|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.58
|
| Rate for Payer: BCBS Trust/PPO |
$37.05
|
| Rate for Payer: BCN Commercial |
$35.08
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Healthscope Commercial |
$40.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: PHP Commercial |
$38.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: Priority Health HMO/PPO |
$39.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.94
|
| Rate for Payer: UHC Core |
$37.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.04
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.58
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.18
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$37.32
|
| Rate for Payer: BCN Commercial |
$35.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.35
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.35
|
| Rate for Payer: Healthscope Commercial |
$40.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.04
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.91
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: PACE Senior Care Partners |
$10.78
|
| Rate for Payer: PACE SWMI |
$11.35
|
| Rate for Payer: PHP Commercial |
$38.58
|
| Rate for Payer: PHP Medicare Advantage |
$11.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: Priority Health HMO/PPO |
$39.49
|
| Rate for Payer: Priority Health Medicare |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.41
|
| Rate for Payer: Railroad Medicare Medicare |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.94
|
| Rate for Payer: UHC Core |
$37.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.35
|
| Rate for Payer: UHC Exchange |
$11.35
|
| Rate for Payer: UHC Medicare Advantage |
$11.35
|
| Rate for Payer: UHCCP Medicaid |
$10.84
|
| Rate for Payer: VA VA |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.04
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$32.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.62
|
| Rate for Payer: BCBS Complete |
$49.44
|
| Rate for Payer: BCBS MAPPO |
$30.90
|
| Rate for Payer: BCBS Trust/PPO |
$101.61
|
| Rate for Payer: BCN Commercial |
$96.10
|
| Rate for Payer: BCN Medicare Advantage |
$30.90
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: PACE Senior Care Partners |
$29.36
|
| Rate for Payer: PACE SWMI |
$30.90
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: PHP Medicare Advantage |
$30.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health HMO/PPO |
$107.53
|
| Rate for Payer: Priority Health Medicare |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.81
|
| Rate for Payer: Railroad Medicare Medicare |
$30.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.77
|
| Rate for Payer: UHC Core |
$103.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.90
|
| Rate for Payer: UHC Exchange |
$30.90
|
| Rate for Payer: UHC Medicare Advantage |
$30.90
|
| Rate for Payer: VA VA |
$30.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.70
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: BCBS Trust/PPO |
$100.89
|
| Rate for Payer: BCN Commercial |
$95.52
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health HMO/PPO |
$107.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.77
|
| Rate for Payer: UHC Core |
$103.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.70
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: BCBS Trust/PPO |
$43.90
|
| Rate for Payer: BCN Commercial |
$41.56
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO |
$46.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.33
|
| Rate for Payer: UHC Core |
$44.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.34
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.81
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$44.21
|
| Rate for Payer: BCN Commercial |
$41.81
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO |
$46.79
|
| Rate for Payer: Priority Health Medicare |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.33
|
| Rate for Payer: UHC Core |
$44.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Exchange |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.34
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: BCBS Trust/PPO |
$126.39
|
| Rate for Payer: BCN Commercial |
$119.65
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$456.05 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.38
|
| Rate for Payer: BCBS Complete |
$456.05
|
| Rate for Payer: BCBS MAPPO |
$38.71
|
| Rate for Payer: BCBS Trust/PPO |
$127.29
|
| Rate for Payer: BCN Commercial |
$120.38
|
| Rate for Payer: BCN Medicare Advantage |
$38.71
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Mclaren Medicaid |
$434.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.64
|
| Rate for Payer: Meridian Medicaid |
$456.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PACE Senior Care Partners |
$36.77
|
| Rate for Payer: PACE SWMI |
$38.71
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Medicare |
$39.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: Railroad Medicare Medicare |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.71
|
| Rate for Payer: UHC Exchange |
$38.71
|
| Rate for Payer: UHC Medicare Advantage |
$38.71
|
| Rate for Payer: UHCCP Medicaid |
$434.31
|
| Rate for Payer: VA VA |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.52
|
| Rate for Payer: BCBS Complete |
$44.19
|
| Rate for Payer: BCBS MAPPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$53.97
|
| Rate for Payer: BCN Commercial |
$51.04
|
| Rate for Payer: BCN Medicare Advantage |
$16.41
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$56.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.24
