|
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 |
$24.62 |
| 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 |
$24.62
|
| 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 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 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 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 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 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 |
$49.72 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| 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 |
$65.02
|
| Rate for Payer: Nomi Health Commercial |
$62.73
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| 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 |
$65.02
|
| 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 |
$65.02
|
| 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 |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.72
|
| 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
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Medicare |
$10.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.35
|
| Rate for Payer: BCBS Complete |
$10.43
|
| Rate for Payer: BCBS MAPPO |
$9.88
|
| Rate for Payer: BCBS Trust/PPO |
$32.48
|
| Rate for Payer: BCN Commercial |
$30.72
|
| Rate for Payer: BCN Medicare Advantage |
$9.88
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.88
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.63
|
| Rate for Payer: Mclaren Medicaid |
$9.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.37
|
| Rate for Payer: Meridian Medicaid |
$10.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: PACE Senior Care Partners |
$9.38
|
| Rate for Payer: PACE SWMI |
$9.88
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Medicare Advantage |
$9.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health HMO/PPO |
$34.37
|
| Rate for Payer: Priority Health Medicare |
$9.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.77
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.88
|
| Rate for Payer: UHC Exchange |
$9.88
|
| Rate for Payer: UHC Medicare Advantage |
$9.88
|
| Rate for Payer: UHCCP Medicaid |
$9.93
|
| Rate for Payer: VA VA |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.63
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$39.51
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$35.56 |
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$32.25
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: Cash Price |
$31.61
|
| Rate for Payer: Cofinity Commercial |
$33.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.61
|
| Rate for Payer: Healthscope Commercial |
$35.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health HMO/PPO |
$34.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.77
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.63
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$252.66 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: BCBS Trust/PPO |
$317.30
|
| Rate for Payer: BCN Commercial |
$300.40
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$388.71
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.32 |
| Max. Negotiated Rate |
$349.84 |
| Rate for Payer: Aetna Commercial |
$330.40
|
| Rate for Payer: Aetna Medicare |
$101.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.47
|
| Rate for Payer: BCBS Complete |
$155.48
|
| Rate for Payer: BCBS MAPPO |
$97.18
|
| Rate for Payer: BCBS Trust/PPO |
$319.56
|
| Rate for Payer: BCN Commercial |
$302.22
|
| Rate for Payer: BCN Medicare Advantage |
$97.18
|
| Rate for Payer: Cash Price |
$310.97
|
| Rate for Payer: Cofinity Commercial |
$334.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.18
|
| Rate for Payer: Healthscope Commercial |
$349.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.40
|
| Rate for Payer: Nomi Health Commercial |
$318.74
|
| Rate for Payer: PACE Senior Care Partners |
$92.32
|
| Rate for Payer: PACE SWMI |
$97.18
|
| Rate for Payer: PHP Commercial |
$330.40
|
| Rate for Payer: PHP Medicare Advantage |
$97.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.66
|
| Rate for Payer: Priority Health HMO/PPO |
$338.18
|
| Rate for Payer: Priority Health Medicare |
$98.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.44
|
| Rate for Payer: Railroad Medicare Medicare |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.06
|
| Rate for Payer: UHC Core |
$324.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.18
|
| Rate for Payer: UHC Exchange |
$97.18
|
| Rate for Payer: UHC Medicare Advantage |
$97.18
|
| Rate for Payer: VA VA |
$97.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.53
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.85 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$45.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.06
|
| Rate for Payer: BCBS Complete |
$70.48
|
| Rate for Payer: BCBS MAPPO |
$44.05
|
| Rate for Payer: BCBS Trust/PPO |
$144.85
|
| Rate for Payer: BCN Commercial |
$136.99
|
| Rate for Payer: BCN Medicare Advantage |
$44.05
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.05
