|
HC DRAINAGE SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$2,142.08
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
76100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,392.35 |
| Max. Negotiated Rate |
$1,927.87 |
| Rate for Payer: Aetna Commercial |
$1,820.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,748.58
|
| Rate for Payer: BCN Commercial |
$1,655.40
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$1,842.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Healthscope Commercial |
$1,927.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: PHP Commercial |
$1,820.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,863.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,435.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,885.03
|
| Rate for Payer: UHC Core |
$1,788.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.56
|
|
|
HC DRAINAGE SOFT TISSUE W IMAGE GUIDANCE
|
Facility
|
OP
|
$3,174.66
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
36100422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$508.70 |
| Max. Negotiated Rate |
$2,857.19 |
| Rate for Payer: Aetna Commercial |
$2,698.46
|
| Rate for Payer: Aetna Medicare |
$825.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$992.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$992.08
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$793.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,609.89
|
| Rate for Payer: BCN Commercial |
$2,468.30
|
| Rate for Payer: BCN Medicare Advantage |
$793.66
|
| Rate for Payer: Cash Price |
$2,539.73
|
| Rate for Payer: Cash Price |
$2,539.73
|
| Rate for Payer: Cofinity Commercial |
$2,730.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,539.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.66
|
| Rate for Payer: Healthscope Commercial |
$2,857.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,380.99
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$833.35
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$912.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,698.46
|
| Rate for Payer: Nomi Health Commercial |
$2,603.22
|
| Rate for Payer: PACE Senior Care Partners |
$753.98
|
| Rate for Payer: PACE SWMI |
$793.66
|
| Rate for Payer: PHP Commercial |
$2,698.46
|
| Rate for Payer: PHP Medicare Advantage |
$793.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,063.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,761.95
|
| Rate for Payer: Priority Health Medicare |
$801.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,127.02
|
| Rate for Payer: Railroad Medicare Medicare |
$793.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.70
|
| Rate for Payer: UHC Core |
$2,650.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.66
|
| Rate for Payer: UHC Exchange |
$793.66
|
| Rate for Payer: UHC Medicare Advantage |
$793.66
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$793.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,380.99
|
|
|
HC DRAINAGE SOFT TISSUE W IMAGE GUIDANCE
|
Facility
|
IP
|
$3,174.66
|
|
|
Service Code
|
CPT 10030
|
| Hospital Charge Code |
36100422
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,063.53 |
| Max. Negotiated Rate |
$2,857.19 |
| Rate for Payer: Aetna Commercial |
$2,698.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,591.47
|
| Rate for Payer: BCN Commercial |
$2,453.38
|
| Rate for Payer: Cash Price |
$2,539.73
|
| Rate for Payer: Cofinity Commercial |
$2,730.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,539.73
|
| Rate for Payer: Healthscope Commercial |
$2,857.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,380.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,698.46
|
| Rate for Payer: Nomi Health Commercial |
$2,603.22
|
| Rate for Payer: PHP Commercial |
$2,698.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,063.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2,761.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,127.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,793.70
|
| Rate for Payer: UHC Core |
$2,650.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,380.99
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
OP
|
$4,064.42
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$965.30 |
| Max. Negotiated Rate |
$3,657.98 |
| Rate for Payer: Aetna Commercial |
$3,454.76
|
| Rate for Payer: Aetna Medicare |
$1,056.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,270.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,270.13
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$1,016.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,341.36
|
| Rate for Payer: BCN Commercial |
$3,160.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,016.11
|
| Rate for Payer: Cash Price |
$3,251.54
|
| Rate for Payer: Cash Price |
$3,251.54
|
| Rate for Payer: Cofinity Commercial |
$3,495.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,251.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,016.11
|
| Rate for Payer: Healthscope Commercial |
$3,657.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,048.32
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,066.91
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,168.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,454.76
|
| Rate for Payer: Nomi Health Commercial |
$3,332.82
|
| Rate for Payer: PACE Senior Care Partners |
$965.30
|
| Rate for Payer: PACE SWMI |
$1,016.11
|
| Rate for Payer: PHP Commercial |
$3,454.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,016.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.87
|
| Rate for Payer: Priority Health HMO/PPO |
$3,536.05
|
| Rate for Payer: Priority Health Medicare |
$1,026.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,723.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,016.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,576.69
|
| Rate for Payer: UHC Core |
