|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
IP
|
$169.26
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$152.33 |
| Rate for Payer: Aetna Commercial |
$143.87
|
| Rate for Payer: BCBS Trust/PPO |
$139.79
|
| Rate for Payer: BCN Commercial |
$139.79
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cofinity Commercial |
$145.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.41
|
| Rate for Payer: Healthscope Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.87
|
| Rate for Payer: Nomi Health Commercial |
$138.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.94
|
| Rate for Payer: PHP Commercial |
$143.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.95
|
| Rate for Payer: UHC Core |
$141.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.94
|
|
|
HC FNA BX EACH ADDL FLUORO GUIDE
|
Facility
|
OP
|
$169.26
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
36100557
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$152.33 |
| Rate for Payer: Aetna Commercial |
$143.87
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.89
|
| Rate for Payer: BCBS Complete |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$42.31
|
| Rate for Payer: BCBS Trust/PPO |
$139.15
|
| Rate for Payer: BCCCP Commercial |
$134.52
|
| Rate for Payer: BCN Commercial |
$139.15
|
| Rate for Payer: BCN Medicare Advantage |
$42.31
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cash Price |
$135.41
|
| Rate for Payer: Cofinity Commercial |
$145.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.31
|
| Rate for Payer: Healthscope Commercial |
$152.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.94
|
| Rate for Payer: Mclaren Medicaid |
$29.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.43
|
| Rate for Payer: Meridian Medicaid |
$31.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.87
|
| Rate for Payer: Nomi Health Commercial |
$138.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.94
|
| Rate for Payer: PACE Senior Care Partners |
$40.20
|
| Rate for Payer: PACE SWMI |
$42.31
|
| Rate for Payer: PHP Commercial |
$143.87
|
| Rate for Payer: PHP Medicare Advantage |
$42.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.26
|
| Rate for Payer: Priority Health Medicare |
$42.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.80
|
| Rate for Payer: Railroad Medicare Medicare |
$42.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.95
|
| Rate for Payer: UHC Core |
$141.33
|
| Rate for Payer: UHC Exchange |
$42.31
|
| Rate for Payer: UHC Medicaid |
$29.84
|
| Rate for Payer: UHC Medicare Advantage |
$42.31
|
| Rate for Payer: UHCCP Medicaid |
$29.84
|
| Rate for Payer: VA VA |
$42.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.94
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$219.05
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.62 |
| Max. Negotiated Rate |
$197.15 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$56.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.45
|
| Rate for Payer: BCBS Complete |
$40.55
|
| Rate for Payer: BCBS MAPPO |
$54.76
|
| Rate for Payer: BCBS Trust/PPO |
$180.08
|
| Rate for Payer: BCCCP Commercial |
$58.15
|
| Rate for Payer: BCN Commercial |
$180.08
|
| Rate for Payer: BCN Medicare Advantage |
$54.76
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cofinity Commercial |
$188.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.76
|
| Rate for Payer: Healthscope Commercial |
$197.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.29
|
| Rate for Payer: Mclaren Medicaid |
$38.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.50
|
| Rate for Payer: Meridian Medicaid |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.19
|
| Rate for Payer: Nomi Health Commercial |
$179.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.29
|
| Rate for Payer: PACE Senior Care Partners |
$52.02
|
| Rate for Payer: PACE SWMI |
$54.76
|
| Rate for Payer: PHP Commercial |
$186.19
|
| Rate for Payer: PHP Medicare Advantage |
$54.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.57
|
| Rate for Payer: Priority Health Medicare |
$55.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.46
|
| Rate for Payer: Railroad Medicare Medicare |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.76
|
| Rate for Payer: UHC Core |
$182.91
|
| Rate for Payer: UHC Exchange |
$54.76
|
| Rate for Payer: UHC Medicaid |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$54.76
|
| Rate for Payer: UHCCP Medicaid |
$38.62
|
| Rate for Payer: VA VA |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.29
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$219.05
