|
HC INFUSION CATH LVL 4
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$347.76
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$363.10 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$460.09
|
| Rate for Payer: BCN Commercial |
$460.09
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna Medicare |
$154.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.05
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: BCBS MAPPO |
$148.84
|
| Rate for Payer: BCBS Trust/PPO |
$462.88
|
| Rate for Payer: BCN Commercial |
$462.88
|
| Rate for Payer: BCN Medicare Advantage |
$148.84
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.84
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$506.05
|
| Rate for Payer: PACE Senior Care Partners |
$141.40
|
| Rate for Payer: PACE SWMI |
$148.84
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: PHP Medicare Advantage |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.95
|
| Rate for Payer: Priority Health Medicare |
$148.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.10
|
| Rate for Payer: Railroad Medicare Medicare |
$148.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.84
|
| Rate for Payer: UHC Medicare Advantage |
$153.30
|
| Rate for Payer: VA VA |
$148.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.37 |
| Max. Negotiated Rate |
$744.27 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: BCBS Trust/PPO |
$639.08
|
| Rate for Payer: BCN Commercial |
$639.08
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$711.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Healthscope Commercial |
$744.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: PHP Commercial |
$702.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$719.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.73
|
| Rate for Payer: UHC Core |
$690.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.23
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$826.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.41 |
| Max. Negotiated Rate |
$744.27 |
| Rate for Payer: Aetna Commercial |
$702.92
|
| Rate for Payer: Aetna Medicare |
$215.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.43
|
| Rate for Payer: BCBS Complete |
$330.79
|
| Rate for Payer: BCBS MAPPO |
$206.74
|
| Rate for Payer: BCBS Trust/PPO |
$642.97
|
| Rate for Payer: BCN Commercial |
$642.97
|
| Rate for Payer: BCN Medicare Advantage |
$206.74
|
| Rate for Payer: Cash Price |
$661.58
|
| Rate for Payer: Cofinity Commercial |
$711.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.74
|
| Rate for Payer: Healthscope Commercial |
$744.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$217.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$702.92
|
| Rate for Payer: PACE Senior Care Partners |
$196.41
|
| Rate for Payer: PACE SWMI |
$206.74
|
| Rate for Payer: PHP Commercial |
$702.92
|
| Rate for Payer: PHP Medicare Advantage |
$206.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$578.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$719.46
|
| Rate for Payer: Priority Health Medicare |
$206.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$504.37
|
| Rate for Payer: Railroad Medicare Medicare |
$206.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.73
|
| Rate for Payer: UHC Core |
$690.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.74
|
| Rate for Payer: UHC Medicare Advantage |
$212.94
|
| Rate for Payer: VA VA |
$206.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.23
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.18 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: BCBS Trust/PPO |
$170.02
|
| Rate for Payer: BCN Commercial |
$170.02
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.60
|
| Rate for Payer: UHC Core |
$183.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna Commercial |
$187.00
|
| Rate for Payer: Aetna Medicare |
$57.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.75
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$55.00
|
| Rate for Payer: BCBS Trust/PPO |
$171.05
|
| Rate for Payer: BCN Commercial |
$171.05
|
| Rate for Payer: BCN Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$189.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.00
|
| Rate for Payer: Healthscope Commercial |
$198.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.00
|
| Rate for Payer: PACE Senior Care Partners |
$52.25
|
| Rate for Payer: PACE SWMI |
$55.00
|
| Rate for Payer: PHP Commercial |
$187.00
|
| Rate for Payer: PHP Medicare Advantage |
$55.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.40
|
| Rate for Payer: Priority Health Medicare |
$55.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.18
|
| Rate for Payer: Railroad Medicare Medicare |
$55.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.60
|
| Rate for Payer: UHC Core |
$183.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.00
|
| Rate for Payer: UHC Medicare Advantage |
$56.65
|
| Rate for Payer: VA VA |
$55.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.00
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.96 |
| Max. Negotiated Rate |
$1,261.76 |
| Rate for Payer: Aetna Commercial |
$1,191.66
|
| Rate for Payer: Aetna Medicare |
$364.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$438.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$438.11
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$350.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.02
|
| Rate for Payer: BCN Commercial |
$1,090.02
|
| Rate for Payer: BCN Medicare Advantage |
$350.49
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$1,205.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.49