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: Nomi Health Commercial |
$144.48
|
| Rate for Payer: PACE Senior Care Partners |
$41.85
|
| Rate for Payer: PACE SWMI |
$44.05
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: PHP Medicare Advantage |
$44.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health HMO/PPO |
$153.29
|
| Rate for Payer: Priority Health Medicare |
$44.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.05
|
| Rate for Payer: Railroad Medicare Medicare |
$44.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.05
|
| Rate for Payer: UHC Core |
$147.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.05
|
| Rate for Payer: UHC Exchange |
$44.05
|
| Rate for Payer: UHC Medicare Advantage |
$44.05
|
| Rate for Payer: VA VA |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.14
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$176.19
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: BCBS Trust/PPO |
$143.82
|
| Rate for Payer: BCN Commercial |
$136.16
|
| Rate for Payer: Cash Price |
$140.95
|
| Rate for Payer: Cofinity Commercial |
$151.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.95
|
| Rate for Payer: Healthscope Commercial |
$158.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.76
|
| Rate for Payer: Nomi Health Commercial |
$144.48
|
| Rate for Payer: PHP Commercial |
$149.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.52
|
| Rate for Payer: Priority Health HMO/PPO |
$153.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.05
|
| Rate for Payer: UHC Core |
$147.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.14
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: BCBS Trust/PPO |
$62.59
|
| Rate for Payer: BCN Commercial |
$59.25
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Nomi Health Commercial |
$62.87
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health HMO/PPO |
$66.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.47
|
| Rate for Payer: UHC Core |
$64.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$76.67
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$65.17
|
| Rate for Payer: Aetna Medicare |
$19.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.96
|
| Rate for Payer: BCBS Complete |
$30.67
|
| Rate for Payer: BCBS MAPPO |
$19.17
|
| Rate for Payer: BCBS Trust/PPO |
$63.03
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: BCN Medicare Advantage |
$19.17
|
| Rate for Payer: Cash Price |
$61.34
|
| Rate for Payer: Cofinity Commercial |
$65.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.17
|
| Rate for Payer: Healthscope Commercial |
$69.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.17
|
| Rate for Payer: Nomi Health Commercial |
$62.87
|
| Rate for Payer: PACE Senior Care Partners |
$18.21
|
| Rate for Payer: PACE SWMI |
$19.17
|
| Rate for Payer: PHP Commercial |
$65.17
|
| Rate for Payer: PHP Medicare Advantage |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.84
|
| Rate for Payer: Priority Health HMO/PPO |
$66.70
|
| Rate for Payer: Priority Health Medicare |
$19.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.37
|
| Rate for Payer: Railroad Medicare Medicare |
$19.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.47
|
| Rate for Payer: UHC Core |
$64.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.17
|
| Rate for Payer: UHC Exchange |
$19.17
|
| Rate for Payer: UHC Medicare Advantage |
$19.17
|
| Rate for Payer: VA VA |
$19.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.50
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: BCBS Trust/PPO |
$135.88
|
| Rate for Payer: BCN Commercial |
$128.64
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health HMO/PPO |
$144.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.48
|
| Rate for Payer: UHC Core |
$138.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.84
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$149.81 |
| Rate for Payer: Aetna Commercial |
$141.49
|
| Rate for Payer: Aetna Medicare |
$43.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.02
|
| Rate for Payer: BCBS Complete |
$66.58
|
| Rate for Payer: BCBS MAPPO |
$41.62
|
| Rate for Payer: BCBS Trust/PPO |
$136.85
|
| Rate for Payer: BCN Commercial |
$129.42
|
| Rate for Payer: BCN Medicare Advantage |
$41.62
|
| Rate for Payer: Cash Price |
$133.17
|
| Rate for Payer: Cofinity Commercial |
$143.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$149.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.49
|
| Rate for Payer: Nomi Health Commercial |
$136.50
|
| Rate for Payer: PACE Senior Care Partners |
$39.53
|
| Rate for Payer: PACE SWMI |
$41.62
|
| Rate for Payer: PHP Commercial |
$141.49
|
| Rate for Payer: PHP Medicare Advantage |
$41.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.20
|
| Rate for Payer: Priority Health HMO/PPO |
$144.82
|
| Rate for Payer: Priority Health Medicare |
$42.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.53
|
| Rate for Payer: Railroad Medicare Medicare |
$41.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.48
|
| Rate for Payer: UHC Core |
$138.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.62
|