|
| Rate for Payer: Mclaren Medicaid |
$42.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.23
|
| Rate for Payer: Meridian Medicaid |
$44.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$53.83
|
| Rate for Payer: PACE Senior Care Partners |
$15.59
|
| Rate for Payer: PACE SWMI |
$16.41
|
| Rate for Payer: PHP Commercial |
$55.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health HMO/PPO |
$57.12
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.99
|
| Rate for Payer: Railroad Medicare Medicare |
$16.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.77
|
| Rate for Payer: UHC Core |
$54.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.41
|
| Rate for Payer: UHC Exchange |
$16.41
|
| Rate for Payer: UHC Medicare Advantage |
$16.41
|
| Rate for Payer: UHCCP Medicaid |
$42.08
|
| Rate for Payer: VA VA |
$16.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.24
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$59.08 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: BCBS Trust/PPO |
$53.59
|
| Rate for Payer: BCN Commercial |
$50.73
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$56.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Healthscope Commercial |
$59.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$53.83
|
| Rate for Payer: PHP Commercial |
$55.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health HMO/PPO |
$57.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.77
|
| Rate for Payer: UHC Core |
$54.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.24
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: BCBS Trust/PPO |
$124.89
|
| Rate for Payer: BCN Commercial |
$118.24
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.03 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$16.83
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Mclaren Medicaid |
$16.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: Meridian Medicaid |
$16.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: UHCCP Medicaid |
$16.03
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
|
HC DISASTER COVERAGE
|
Facility
|
IP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna Commercial |
$123.11
|
| Rate for Payer: BCBS Trust/PPO |
$118.23
|
| Rate for Payer: BCN Commercial |
$111.93
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$124.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: Nomi Health Commercial |
$118.77
|
| Rate for Payer: PHP Commercial |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health HMO/PPO |
$126.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.46
|
| Rate for Payer: UHC Core |
$120.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.63
|
|
|
HC DISASTER COVERAGE
|
Facility
|
OP
|
$144.84
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Aetna Commercial |
$123.11
|
| Rate for Payer: Aetna Medicare |
$37.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.26
|
| Rate for Payer: BCBS Complete |
$57.94
|
| Rate for Payer: BCBS MAPPO |
$36.21
|
| Rate for Payer: BCBS Trust/PPO |
$119.07
|
| Rate for Payer: BCN Commercial |
$112.61
|
| Rate for Payer: BCN Medicare Advantage |
$36.21
|
| Rate for Payer: Cash Price |
$115.87
|
| Rate for Payer: Cofinity Commercial |
$124.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.21
|
| Rate for Payer: Healthscope Commercial |
$130.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.11
|
| Rate for Payer: Nomi Health Commercial |
$118.77
|
| Rate for Payer: PACE Senior Care Partners |
$34.40
|
| Rate for Payer: PACE SWMI |
$36.21
|
| Rate for Payer: PHP Commercial |
$123.11
|
| Rate for Payer: PHP Medicare Advantage |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.15
|
| Rate for Payer: Priority Health HMO/PPO |
$126.01
|
| Rate for Payer: Priority Health Medicare |
$36.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.04
|
| Rate for Payer: Railroad Medicare Medicare |
$36.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.46
|
| Rate for Payer: UHC Core |
$120.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.21
|
| Rate for Payer: UHC Exchange |
$36.21
|
| Rate for Payer: UHC Medicare Advantage |
$36.21
|
| Rate for Payer: VA VA |
$36.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.63
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$115.07 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: Aetna Medicare |
$125.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.41
|
| Rate for Payer: BCBS Complete |
$193.80
|
| Rate for Payer: BCBS MAPPO |
$121.12
|
| Rate for Payer: BCBS Trust/PPO |
$398.31
|
| Rate for Payer: BCN Commercial |
$376.70
|
| Rate for Payer: BCN Medicare Advantage |
$121.12
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.12
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: PACE Senior Care Partners |
$115.07
|
| Rate for Payer: PACE SWMI |
$121.12
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: PHP Medicare Advantage |
$121.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health HMO/PPO |
$421.52
|
| Rate for Payer: Priority Health Medicare |
$122.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.62
|
| Rate for Payer: Railroad Medicare Medicare |
$121.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.36
|
| Rate for Payer: UHC Core |
$404.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.12
|
| Rate for Payer: UHC Exchange |
$121.12
|
| Rate for Payer: UHC Medicare Advantage |
$121.12
|
| Rate for Payer: VA VA |
$121.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$484.50
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$314.92 |
| Max. Negotiated Rate |
$436.05 |
