|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$27.58
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$117.65
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Medicaid |
$117.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$27.58
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: Aetna Medicare |
$40.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.75
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$39.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.29
|
| Rate for Payer: BCN Commercial |
$121.29
|
| Rate for Payer: BCN Medicare Advantage |
$39.00
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.00
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PACE Senior Care Partners |
$37.05
|
| Rate for Payer: PACE SWMI |
$39.00
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: PHP Medicare Advantage |
$39.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.72
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.14
|
| Rate for Payer: Railroad Medicare Medicare |
$39.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.28
|
| Rate for Payer: UHC Core |
$130.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.00
|
| Rate for Payer: UHC Medicare Advantage |
$40.17
|
| Rate for Payer: VA VA |
$39.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.14 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Commercial |
$132.60
|
| Rate for Payer: BCBS Trust/PPO |
$120.56
|
| Rate for Payer: BCN Commercial |
$120.56
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$134.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.80
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.60
|
| Rate for Payer: PHP Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.28
|
| Rate for Payer: UHC Core |
$130.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.00
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.83
|
| Rate for Payer: BCN Commercial |
$1.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PACE Senior Care Partners |
$0.56
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.43
|
| Rate for Payer: Railroad Medicare Medicare |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.61
|
| Rate for Payer: VA VA |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.40
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.80
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.09
|
| Rate for Payer: UHC Medicare Advantage |
$1.13
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.65
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.16
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.49
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.47
|
| Rate for Payer: BCN Commercial |
$1.47
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.51
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$0.41
|
| Rate for Payer: BCBS Trust/PPO |
$1.28
|
| Rate for Payer: BCN Commercial |
$1.28
|
| Rate for Payer: BCN Medicare Advantage |
$0.41
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.41
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PACE Senior Care Partners |
$0.39
|
| Rate for Payer: PACE SWMI |
$0.41
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.43
|
| Rate for Payer: Priority Health Medicare |
$0.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.41
|
| Rate for Payer: UHC Medicare Advantage |
$0.42
|
| Rate for Payer: VA VA |
$0.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.39
|
| Rate for Payer: BCBS Trust/PPO |
$1.27
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cofinity Commercial |
$1.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.31
|
| Rate for Payer: Healthscope Commercial |
$1.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.39
|
| Rate for Payer: PHP Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.44
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.23
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS MAPPO |
$0.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.45
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.47
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.44
|
| Rate for Payer: PACE SWMI |
$0.47
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Medicare |
$0.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.13
|
| Rate for Payer: Railroad Medicare Medicare |
$0.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.64
|
| Rate for Payer: UHC Core |
$1.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.64
|
| Rate for Payer: UHC Core |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.66
|
| Rate for Payer: Aetna Medicare |
$80.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.20
|
| Rate for Payer: BCBS Complete |
$220.97
|
| Rate for Payer: BCBS MAPPO |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$239.35
|
| Rate for Payer: BCN Commercial |
$239.35
|
| Rate for Payer: BCN Medicare Advantage |
$76.96
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$264.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.96
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.88
|
| Rate for Payer: Mclaren Medicaid |
$210.45
|
| Rate for Payer: Meridian Medicaid |
$220.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: PACE Senior Care Partners |
$73.11
|
| Rate for Payer: PACE SWMI |
$76.96
|
| Rate for Payer: PHP Commercial |
$261.66
|
| Rate for Payer: PHP Medicare Advantage |
$76.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.82
|
| Rate for Payer: Priority Health Medicare |
$76.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.75
|
| Rate for Payer: Railroad Medicare Medicare |
$76.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.90
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.96
|
| Rate for Payer: UHC Medicare Advantage |
$79.27
|
| Rate for Payer: VA VA |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.88
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$307.84
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.75 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.66
|
| Rate for Payer: BCBS Trust/PPO |
$237.90
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$246.27
|
| Rate for Payer: Cofinity Commercial |
$264.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.27
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.66