|
| Rate for Payer: Healthscope Commercial |
$1,261.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.46
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$368.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: PACE Senior Care Partners |
$332.96
|
| Rate for Payer: PACE SWMI |
$350.49
|
| Rate for Payer: PHP Commercial |
$1,191.66
|
| Rate for Payer: PHP Medicare Advantage |
$350.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.70
|
| Rate for Payer: Priority Health Medicare |
$350.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.05
|
| Rate for Payer: Railroad Medicare Medicare |
$350.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,233.72
|
| Rate for Payer: UHC Core |
$1,170.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.49
|
| Rate for Payer: UHC Medicare Advantage |
$361.00
|
| Rate for Payer: VA VA |
$350.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.46
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,401.95
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$855.05 |
| Max. Negotiated Rate |
$1,261.76 |
| Rate for Payer: Aetna Commercial |
$1,191.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,083.43
|
| Rate for Payer: BCN Commercial |
$1,083.43
|
| Rate for Payer: Cash Price |
$1,121.56
|
| Rate for Payer: Cofinity Commercial |
$1,205.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,121.56
|
| Rate for Payer: Healthscope Commercial |
$1,261.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,051.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,191.66
|
| Rate for Payer: PHP Commercial |
$1,191.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$855.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,233.72
|
| Rate for Payer: UHC Core |
$1,170.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,051.46
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$296.01 |
| Max. Negotiated Rate |
$436.81 |
| Rate for Payer: Aetna Commercial |
$412.54
|
| Rate for Payer: BCBS Trust/PPO |
$375.07
|
| Rate for Payer: BCN Commercial |
$375.07
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$417.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Healthscope Commercial |
$436.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: PHP Commercial |
$412.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.10
|
| Rate for Payer: UHC Core |
$405.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.00
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$485.34
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$115.27 |
| Max. Negotiated Rate |
$436.81 |
| Rate for Payer: Aetna Commercial |
$412.54
|
| Rate for Payer: Aetna Medicare |
$126.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.67
|
| Rate for Payer: BCBS Complete |
$369.18
|
| Rate for Payer: BCBS MAPPO |
$121.34
|
| Rate for Payer: BCBS Trust/PPO |
$377.35
|
| Rate for Payer: BCN Commercial |
$377.35
|
| Rate for Payer: BCN Medicare Advantage |
$121.34
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cash Price |
$388.27
|
| Rate for Payer: Cofinity Commercial |
$417.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.34
|
| Rate for Payer: Healthscope Commercial |
$436.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$364.00
|
| Rate for Payer: Mclaren Medicaid |
$351.60
|
| Rate for Payer: Meridian Medicaid |
$369.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$127.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$412.54
|
| Rate for Payer: PACE Senior Care Partners |
$115.27
|
| Rate for Payer: PACE SWMI |
$121.34
|
| Rate for Payer: PHP Commercial |
$412.54
|
| Rate for Payer: PHP Medicare Advantage |
$121.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.25
|
| Rate for Payer: Priority Health Medicare |
$121.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.01
|
| Rate for Payer: Railroad Medicare Medicare |
$121.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.10
|
| Rate for Payer: UHC Core |
$405.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.34
|
| Rate for Payer: UHC Medicare Advantage |
$124.98
|
| Rate for Payer: VA VA |
$121.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$364.00
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$18.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.50
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$55.98
|
| Rate for Payer: BCN Commercial |
$55.98
|
| Rate for Payer: BCN Medicare Advantage |
$18.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.00
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$11.51
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PACE Senior Care Partners |
$17.10
|
| Rate for Payer: PACE SWMI |
$18.00
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: PHP Medicare Advantage |
$18.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.64
|
| Rate for Payer: Priority Health Medicare |
$18.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.91
|
| Rate for Payer: Railroad Medicare Medicare |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.36
|
| Rate for Payer: UHC Core |
$60.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.00
|
| Rate for Payer: UHC Medicare Advantage |
$18.54
|
| Rate for Payer: VA VA |
$18.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.91 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$55.64
|
| Rate for Payer: BCN Commercial |
$55.64
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.20
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.36
|
| Rate for Payer: UHC Core |
$60.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.86 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.84
|
| Rate for Payer: BCN Commercial |