$3,393.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,016.11
|
| Rate for Payer: UHC Exchange |
$1,016.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,016.11
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$1,016.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,048.32
|
|
|
HC DRAINAGE VISCERAL
|
Facility
|
IP
|
$4,064.42
|
|
|
Service Code
|
CPT 49405
|
| Hospital Charge Code |
36100432
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,641.87 |
| Max. Negotiated Rate |
$3,657.98 |
| Rate for Payer: Aetna Commercial |
$3,454.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,317.79
|
| Rate for Payer: BCN Commercial |
$3,140.98
|
| Rate for Payer: Cash Price |
$3,251.54
|
| Rate for Payer: Cofinity Commercial |
$3,495.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,251.54
|
| Rate for Payer: Healthscope Commercial |
$3,657.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,048.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,454.76
|
| Rate for Payer: Nomi Health Commercial |
$3,332.82
|
| Rate for Payer: PHP Commercial |
$3,454.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,641.87
|
| Rate for Payer: Priority Health HMO/PPO |
$3,536.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,723.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,576.69
|
| Rate for Payer: UHC Core |
$3,393.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,048.32
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
OP
|
$4,095.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$972.56 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: Aetna Commercial |
$3,480.75
|
| Rate for Payer: Aetna Medicare |
$1,064.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,279.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,279.69
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$1,023.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,366.50
|
| Rate for Payer: BCN Commercial |
$3,183.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.75
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cofinity Commercial |
$3,521.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.75
|
| Rate for Payer: Healthscope Commercial |
$3,685.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,071.25
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,074.94
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,177.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,480.75
|
| Rate for Payer: Nomi Health Commercial |
$3,357.90
|
| Rate for Payer: PACE Senior Care Partners |
$972.56
|
| Rate for Payer: PACE SWMI |
$1,023.75
|
| Rate for Payer: PHP Commercial |
$3,480.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,562.65
|
| Rate for Payer: Priority Health Medicare |
$1,033.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,743.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,023.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,603.60
|
| Rate for Payer: UHC Core |
$3,419.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.75
|
| Rate for Payer: UHC Exchange |
$1,023.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.75
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$1,023.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,071.25
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA CMPLX
|
Facility
|
IP
|
$4,095.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
76100479
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,661.75 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: Aetna Commercial |
$3,480.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,342.75
|
| Rate for Payer: BCN Commercial |
$3,164.62
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cofinity Commercial |
$3,521.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,276.00
|
| Rate for Payer: Healthscope Commercial |
$3,685.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,071.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,480.75
|
| Rate for Payer: Nomi Health Commercial |
$3,357.90
|
| Rate for Payer: PHP Commercial |
$3,480.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,661.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,562.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,743.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,603.60
|
| Rate for Payer: UHC Core |
$3,419.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,071.25
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
IP
|
$970.69
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$630.95 |
| Max. Negotiated Rate |
$873.62 |
| Rate for Payer: Aetna Commercial |
$825.09
|
| Rate for Payer: BCBS Trust/PPO |
$792.37
|
| Rate for Payer: BCN Commercial |
$750.15
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$834.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.55
|
| Rate for Payer: Healthscope Commercial |
$873.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.09
|
| Rate for Payer: Nomi Health Commercial |
$795.97
|
| Rate for Payer: PHP Commercial |
$825.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.95
|
| Rate for Payer: Priority Health HMO/PPO |
$844.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$650.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.21
|
| Rate for Payer: UHC Core |
$810.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.02
|
|
|
HC DRAIN EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Facility
|
OP
|
$970.69
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
76100298
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.54 |
| Max. Negotiated Rate |
$873.62 |
| Rate for Payer: Aetna Commercial |
$825.09
|
| Rate for Payer: Aetna Medicare |
$252.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.34
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$242.67
|
| Rate for Payer: BCBS Trust/PPO |
$798.00
|
| Rate for Payer: BCN Commercial |
$754.71
|
| Rate for Payer: BCN Medicare Advantage |
$242.67
