|
| Rate for Payer: Nomi Health Commercial |
$811.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.58
|
| Rate for Payer: PHP Commercial |
$841.59
|
| Rate for Payer: PHP Commercial |
$1,262.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$861.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,292.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.29
|
| Rate for Payer: UHC Core |
$1,240.11
|
| Rate for Payer: UHC Core |
$826.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.58
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
OP
|
$1,485.16
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.83 |
| Max. Negotiated Rate |
$1,336.64 |
| Rate for Payer: Aetna Commercial |
$1,262.39
|
| Rate for Payer: Aetna Commercial |
$841.59
|
| Rate for Payer: Aetna Medicare |
$257.43
|
| Rate for Payer: Aetna Medicare |
$386.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$464.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$464.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.41
|
| Rate for Payer: BCBS Complete |
$274.90
|
| Rate for Payer: BCBS Complete |
$183.27
|
| Rate for Payer: BCBS MAPPO |
$371.29
|
| Rate for Payer: BCBS MAPPO |
$247.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.95
|
| Rate for Payer: BCBS Trust/PPO |
$813.96
|
| Rate for Payer: BCN Commercial |
$813.96
|
| Rate for Payer: BCN Commercial |
$1,220.95
|
| Rate for Payer: BCN Medicare Advantage |
$247.53
|
| Rate for Payer: BCN Medicare Advantage |
$371.29
|
| Rate for Payer: Cash Price |
$1,188.13
|
| Rate for Payer: Cash Price |
$792.08
|
| Rate for Payer: Cofinity Commercial |
$1,277.24
|
| Rate for Payer: Cofinity Commercial |
$851.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,188.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.29
|
| Rate for Payer: Healthscope Commercial |
$1,336.64
|
| Rate for Payer: Healthscope Commercial |
$891.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.58
|
| Rate for Payer: Mclaren Medicaid |
$174.55
|
| Rate for Payer: Mclaren Medicaid |
$261.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.85
|
| Rate for Payer: Meridian Medicaid |
$274.90
|
| Rate for Payer: Meridian Medicaid |
$183.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$272.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$408.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.39
|
| Rate for Payer: Nomi Health Commercial |
$811.88
|
| Rate for Payer: Nomi Health Commercial |
$1,217.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.58
|
| Rate for Payer: PACE Senior Care Partners |
$235.15
|
| Rate for Payer: PACE Senior Care Partners |
$352.73
|
| Rate for Payer: PACE SWMI |
$247.53
|
| Rate for Payer: PACE SWMI |
$371.29
|
| Rate for Payer: PHP Commercial |
$1,262.39
|
| Rate for Payer: PHP Commercial |
$841.59
|
| Rate for Payer: PHP Medicare Advantage |
$371.29
|
| Rate for Payer: PHP Medicare Advantage |
$247.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$861.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,292.09
|
| Rate for Payer: Priority Health Medicare |
$250.00
|
| Rate for Payer: Priority Health Medicare |
$375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.11
|
| Rate for Payer: Railroad Medicare Medicare |
$371.29
|
| Rate for Payer: Railroad Medicare Medicare |
$247.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.29
|
| Rate for Payer: UHC Core |
$826.73
|
| Rate for Payer: UHC Core |
$1,240.11
|
| Rate for Payer: UHC Exchange |
$247.53
|
| Rate for Payer: UHC Exchange |
$371.29
|
| Rate for Payer: UHC Medicaid |
$174.55
|
| Rate for Payer: UHC Medicaid |
$261.83
|
| Rate for Payer: UHC Medicare Advantage |
$371.29
|
| Rate for Payer: UHC Medicare Advantage |
$247.53
|
| Rate for Payer: UHCCP Medicaid |
$261.83
|
| Rate for Payer: UHCCP Medicaid |
$174.55
|
| Rate for Payer: VA VA |
$371.29
|
| Rate for Payer: VA VA |
$247.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.87
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
IP
|
$15.92
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$14.33 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCN Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
OP
|
$15.92
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$13.53
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.97
|
| Rate for Payer: BCBS Complete |
$2.95
|
| Rate for Payer: BCBS MAPPO |
$3.98
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$3.98
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: Cash Price |
$12.74
|
| Rate for Payer: City of Battle Creek Police Dept Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.98
|
| Rate for Payer: Healthscope Commercial |
$14.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.94
|
| Rate for Payer: Mclaren Medicaid |
$2.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.18
|
| Rate for Payer: Meridian Medicaid |
$2.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.58
|
| Rate for Payer: Michigan State Police Michigan State Police |
$50.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.53
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.94
|
| Rate for Payer: PACE Senior Care Partners |
$3.78
|
| Rate for Payer: PACE SWMI |
$3.98
|
| Rate for Payer: PHP Commercial |
$13.53
|
| Rate for Payer: PHP Medicare Advantage |
$3.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.85
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.01
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$3.98
|
| Rate for Payer: UHC Medicaid |
$2.81
|
| Rate for Payer: UHC Medicare Advantage |
$3.98
|
| Rate for Payer: UHCCP Medicaid |
$2.81
|
| Rate for Payer: VA VA |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.94
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
IP
|
$377.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$340.03 |
| Rate for Payer: Aetna Commercial |
$321.14
|
| Rate for Payer: BCBS Trust/PPO |
$312.03
|
| Rate for Payer: BCN Commercial |
$312.03
|
| Rate for Payer: Cash Price |
$302.25
|
| Rate for Payer: Cofinity Commercial |
$324.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.25
|
| Rate for Payer: Healthscope Commercial |
$340.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.14
|
| Rate for Payer: Nomi Health Commercial |
$309.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.36
|
| Rate for Payer: PHP Commercial |
$321.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$328.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.47
|
| Rate for Payer: UHC Core |
$315.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.36
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
OP
|
$377.81
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$340.03 |
| Rate for Payer: Aetna Commercial |
$321.14
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.07
|
| Rate for Payer: BCBS Complete |
$69.93
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCBS Trust/PPO |
$310.60
|
| Rate for Payer: BCN Commercial |
$310.60
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$302.25
|
| Rate for Payer: Cofinity Commercial |
$324.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$340.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.36
|
| Rate for Payer: Mclaren Medicaid |
$66.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.18
|
| Rate for Payer: Meridian Medicaid |
$69.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$321.14
|
| Rate for Payer: Nomi Health Commercial |
$309.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.36
|
| Rate for Payer: PACE Senior Care Partners |
$89.73