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$197.15 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: BCBS Trust/PPO |
$180.91
|
| Rate for Payer: BCN Commercial |
$180.91
|
| Rate for Payer: Cash Price |
$175.24
|
| Rate for Payer: Cofinity Commercial |
$188.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.24
|
| Rate for Payer: Healthscope Commercial |
$197.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.19
|
| Rate for Payer: Nomi Health Commercial |
$179.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.29
|
| Rate for Payer: PHP Commercial |
$186.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.76
|
| Rate for Payer: UHC Core |
$182.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.29
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
OP
|
$1,161.09
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.42 |
| Max. Negotiated Rate |
$1,044.98 |
| Rate for Payer: Aetna Commercial |
$986.93
|
| Rate for Payer: Aetna Medicare |
$301.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$362.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$362.84
|
| Rate for Payer: BCBS Complete |
$214.92
|
| Rate for Payer: BCBS MAPPO |
$290.27
|
| Rate for Payer: BCBS Trust/PPO |
$954.53
|
| Rate for Payer: BCCCP Commercial |
$96.42
|
| Rate for Payer: BCN Commercial |
$954.53
|
| Rate for Payer: BCN Medicare Advantage |
$290.27
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cofinity Commercial |
$998.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.27
|
| Rate for Payer: Healthscope Commercial |
$1,044.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.82
|
| Rate for Payer: Mclaren Medicaid |
$204.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.79
|
| Rate for Payer: Meridian Medicaid |
$214.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$319.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.93
|
| Rate for Payer: Nomi Health Commercial |
$952.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.82
|
| Rate for Payer: PACE Senior Care Partners |
$275.76
|
| Rate for Payer: PACE SWMI |
$290.27
|
| Rate for Payer: PHP Commercial |
$986.93
|
| Rate for Payer: PHP Medicare Advantage |
$290.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,010.15
|
| Rate for Payer: Priority Health Medicare |
$293.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.12
|
| Rate for Payer: Railroad Medicare Medicare |
$290.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.76
|
| Rate for Payer: UHC Core |
$969.51
|
| Rate for Payer: UHC Exchange |
$290.27
|
| Rate for Payer: UHC Medicaid |
$204.70
|
| Rate for Payer: UHC Medicare Advantage |
$290.27
|
| Rate for Payer: UHCCP Medicaid |
$204.70
|
| Rate for Payer: VA VA |
$290.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.82
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
IP
|
$1,161.09
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.12 |
| Max. Negotiated Rate |
$1,044.98 |
| Rate for Payer: Aetna Commercial |
$986.93
|
| Rate for Payer: BCBS Trust/PPO |
$958.94
|
| Rate for Payer: BCN Commercial |
$958.94
|
| Rate for Payer: Cash Price |
$928.87
|
| Rate for Payer: Cofinity Commercial |
$998.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$928.87
|
| Rate for Payer: Healthscope Commercial |
$1,044.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$870.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.93
|
| Rate for Payer: Nomi Health Commercial |
$952.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$870.82
|
| Rate for Payer: PHP Commercial |
$986.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,010.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.76
|
| Rate for Payer: UHC Core |
$969.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$870.82
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$76.19
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$68.57 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: Aetna Medicare |
$19.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.81
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: BCBS MAPPO |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$62.64
|
| Rate for Payer: BCCCP Commercial |
$53.08
|
| Rate for Payer: BCN Commercial |
$62.64
|
| Rate for Payer: BCN Medicare Advantage |
$19.05
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.05
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.14
|
| Rate for Payer: Mclaren Medicaid |
$13.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.00
|
| Rate for Payer: Meridian Medicaid |
$14.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Nomi Health Commercial |
$62.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PACE Senior Care Partners |
$18.10
|
| Rate for Payer: PACE SWMI |
$19.05