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cash Price |
$776.55
|
| Rate for Payer: Cofinity Commercial |
$834.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$776.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.67
|
| Rate for Payer: Healthscope Commercial |
$873.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.02
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.81
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.09
|
| Rate for Payer: Nomi Health Commercial |
$795.97
|
| Rate for Payer: PACE Senior Care Partners |
$230.54
|
| Rate for Payer: PACE SWMI |
$242.67
|
| Rate for Payer: PHP Commercial |
$825.09
|
| Rate for Payer: PHP Medicare Advantage |
$242.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.95
|
| Rate for Payer: Priority Health HMO/PPO |
$844.50
|
| Rate for Payer: Priority Health Medicare |
$245.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$650.36
|
| Rate for Payer: Railroad Medicare Medicare |
$242.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.21
|
| Rate for Payer: UHC Core |
$810.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.67
|
| Rate for Payer: UHC Exchange |
$242.67
|
| Rate for Payer: UHC Medicare Advantage |
$242.67
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$242.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.02
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
OP
|
$15.61
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCN Commercial |
$12.14
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: City of Battle Creek Police Dept Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Mclaren Medicaid |
$6.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$6.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.49
|
| Rate for Payer: Michigan State Police Michigan State Police |
$50.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$3.71
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Medicare |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$6.57
|
| Rate for Payer: VA VA |
$3.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC DRAW VENIPUNCTURE
|
Facility
|
IP
|
$15.61
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
30000001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$14.05 |
| Rate for Payer: Aetna Commercial |
$13.27
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$12.06
|
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$13.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.74
|
| Rate for Payer: UHC Core |
$13.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.71
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
OP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$333.36 |
| Rate for Payer: Aetna Commercial |
$314.84
|
| Rate for Payer: Aetna Medicare |
$96.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.75
|
| Rate for Payer: BCBS Complete |
$148.16
|
| Rate for Payer: BCBS MAPPO |
$92.60
|
| Rate for Payer: BCBS Trust/PPO |
$304.51
|
| Rate for Payer: BCN Commercial |
$287.99
|
| Rate for Payer: BCN Medicare Advantage |
$92.60
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.60
|
| Rate for Payer: Healthscope Commercial |
$333.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: Nomi Health Commercial |
$303.73
|
| Rate for Payer: PACE Senior Care Partners |
$87.97
|
| Rate for Payer: PACE SWMI |
$92.60
|
| Rate for Payer: PHP Commercial |
$314.84
|
| Rate for Payer: PHP Medicare Advantage |
$92.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: Priority Health HMO/PPO |
$322.25
|
| Rate for Payer: Priority Health Medicare |
$93.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.17
|
| Rate for Payer: Railroad Medicare Medicare |
$92.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.95
|
| Rate for Payer: UHC Core |
$309.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.60
|
| Rate for Payer: UHC Exchange |
$92.60
|
| Rate for Payer: UHC Medicare Advantage |
$92.60
|
| Rate for Payer: VA VA |
$92.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.80
|
|
|
HC DRSG MEPILEX AG FOAM 8X20
|
Facility
|
IP
|
$370.40
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$240.76 |
| Max. Negotiated Rate |
$333.36 |
| Rate for Payer: Aetna Commercial |
$314.84
|
| Rate for Payer: BCBS Trust/PPO |
$302.36
|
| Rate for Payer: BCN Commercial |
$286.25
|
| Rate for Payer: Cash Price |
$296.32
|
| Rate for Payer: Cofinity Commercial |
$318.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$333.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.84
|
| Rate for Payer: Nomi Health Commercial |
$303.73
|
| Rate for Payer: PHP Commercial |
$314.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.76
|
| Rate for Payer: Priority Health HMO/PPO |
$322.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.95
|
| Rate for Payer: UHC Core |
$309.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.80
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
IP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: BCBS Trust/PPO |
$4.60
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health HMO/PPO |
$4.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.96
|
| Rate for Payer: UHC Core |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.23
|
|
|
HC DRSG MEPILEX BORDER LITE 4X5 EA
|
Facility
|
OP
|
$5.64
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300221
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna Commercial |
$4.79
|
| Rate for Payer: Aetna Medicare |
$1.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.76
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: BCBS MAPPO |
$1.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.64
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: BCN Medicare Advantage |
$1.41
|
| Rate for Payer: Cash Price |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.41
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.79
|
| Rate for Payer: Nomi Health Commercial |
$4.62
|
| Rate for Payer: PACE Senior Care Partners |