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$321.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$328.69
|
| Rate for Payer: Priority Health Medicare |
$95.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.96
|
| Rate for Payer: Railroad Medicare Medicare |
$94.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.47
|
| Rate for Payer: UHC Core |
$315.47
|
| Rate for Payer: UHC Exchange |
$94.45
|
| Rate for Payer: UHC Medicaid |
$66.61
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP Medicaid |
$66.61
|
| Rate for Payer: VA VA |
$94.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.36
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
OP
|
$5.75
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.80
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS MAPPO |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.73
|
| Rate for Payer: BCN Medicare Advantage |
$1.44
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$5.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Mclaren Medicaid |
$1.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.51
|
| Rate for Payer: Meridian Medicaid |
$1.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.31
|
| Rate for Payer: PACE Senior Care Partners |
$1.37
|
| Rate for Payer: PACE SWMI |
$1.44
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Medicaid |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$1.44
|
| Rate for Payer: UHCCP Medicaid |
$1.01
|
| Rate for Payer: VA VA |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
IP
|
$5.75
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$4.75
|
| Rate for Payer: BCN Commercial |
$4.75
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.31
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.72
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Mclaren Medicaid |
$4.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: Meridian Medicaid |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PACE Senior Care Partners |
$6.63
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Medicare |
$7.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: UHC Exchange |
$6.97
|
| Rate for Payer: UHC Medicaid |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.97
|
| Rate for Payer: UHCCP Medicaid |
$4.92
|
| Rate for Payer: VA VA |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCN Commercial |
$23.04
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$106.12
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.71 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: Aetna Medicare |
$27.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.16
|
| Rate for Payer: BCBS Complete |
$19.64
|
| Rate for Payer: BCBS MAPPO |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$26.53
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.53
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Mclaren Medicaid |
$18.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.86
|
| Rate for Payer: Meridian Medicaid |
$19.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.20
|
| Rate for Payer: PACE SWMI |
$26.53
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: PHP Medicare Advantage |
$26.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Medicare |
$26.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: Railroad Medicare Medicare |
$26.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: UHC Exchange |
$26.53
|
| Rate for Payer: UHC Medicaid |
$18.71
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: VA VA |
$26.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$106.12
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.86 |
| Max. Negotiated Rate |
$95.51 |
| Rate for Payer: Aetna Commercial |
$90.20
|
| Rate for Payer: BCBS Trust/PPO |
$87.64
|
| Rate for Payer: BCN Commercial |
$87.64
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cofinity Commercial |
$91.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.90
|
| Rate for Payer: Healthscope Commercial |
$95.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.20
|
| Rate for Payer: Nomi Health Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.59
|
| Rate for Payer: PHP Commercial |
$90.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.39
|
| Rate for Payer: UHC Core |
$88.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.59
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.62
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Mclaren Medicaid |
$4.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: Meridian Medicaid |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicaid |
$4.40
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: UHCCP Medicaid |
$4.40
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.73
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.38
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$49.19
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: Aetna Commercial |
$41.81
|
| Rate for Payer: Aetna Medicare |
$12.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.37
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS MAPPO |
$12.30
|
| Rate for Payer: BCBS Trust/PPO |
$40.44
|
| Rate for Payer: BCN Commercial |
$40.44
|
| Rate for Payer: BCN Medicare Advantage |
$12.30
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.89
|
| Rate for Payer: Mclaren Medicaid |
$8.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.91
|
| Rate for Payer: Meridian Medicaid |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.81
|
| Rate for Payer: Nomi Health Commercial |
$40.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.89
|
| Rate for Payer: PACE Senior Care Partners |
$11.68
|
| Rate for Payer: PACE SWMI |
$12.30
|
| Rate for Payer: PHP Commercial |
$41.81
|
| Rate for Payer: PHP Medicare Advantage |
$12.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.80
|
| Rate for Payer: Priority Health Medicare |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.24
|
| Rate for Payer: Railroad Medicare Medicare |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$41.07
|
| Rate for Payer: UHC Exchange |
$12.30
|
| Rate for Payer: UHC Medicaid |
$8.67
|
| Rate for Payer: UHC Medicare Advantage |
$12.30
|
| Rate for Payer: UHCCP Medicaid |
$8.67
|
| Rate for Payer: VA VA |
$12.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.89
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$49.19
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: Aetna Commercial |
$41.81
|
| Rate for Payer: BCBS Trust/PPO |
$40.63
|
| Rate for Payer: BCN Commercial |
$40.63
|
| Rate for Payer: Cash Price |
$39.35
|
| Rate for Payer: Cofinity Commercial |
$42.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.35
|
| Rate for Payer: Healthscope Commercial |
$44.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.81
|
| Rate for Payer: Nomi Health Commercial |
$40.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.89
|
| Rate for Payer: PHP Commercial |
$41.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.29
|
| Rate for Payer: UHC Core |
$41.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.89
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$64.15
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.31
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicaid |
$13.76
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$13.76
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.31 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$64.44
|
| Rate for Payer: BCN Commercial |
$64.44
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