$37.84
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$48.96
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$44.06 |
| Rate for Payer: Aetna Commercial |
$41.62
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.30
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$38.07
|
| Rate for Payer: BCN Commercial |
$38.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.24
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cash Price |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.72
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.62
|
| Rate for Payer: PACE Senior Care Partners |
$11.63
|
| Rate for Payer: PACE SWMI |
$12.24
|
| Rate for Payer: PHP Commercial |
$41.62
|
| Rate for Payer: PHP Medicare Advantage |
$12.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.60
|
| Rate for Payer: Priority Health Medicare |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.08
|
| Rate for Payer: UHC Core |
$40.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.61
|
| Rate for Payer: VA VA |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.72
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$159.64 |
| Rate for Payer: Aetna Commercial |
$150.77
|
| Rate for Payer: Aetna Medicare |
$46.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.43
|
| Rate for Payer: BCBS Complete |
$91.05
|
| Rate for Payer: BCBS MAPPO |
$44.34
|
| Rate for Payer: BCBS Trust/PPO |
$137.91
|
| Rate for Payer: BCN Commercial |
$137.91
|
| Rate for Payer: BCN Medicare Advantage |
$44.34
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$152.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.34
|
| Rate for Payer: Healthscope Commercial |
$159.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.04
|
| Rate for Payer: Mclaren Medicaid |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$91.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: PACE Senior Care Partners |
$42.13
|
| Rate for Payer: PACE SWMI |
$44.34
|
| Rate for Payer: PHP Commercial |
$150.77
|
| Rate for Payer: PHP Medicare Advantage |
$44.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.32
|
| Rate for Payer: Priority Health Medicare |
$44.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.18
|
| Rate for Payer: Railroad Medicare Medicare |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.09
|
| Rate for Payer: UHC Core |
$148.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.34
|
| Rate for Payer: UHC Medicare Advantage |
$45.68
|
| Rate for Payer: VA VA |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.04
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$177.38
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.18 |
| Max. Negotiated Rate |
$159.64 |
| Rate for Payer: Aetna Commercial |
$150.77
|
| Rate for Payer: BCBS Trust/PPO |
$137.08
|
| Rate for Payer: BCN Commercial |
$137.08
|
| Rate for Payer: Cash Price |
$141.90
|
| Rate for Payer: Cofinity Commercial |
$152.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.90
|
| Rate for Payer: Healthscope Commercial |
$159.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.77
|
| Rate for Payer: PHP Commercial |
$150.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.09
|
| Rate for Payer: UHC Core |
$148.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.04
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$134.97 |
| Max. Negotiated Rate |
$511.48 |
| Rate for Payer: Aetna Commercial |
$483.06
|
| Rate for Payer: Aetna Medicare |
$147.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$177.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$177.60
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$142.08
|
| Rate for Payer: BCBS Trust/PPO |
$441.86
|
| Rate for Payer: BCN Commercial |
$441.86
|
| Rate for Payer: BCN Medicare Advantage |
$142.08
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$488.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$511.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.23
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: PACE Senior Care Partners |
$134.97
|
| Rate for Payer: PACE SWMI |
$142.08
|
| Rate for Payer: PHP Commercial |
$483.06
|
| Rate for Payer: PHP Medicare Advantage |
$142.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.43
|
| Rate for Payer: Priority Health Medicare |
$142.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.61
|
| Rate for Payer: Railroad Medicare Medicare |
$142.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.11
|
| Rate for Payer: UHC Core |
$474.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.08
|
| Rate for Payer: UHC Medicare Advantage |
$146.34
|
| Rate for Payer: VA VA |
$142.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.23
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$568.31
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$346.61 |
| Max. Negotiated Rate |
$511.48 |
| Rate for Payer: Aetna Commercial |
$483.06
|
| Rate for Payer: BCBS Trust/PPO |
$439.19
|
| Rate for Payer: BCN Commercial |
$439.19
|
| Rate for Payer: Cash Price |
$454.65
|
| Rate for Payer: Cofinity Commercial |
$488.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$454.65
|
| Rate for Payer: Healthscope Commercial |
$511.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$426.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.06
|
| Rate for Payer: PHP Commercial |
$483.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$494.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.11
|
| Rate for Payer: UHC Core |
$474.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$426.23
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Aetna Medicare |