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: PHP Medicare Advantage |
$19.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.29
|
| Rate for Payer: Priority Health Medicare |
$19.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.03
|
| Rate for Payer: Railroad Medicare Medicare |
$19.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.05
|
| Rate for Payer: UHC Core |
$63.62
|
| Rate for Payer: UHC Exchange |
$19.05
|
| Rate for Payer: UHC Medicaid |
$13.43
|
| Rate for Payer: UHC Medicare Advantage |
$19.05
|
| Rate for Payer: UHCCP Medicaid |
$13.43
|
| Rate for Payer: VA VA |
$19.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.14
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$76.19
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.03 |
| Max. Negotiated Rate |
$68.57 |
| Rate for Payer: Aetna Commercial |
$64.76
|
| Rate for Payer: BCBS Trust/PPO |
$62.93
|
| Rate for Payer: BCN Commercial |
$62.93
|
| Rate for Payer: Cash Price |
$60.95
|
| Rate for Payer: Cofinity Commercial |
$65.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$68.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.76
|
| Rate for Payer: Nomi Health Commercial |
$62.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.14
|
| Rate for Payer: PHP Commercial |
$64.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.05
|
| Rate for Payer: UHC Core |
$63.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.14
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$24.80
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.26 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.48
|
| Rate for Payer: BCN Commercial |
$20.48
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: Nomi Health Commercial |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.60
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$24.80
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.75
|
| Rate for Payer: BCBS Complete |
$4.59
|
| Rate for Payer: BCBS MAPPO |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$20.39
|
| Rate for Payer: BCCCP Commercial |
$28.02
|
| Rate for Payer: BCN Commercial |
$20.39
|
| Rate for Payer: BCN Medicare Advantage |
$6.20
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Mclaren Medicaid |
$4.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.51
|
| Rate for Payer: Meridian Medicaid |
$4.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.08
|
| Rate for Payer: Nomi Health Commercial |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.60
|
| Rate for Payer: PACE Senior Care Partners |
$5.89
|
| Rate for Payer: PACE SWMI |
$6.20
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: PHP Medicare Advantage |
$6.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.58
|
| Rate for Payer: Priority Health Medicare |
$6.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: UHC Exchange |
$6.20
|
| Rate for Payer: UHC Medicaid |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$6.20
|
| Rate for Payer: UHCCP Medicaid |
$4.37
|
| Rate for Payer: VA VA |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$266.16
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.92 |
| Max. Negotiated Rate |
$239.54 |
| Rate for Payer: Aetna Commercial |
$226.24
|
| Rate for Payer: Aetna Medicare |
$69.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.17
|
| Rate for Payer: BCBS Complete |
$49.27
|
| Rate for Payer: BCBS MAPPO |
$66.54
|
| Rate for Payer: BCBS Trust/PPO |
$218.81
|
| Rate for Payer: BCCCP Commercial |
$160.49
|
| Rate for Payer: BCN Commercial |
$218.81
|
| Rate for Payer: BCN Medicare Advantage |
$66.54
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cofinity Commercial |
$228.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.54
|
| Rate for Payer: Healthscope Commercial |
$239.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.62
|
| Rate for Payer: Mclaren Medicaid |
$46.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.87
|
| Rate for Payer: Meridian Medicaid |
$49.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.24
|
| Rate for Payer: Nomi Health Commercial |
$218.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.62
|
| Rate for Payer: PACE Senior Care Partners |
$63.21
|
| Rate for Payer: PACE SWMI |
$66.54
|
| Rate for Payer: PHP Commercial |
$226.24
|
| Rate for Payer: PHP Medicare Advantage |
$66.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.56
|
| Rate for Payer: Priority Health Medicare |
$67.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.25
|
| Rate for Payer: Railroad Medicare Medicare |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.22
|
| Rate for Payer: UHC Core |
$222.24
|
| Rate for Payer: UHC Exchange |
$66.54
|