$1.34
|
| Rate for Payer: PACE SWMI |
$1.41
|
| Rate for Payer: PHP Commercial |
$4.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.67
|
| Rate for Payer: Priority Health HMO/PPO |
$4.91
|
| Rate for Payer: Priority Health Medicare |
$1.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.96
|
| Rate for Payer: UHC Core |
$4.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.41
|
| Rate for Payer: UHC Exchange |
$1.41
|
| Rate for Payer: UHC Medicare Advantage |
$1.41
|
| Rate for Payer: VA VA |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.23
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
OP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.55
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.48
|
| Rate for Payer: BCN Commercial |
$21.26
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Healthscope Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Nomi Health Commercial |
$22.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health HMO/PPO |
$23.79
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.07
|
| Rate for Payer: UHC Core |
$22.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.84
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: VA VA |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.51
|
|
|
HC DRSG MEPILEX BORDER SACRUM 9X9 EA
|
Facility
|
IP
|
$27.35
|
|
|
Service Code
|
HCPCS A6214
|
| Hospital Charge Code |
62300222
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$24.61 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: BCBS Trust/PPO |
$22.33
|
| Rate for Payer: BCN Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$21.88
|
| Rate for Payer: Cofinity Commercial |
$23.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.25
|
| Rate for Payer: Nomi Health Commercial |
$22.43
|
| Rate for Payer: PHP Commercial |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health HMO/PPO |
$23.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.07
|
| Rate for Payer: UHC Core |
$22.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.51
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$84.93
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC DRUG SCREEN 10 URINE
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$85.53
|
| Rate for Payer: BCN Commercial |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.43
|
| Rate for Payer: Nomi Health Commercial |
$85.31
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.63
|
| Rate for Payer: Priority Health HMO/PPO |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.71
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Exchange |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$19.98
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC DRUG SCREEN COLLECT-OUTSIDE SVC
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 99000
|
| Hospital Charge Code |
98300005
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$9.79
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$19.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.12
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
IP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: BCBS Trust/PPO |
$39.37
|
| Rate for Payer: BCN Commercial |
$37.27
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Nomi Health Commercial |
$39.55
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health HMO/PPO |
$41.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.44
|
| Rate for Payer: UHC Core |
$40.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.17
|
|
|
HC DRUG SCREEN QUAL EA PROC
|
Facility
|
OP
|
$48.23
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100652
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$43.41 |
| Rate for Payer: Aetna Commercial |
$41.00
|
| Rate for Payer: Aetna Medicare |
$12.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.07
|
| Rate for Payer: BCBS Complete |
$9.57
|
| Rate for Payer: BCBS MAPPO |
$12.06
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$37.50
|
| Rate for Payer: BCN Medicare Advantage |
$12.06
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$43.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.17
|
| Rate for Payer: Mclaren Medicaid |
$9.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.66
|
| Rate for Payer: Meridian Medicaid |
$9.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.00
|
| Rate for Payer: Nomi Health Commercial |
$39.55
|
| Rate for Payer: PACE Senior Care Partners |
$11.45
|
| Rate for Payer: PACE SWMI |
$12.06
|
| Rate for Payer: PHP Commercial |
$41.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.35
|
| Rate for Payer: Priority Health HMO/PPO |
$41.96
|
| Rate for Payer: Priority Health Medicare |
$12.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.31
|
| Rate for Payer: Railroad Medicare Medicare |
$12.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.44
|
| Rate for Payer: UHC Core |
$40.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.06
|
| Rate for Payer: UHC Exchange |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$12.06
|
| Rate for Payer: UHCCP Medicaid |
$9.11
|
| Rate for Payer: VA VA |
$12.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.17
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DRUG SCREEN QUANTALCOHOLS
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100732
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.03
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$30.60
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$62.89
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.03
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.03
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.73
|
| Rate for Payer: Priority Health HMO/PPO |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.26
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Exchange |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.12
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