$40.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.44
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$38.75
|
| Rate for Payer: BCBS Trust/PPO |
$120.51
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$38.75
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.75
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PACE Senior Care Partners |
$36.81
|
| Rate for Payer: PACE SWMI |
$38.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: PHP Medicare Advantage |
$38.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.85
|
| Rate for Payer: Priority Health Medicare |
$38.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.53
|
| Rate for Payer: Railroad Medicare Medicare |
$38.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.40
|
| Rate for Payer: UHC Core |
$129.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.75
|
| Rate for Payer: UHC Medicare Advantage |
$39.91
|
| Rate for Payer: VA VA |
$38.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.25
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.53 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: BCBS Trust/PPO |
$119.78
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.00
|
| Rate for Payer: Healthscope Commercial |
$139.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.75
|
| Rate for Payer: PHP Commercial |
$131.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.40
|
| Rate for Payer: UHC Core |
$129.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.25
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: BCBS Trust/PPO |
$96.17
|
| Rate for Payer: BCN Commercial |
$96.17
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.55
|
| Rate for Payer: Healthscope Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: PHP Commercial |
$105.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.51
|
| Rate for Payer: UHC Core |
$103.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.33
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$124.44
|
|
|
Service Code
|
CPT G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Medicare |
$32.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.89
|
| Rate for Payer: BCBS Complete |
$61.40
|
| Rate for Payer: BCBS MAPPO |
$31.11
|
| Rate for Payer: BCBS Trust/PPO |
$96.75
|
| Rate for Payer: BCN Commercial |
$96.75
|
| Rate for Payer: BCN Medicare Advantage |
$31.11
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cofinity Commercial |
$107.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.11
|
| Rate for Payer: Healthscope Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.33
|
| Rate for Payer: Mclaren Medicaid |
$58.47
|
| Rate for Payer: Meridian Medicaid |
$61.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.77
|
| Rate for Payer: PACE Senior Care Partners |
$29.55
|
| Rate for Payer: PACE SWMI |
$31.11
|
| Rate for Payer: PHP Commercial |
$105.77
|
| Rate for Payer: PHP Medicare Advantage |
$31.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.26
|
| Rate for Payer: Priority Health Medicare |
$31.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.90
|
| Rate for Payer: Railroad Medicare Medicare |
$31.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.51
|
| Rate for Payer: UHC Core |
$103.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.11
|
| Rate for Payer: UHC Medicare Advantage |
$32.04
|
| Rate for Payer: VA VA |
$31.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.33
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.57 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$803.73
|
| Rate for Payer: Aetna Medicare |
$245.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.49
|
| Rate for Payer: BCBS Complete |
$378.22
|
| Rate for Payer: BCBS MAPPO |
$236.39
|
| Rate for Payer: BCBS Trust/PPO |
$735.17
|
| Rate for Payer: BCN Commercial |
$735.17
|
| Rate for Payer: BCN Medicare Advantage |
$236.39
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$813.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.39
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$248.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: PACE Senior Care Partners |
$224.57
|
| Rate for Payer: PACE SWMI |
$236.39
|
| Rate for Payer: PHP Commercial |
$803.73
|
| Rate for Payer: PHP Medicare Advantage |
$236.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.64
|
| Rate for Payer: Priority Health Medicare |
$236.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$576.70
|
| Rate for Payer: Railroad Medicare Medicare |
$236.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.09
|
| Rate for Payer: UHC Core |
$789.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.39
|
| Rate for Payer: UHC Medicare Advantage |
$243.48
|
| Rate for Payer: VA VA |
$236.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.17
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$945.56
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$576.70 |
| Max. Negotiated Rate |
$851.00 |
| Rate for Payer: Aetna Commercial |
$803.73
|
| Rate for Payer: BCBS Trust/PPO |
$730.73
|
| Rate for Payer: BCN Commercial |
$730.73
|
| Rate for Payer: Cash Price |
$756.45
|
| Rate for Payer: Cofinity Commercial |
$813.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.45
|
| Rate for Payer: Healthscope Commercial |
$851.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$709.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$803.73
|
| Rate for Payer: PHP Commercial |
$803.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$576.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.09
|
| Rate for Payer: UHC Core |
$789.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$709.17
|
|