| Rate for Payer: UHC Medicaid |
$46.92
|
| Rate for Payer: UHC Medicare Advantage |
$66.54
|
| Rate for Payer: UHCCP Medicaid |
$46.92
|
| Rate for Payer: VA VA |
$66.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.62
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$266.16
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$239.54 |
| Rate for Payer: Aetna Commercial |
$226.24
|
| Rate for Payer: BCBS Trust/PPO |
$219.82
|
| Rate for Payer: BCN Commercial |
$219.82
|
| Rate for Payer: Cash Price |
$212.93
|
| Rate for Payer: Cofinity Commercial |
$228.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.93
|
| Rate for Payer: Healthscope Commercial |
$239.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.24
|
| Rate for Payer: Nomi Health Commercial |
$218.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.62
|
| Rate for Payer: PHP Commercial |
$226.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.22
|
| Rate for Payer: UHC Core |
$222.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.62
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$63.67
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.31 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: BCBS Trust/PPO |
$52.59
|
| Rate for Payer: BCN Commercial |
$52.59
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$63.67
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$54.12
|
| Rate for Payer: Aetna Medicare |
$16.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.90
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.94
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$57.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.75
|
| Rate for Payer: Mclaren Medicaid |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.71
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.12
|
| Rate for Payer: Nomi Health Commercial |
$52.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.12
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$54.12
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.39
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.31
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.03
|
| Rate for Payer: UHC Core |
$53.16
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicaid |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: UHCCP Medicaid |
$11.23
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.75
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$510.33
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: BCBS Trust/PPO |
$421.48
|
| Rate for Payer: BCN Commercial |
$421.48
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$443.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.09
|
| Rate for Payer: UHC Core |
$426.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$510.33
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.97 |
| Max. Negotiated Rate |
$459.30 |
| Rate for Payer: Aetna Commercial |
$433.78
|
| Rate for Payer: Aetna Medicare |
$132.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.48
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS MAPPO |
$127.58
|
| Rate for Payer: BCBS Trust/PPO |
$419.54
|
| Rate for Payer: BCN Commercial |
$419.54
|
| Rate for Payer: BCN Medicare Advantage |
$127.58
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cash Price |
$408.26
|
| Rate for Payer: Cofinity Commercial |
$438.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.58
|
| Rate for Payer: Healthscope Commercial |
$459.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.75
|
| Rate for Payer: Mclaren Medicaid |
$89.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.96
|
| Rate for Payer: Meridian Medicaid |
$94.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$433.78
|
| Rate for Payer: Nomi Health Commercial |
$418.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.75
|
| Rate for Payer: PACE Senior Care Partners |
$121.20
|
| Rate for Payer: PACE SWMI |
$127.58
|
| Rate for Payer: PHP Commercial |
$433.78
|
| Rate for Payer: PHP Medicare Advantage |
$127.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$443.99
|
| Rate for Payer: Priority Health Medicare |
$128.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.19
|
| Rate for Payer: Railroad Medicare Medicare |
$127.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.09
|
| Rate for Payer: UHC Core |
$426.13
|
| Rate for Payer: UHC Exchange |
$127.58
|
| Rate for Payer: UHC Medicaid |
$89.97
|
| Rate for Payer: UHC Medicare Advantage |
$127.58
|
| Rate for Payer: UHCCP Medicaid |
$125.00
|
| Rate for Payer: VA VA |
$127.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.75
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$66.86