| Rate for Payer: UHC Exchange |
$41.62
|
| Rate for Payer: UHC Medicare Advantage |
$41.62
|
| Rate for Payer: VA VA |
$41.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.84
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$110.61 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: BCBS Trust/PPO |
$138.91
|
| Rate for Payer: BCN Commercial |
$131.51
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: Nomi Health Commercial |
$139.54
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health HMO/PPO |
$148.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.75
|
| Rate for Payer: UHC Core |
$142.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.63
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$170.17
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$153.15 |
| Rate for Payer: Aetna Commercial |
$144.64
|
| Rate for Payer: Aetna Medicare |
$44.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.18
|
| Rate for Payer: BCBS Complete |
$68.07
|
| Rate for Payer: BCBS MAPPO |
$42.54
|
| Rate for Payer: BCBS Trust/PPO |
$139.90
|
| Rate for Payer: BCN Commercial |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$42.54
|
| Rate for Payer: Cash Price |
$136.14
|
| Rate for Payer: Cofinity Commercial |
$146.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.54
|
| Rate for Payer: Healthscope Commercial |
$153.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.64
|
| Rate for Payer: Nomi Health Commercial |
$139.54
|
| Rate for Payer: PACE Senior Care Partners |
$40.42
|
| Rate for Payer: PACE SWMI |
$42.54
|
| Rate for Payer: PHP Commercial |
$144.64
|
| Rate for Payer: PHP Medicare Advantage |
$42.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.61
|
| Rate for Payer: Priority Health HMO/PPO |
$148.05
|
| Rate for Payer: Priority Health Medicare |
$42.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.01
|
| Rate for Payer: Railroad Medicare Medicare |
$42.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.75
|
| Rate for Payer: UHC Core |
$142.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.54
|
| Rate for Payer: UHC Exchange |
$42.54
|
| Rate for Payer: UHC Medicare Advantage |
$42.54
|
| Rate for Payer: VA VA |
$42.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.63
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,018.71 |
| Max. Negotiated Rate |
$11,439.32 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: Aetna Medicare |
$3,304.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.98
|
| Rate for Payer: BCBS Complete |
$6,156.08
|
| Rate for Payer: BCBS MAPPO |
$3,177.59
|
| Rate for Payer: BCBS Trust/PPO |
$10,449.18
|
| Rate for Payer: BCN Commercial |
$9,882.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.59
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.59
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,532.76
|
| Rate for Payer: Mclaren Medicaid |
$5,862.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.47
|
| Rate for Payer: Meridian Medicaid |
$6,156.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: Nomi Health Commercial |
$10,422.49
|
| Rate for Payer: PACE Senior Care Partners |
$3,018.71
|
| Rate for Payer: PACE SWMI |
$3,177.59
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,862.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health HMO/PPO |
$11,058.00
|
| Rate for Payer: Priority Health Medicare |
$3,209.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,515.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,185.11
|
| Rate for Payer: UHC Core |
$10,613.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.59
|
| Rate for Payer: UHC Exchange |
$3,177.59
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.59
|
| Rate for Payer: UHCCP Medicaid |
$5,862.55
|
| Rate for Payer: VA VA |
$3,177.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,532.76
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,710.35
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,261.73 |
| Max. Negotiated Rate |
$11,439.32 |
| Rate for Payer: Aetna Commercial |
$10,803.80
|
| Rate for Payer: BCBS Trust/PPO |
$10,375.46
|
| Rate for Payer: BCN Commercial |
$9,822.56
|
| Rate for Payer: Cash Price |
$10,168.28
|
| Rate for Payer: Cofinity Commercial |
$10,930.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,168.28
|
| Rate for Payer: Healthscope Commercial |
$11,439.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,532.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,803.80
|
| Rate for Payer: Nomi Health Commercial |
$10,422.49
|
| Rate for Payer: PHP Commercial |
$10,803.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,261.73
|
| Rate for Payer: Priority Health HMO/PPO |
$11,058.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,515.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,185.11
|
| Rate for Payer: UHC Core |
$10,613.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,532.76
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
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 DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
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
|
|