| Rate for Payer: Aetna Commercial |
$411.82
|
| Rate for Payer: BCBS Trust/PPO |
$395.50
|
| Rate for Payer: BCN Commercial |
$374.42
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cofinity Commercial |
$416.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.60
|
| Rate for Payer: Healthscope Commercial |
$436.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.82
|
| Rate for Payer: Nomi Health Commercial |
$397.29
|
| Rate for Payer: PHP Commercial |
$411.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.92
|
| Rate for Payer: Priority Health HMO/PPO |
$421.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.36
|
| Rate for Payer: UHC Core |
$404.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.38
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
IP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$182.32 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: BCBS Trust/PPO |
$228.97
|
| Rate for Payer: BCN Commercial |
$216.77
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$230.60
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.42
|
| Rate for Payer: Nomi Health Commercial |
$230.01
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.32
|
| Rate for Payer: Priority Health HMO/PPO |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.94
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Exchange |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$70.12
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
IP
|
$28.41
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
OP
|
$28.41
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$25.57 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.88
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: BCBS MAPPO |
$7.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.36
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Medicare Advantage |
$7.10
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cash Price |
$22.73
|
| Rate for Payer: Cofinity Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$25.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.31
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.46
|
| Rate for Payer: Meridian Medicaid |
$10.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.15
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE SWMI |
$7.10
|
| Rate for Payer: PHP Commercial |
$24.15
|
| Rate for Payer: PHP Medicare Advantage |
$7.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health HMO/PPO |
$24.72
|
| Rate for Payer: Priority Health Medicare |
$7.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.03
|
| Rate for Payer: Railroad Medicare Medicare |
$7.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.00
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.10
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$7.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.31
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
OP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.33
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS MAPPO |
$19.47
|
| Rate for Payer: BCBS Trust/PPO |
$64.02
|
| Rate for Payer: BCN Commercial |
$60.54
|
| Rate for Payer: BCN Medicare Advantage |
$19.47
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.47
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.40
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.44
|
| Rate for Payer: Meridian Medicaid |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: PACE Senior Care Partners |
$18.49
|
| Rate for Payer: PACE SWMI |
$19.47
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: PHP Medicare Advantage |
$19.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO |
$67.75
|
| Rate for Payer: Priority Health Medicare |
$19.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.17
|
| Rate for Payer: Railroad Medicare Medicare |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC Core |
$65.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.47
|
| Rate for Payer: UHC Exchange |
$19.47
|
| Rate for Payer: UHC Medicare Advantage |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: VA VA |
$19.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.40
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
IP
|
$77.87
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$66.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.57
|
| Rate for Payer: BCN Commercial |
$60.18
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$63.85
|
| Rate for Payer: PHP Commercial |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health HMO/PPO |
$67.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC Core |
$65.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.40
|
|
|
HC DOG IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC DOG IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
IP
|
$440.60
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$286.39 |
| Max. Negotiated Rate |
$396.54 |
| Rate for Payer: Aetna Commercial |
$374.51
|
| Rate for Payer: BCBS Trust/PPO |
$359.66
|
| Rate for Payer: BCN Commercial |
$340.50
|
| Rate for Payer: Cash Price |
$352.48
|
| Rate for Payer: Cofinity Commercial |
$378.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.48
|
| Rate for Payer: Healthscope Commercial |
$396.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.51
|
| Rate for Payer: Nomi Health Commercial |
$361.29
|
| Rate for Payer: PHP Commercial |
$374.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.39
|
| Rate for Payer: Priority Health HMO/PPO |
$383.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.73
|
| Rate for Payer: UHC Core |
$367.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.45
|
|