|
| Rate for Payer: PHP Commercial |
$261.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.90
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.88
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.58 |
| Max. Negotiated Rate |
$105.63 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: BCBS Trust/PPO |
$90.70
|
| Rate for Payer: BCN Commercial |
$90.70
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Healthscope Commercial |
$105.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.29
|
| Rate for Payer: UHC Core |
$98.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.03
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$117.37
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.88 |
| Max. Negotiated Rate |
$105.63 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna Medicare |
$30.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.68
|
| Rate for Payer: BCBS Complete |
$46.95
|
| Rate for Payer: BCBS MAPPO |
$29.34
|
| Rate for Payer: BCBS Trust/PPO |
$91.26
|
| Rate for Payer: BCN Commercial |
$91.26
|
| Rate for Payer: BCN Medicare Advantage |
$29.34
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$100.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$105.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.76
|
| Rate for Payer: PACE Senior Care Partners |
$27.88
|
| Rate for Payer: PACE SWMI |
$29.34
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: PHP Medicare Advantage |
$29.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.11
|
| Rate for Payer: Priority Health Medicare |
$29.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.58
|
| Rate for Payer: Railroad Medicare Medicare |
$29.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.29
|
| Rate for Payer: UHC Core |
$98.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.34
|
| Rate for Payer: UHC Medicare Advantage |
$30.22
|
| Rate for Payer: VA VA |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.03
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.07 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: BCBS Trust/PPO |
$64.71
|
| Rate for Payer: BCN Commercial |
$64.71
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$83.74
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$75.37 |
| Rate for Payer: Aetna Commercial |
$71.18
|
| Rate for Payer: Aetna Medicare |
$21.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.17
|
| Rate for Payer: BCBS Complete |
$33.50
|
| Rate for Payer: BCBS MAPPO |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$65.11
|
| Rate for Payer: BCN Commercial |
$65.11
|
| Rate for Payer: BCN Medicare Advantage |
$20.94
|
| Rate for Payer: Cash Price |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$72.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$75.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.18
|
| Rate for Payer: PACE Senior Care Partners |
$19.89
|
| Rate for Payer: PACE SWMI |
$20.94
|
| Rate for Payer: PHP Commercial |
$71.18
|
| Rate for Payer: PHP Medicare Advantage |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.85
|
| Rate for Payer: Priority Health Medicare |
$20.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.07
|
| Rate for Payer: Railroad Medicare Medicare |
$20.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.69
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.94
|
| Rate for Payer: UHC Medicare Advantage |
$21.56
|
| Rate for Payer: VA VA |
$20.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.80
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna Commercial |
$169.64
|
| Rate for Payer: BCBS Trust/PPO |
$154.24
|
| Rate for Payer: BCN Commercial |
$154.24
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$171.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: PHP Commercial |
$169.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.63
|
| Rate for Payer: UHC Core |
$166.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$199.58
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.16 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Aetna Commercial |
$169.64
|
| Rate for Payer: Aetna Medicare |
$51.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.37
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$49.90
|
| Rate for Payer: BCBS Trust/PPO |
$155.17
|
| Rate for Payer: BCN Commercial |
$155.17
|
| Rate for Payer: BCN Medicare Advantage |
$49.90
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cash Price |
$159.66
|
| Rate for Payer: Cofinity Commercial |
$171.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.90
|
| Rate for Payer: Healthscope Commercial |
$179.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.68
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$169.64
|
| Rate for Payer: PACE Senior Care Partners |
$47.40
|
| Rate for Payer: PACE SWMI |
$49.90
|
| Rate for Payer: PHP Commercial |
$169.64
|
| Rate for Payer: PHP Medicare Advantage |
$49.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.63
|
| Rate for Payer: Priority Health Medicare |
$49.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.72
|
| Rate for Payer: Railroad Medicare Medicare |
$49.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.63
|
| Rate for Payer: UHC Core |
$166.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.90
|
| Rate for Payer: UHC Medicare Advantage |
$51.39
|
| Rate for Payer: VA VA |
$49.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.68
|
|
|
HC IV HYDRATION ONLY,INITIAL HR
|
Facility
|
IP
|
$500.24
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
26000001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$305.10 |
| Max. Negotiated Rate |
$450.22 |
| Rate for Payer: Aetna Commercial |
$425.20
|
| Rate for Payer: BCBS Trust/PPO |
$386.59
|
| Rate for Payer: BCN Commercial |
$386.59
|
| Rate for Payer: Cash Price |
$400.19
|
| Rate for Payer: Cofinity Commercial |
$430.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.19
|
| Rate for Payer: Healthscope Commercial |
$450.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.20
|
| Rate for Payer: PHP Commercial |
$425.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.21
|
| Rate for Payer: UHC Core |
$417.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.18
|
|