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: Aetna Medicare |
$17.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.89
|
| Rate for Payer: BCBS Complete |
$12.38
|
| Rate for Payer: BCBS MAPPO |
$16.71
|
| Rate for Payer: BCBS Trust/PPO |
$54.97
|
| Rate for Payer: BCN Commercial |
$54.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.71
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.71
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.15
|
| Rate for Payer: Mclaren Medicaid |
$11.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.55
|
| Rate for Payer: Meridian Medicaid |
$12.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PACE Senior Care Partners |
$15.88
|
| Rate for Payer: PACE SWMI |
$16.71
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: PHP Medicare Advantage |
$16.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.17
|
| Rate for Payer: Priority Health Medicare |
$16.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.53
|
| Rate for Payer: Railroad Medicare Medicare |
$16.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$55.83
|
| Rate for Payer: UHC Exchange |
$16.71
|
| Rate for Payer: UHC Medicaid |
$11.79
|
| Rate for Payer: UHC Medicare Advantage |
$16.71
|
| Rate for Payer: UHCCP Medicaid |
$11.79
|
| Rate for Payer: VA VA |
$16.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.15
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$66.86
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$60.17 |
| Rate for Payer: Aetna Commercial |
$56.83
|
| Rate for Payer: BCBS Trust/PPO |
$55.22
|
| Rate for Payer: BCN Commercial |
$55.22
|
| Rate for Payer: Cash Price |
$53.49
|
| Rate for Payer: Cofinity Commercial |
$57.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.49
|
| Rate for Payer: Healthscope Commercial |
$60.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.83
|
| Rate for Payer: Nomi Health Commercial |
$54.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.15
|
| Rate for Payer: PHP Commercial |
$56.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.84
|
| Rate for Payer: UHC Core |
$55.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.15
|
|
|
HC FOLLOWUP EVAL OF FOOT PT LOP
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.01 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Aetna Commercial |
$338.30
|
| Rate for Payer: BCBS Trust/PPO |
$328.71
|
| Rate for Payer: BCN Commercial |
$328.71
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$342.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.40
|
| Rate for Payer: Healthscope Commercial |
$358.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.30
|
| Rate for Payer: Nomi Health Commercial |
$326.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.50
|
| Rate for Payer: PHP Commercial |
$338.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.24
|
| Rate for Payer: UHC Core |
$332.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.50
|
|
|
HC FOLLOWUP EVAL OF FOOT PT LOP
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000134
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$358.20 |
| Rate for Payer: Aetna Commercial |
$338.30
|
| Rate for Payer: Aetna Medicare |
$103.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.38
|
| Rate for Payer: BCBS Complete |
$73.67
|
| Rate for Payer: BCBS MAPPO |
$99.50
|
| Rate for Payer: BCBS Trust/PPO |
$327.20
|
| Rate for Payer: BCN Commercial |
$327.20
|
| Rate for Payer: BCN Medicare Advantage |
$99.50
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$342.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.50
|
| Rate for Payer: Healthscope Commercial |
$358.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.50
|
| Rate for Payer: Mclaren Medicaid |
$70.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.47
|
| Rate for Payer: Meridian Medicaid |
$73.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.30
|
| Rate for Payer: Nomi Health Commercial |
$326.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.50
|
| Rate for Payer: PACE Senior Care Partners |
$94.53
|
| Rate for Payer: PACE SWMI |
$99.50
|
| Rate for Payer: PHP Commercial |
$338.30
|
| Rate for Payer: PHP Medicare Advantage |
$99.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.26
|
| Rate for Payer: Priority Health Medicare |
$100.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.01
|
| Rate for Payer: Railroad Medicare Medicare |
$99.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.24
|
| Rate for Payer: UHC Core |
$332.33
|
| Rate for Payer: UHC Exchange |
$99.50
|
| Rate for Payer: UHC Medicaid |
$70.17
|
| Rate for Payer: UHC Medicare Advantage |
$99.50
|
| Rate for Payer: UHCCP Medicaid |
$70.17
|
| Rate for Payer: VA VA |
$99.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.50
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$663.26
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$461.63 |
| Max. Negotiated Rate |
$596.93 |
| Rate for Payer: Aetna Commercial |
$563.77
|
| Rate for Payer: BCBS Trust/PPO |
$547.79
|
| Rate for Payer: BCN Commercial |
$547.79
|
| Rate for Payer: Cash Price |
$530.61
|
| Rate for Payer: Cofinity Commercial |
$570.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.61
|
| Rate for Payer: Healthscope Commercial |
$596.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.77
|
| Rate for Payer: Nomi Health Commercial |
$543.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.44
|
| Rate for Payer: PHP Commercial |
$563.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$577.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.67
|
| Rate for Payer: UHC Core |
$553.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.44
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$663.26
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$116.93 |
| Max. Negotiated Rate |
$596.93 |
| Rate for Payer: Aetna Commercial |
$563.77
|
| Rate for Payer: Aetna Medicare |
$172.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.27
|
| Rate for Payer: BCBS Complete |
$122.77
|
| Rate for Payer: BCBS MAPPO |
$165.81
|
| Rate for Payer: BCBS Trust/PPO |
$545.27
|
| Rate for Payer: BCN Commercial |
$545.27
|
| Rate for Payer: BCN Medicare Advantage |
$165.81
|
| Rate for Payer: Cash Price |
$530.61
|
| Rate for Payer: Cofinity Commercial |
$570.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$530.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.81
|
| Rate for Payer: Healthscope Commercial |
$596.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.44
|
| Rate for Payer: Mclaren Medicaid |
$116.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.11
|
| Rate for Payer: Meridian Medicaid |
$122.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.77
|
| Rate for Payer: Nomi Health Commercial |
$543.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$497.44
|
| Rate for Payer: PACE Senior Care Partners |
$157.52
|
| Rate for Payer: PACE SWMI |
$165.81
|
| Rate for Payer: PHP Commercial |
$563.77
|
| Rate for Payer: PHP Medicare Advantage |
$165.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$577.04
|
| Rate for Payer: Priority Health Medicare |
$167.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.63
|
| Rate for Payer: Railroad Medicare Medicare |
$165.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$583.67
|
| Rate for Payer: UHC Core |
$553.82
|
| Rate for Payer: UHC Exchange |
$165.81
|
| Rate for Payer: UHC Medicaid |
$116.93
|
| Rate for Payer: UHC Medicare Advantage |
$165.81
|
| Rate for Payer: UHCCP Medicaid |
$116.93
|
| Rate for Payer: VA VA |
$165.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.44
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$287.22
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.64 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$244.14
|
| Rate for Payer: Aetna Medicare |
$74.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.76
|
| Rate for Payer: BCBS Complete |
$53.16
|
| Rate for Payer: BCBS MAPPO |
$71.81
|
| Rate for Payer: BCBS Trust/PPO |
$236.12
|
| Rate for Payer: BCN Commercial |
$236.12
|
| Rate for Payer: BCN Medicare Advantage |
$71.81
|
| Rate for Payer: Cash Price |
$229.78
|
| Rate for Payer: Cofinity Commercial |
$247.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$258.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.41
|
| Rate for Payer: Mclaren Medicaid |
$50.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.40
|
| Rate for Payer: Meridian Medicaid |
$53.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.14
|
| Rate for Payer: Nomi Health Commercial |
$235.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.41
|
| Rate for Payer: PACE Senior Care Partners |
$68.21
|
| Rate for Payer: PACE SWMI |
$71.81
|
| Rate for Payer: PHP Commercial |
$244.14
|
| Rate for Payer: PHP Medicare Advantage |
$71.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.88
|
| Rate for Payer: Priority Health Medicare |
$72.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.91
|
| Rate for Payer: Railroad Medicare Medicare |
$71.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.75
|
| Rate for Payer: UHC Core |
$239.83
|
| Rate for Payer: UHC Exchange |
$71.81
|
| Rate for Payer: UHC Medicaid |
$50.64
|
| Rate for Payer: UHC Medicare Advantage |
$71.81
|
| Rate for Payer: UHCCP Medicaid |
$50.64
|
| Rate for Payer: VA VA |
$71.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.41
|
|
