|
HC LIPID PANEL
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
30100015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC LIPOPROTEIN A
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$11.10
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$10.57
|
| Rate for Payer: Meridian Medicaid |
$11.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC LIPOPROTEIN A
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
30100280
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
OP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.84
|
| Rate for Payer: BCBS Complete |
$57.81
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCBS Trust/PPO |
$278.26
|
| Rate for Payer: BCN Commercial |
$278.26
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.42
|
| Rate for Payer: Mclaren Medicaid |
$55.05
|
| Rate for Payer: Meridian Medicaid |
$57.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PACE Senior Care Partners |
$85.00
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.36
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.28
|
| Rate for Payer: Railroad Medicare Medicare |
$89.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.94
|
| Rate for Payer: UHC Core |
$298.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Medicare Advantage |
$92.16
|
| Rate for Payer: VA VA |
$89.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.42
|
|
|
HC LIQUID PLASMA IRRADIATED
|
Facility
|
IP
|
$357.89
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000096
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$218.28 |
| Max. Negotiated Rate |
$322.10 |
| Rate for Payer: Aetna Commercial |
$304.21
|
| Rate for Payer: BCBS Trust/PPO |
$276.58
|
| Rate for Payer: BCN Commercial |
$276.58
|
| Rate for Payer: Cash Price |
$286.31
|
| Rate for Payer: Cofinity Commercial |
$307.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.31
|
| Rate for Payer: Healthscope Commercial |
$322.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$304.21
|
| Rate for Payer: PHP Commercial |
$304.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.94
|
| Rate for Payer: UHC Core |
$298.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.42
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC LISTERIA MONOCYTOGENES
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600274
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC LITHIUM LEVEL
|
Facility
|
OP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.88 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.83
|
| Rate for Payer: BCBS Complete |
$5.12
|
| Rate for Payer: BCBS MAPPO |
$13.46
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$41.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.46
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.40
|
| Rate for Payer: Mclaren Medicaid |
$4.88
|
| Rate for Payer: Meridian Medicaid |
$5.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PACE Senior Care Partners |
$12.79
|
| Rate for Payer: PACE SWMI |
$13.46
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: PHP Medicare Advantage |
$13.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.86
|
| Rate for Payer: Priority Health Medicare |
$13.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.40
|
| Rate for Payer: UHC Core |
$44.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.87
|
| Rate for Payer: VA VA |
$13.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.40
|
|
|
HC LITHIUM LEVEL
|
Facility
|
IP
|
$53.86
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
30100034
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$48.47 |
| Rate for Payer: Aetna Commercial |
$45.78
|
| Rate for Payer: BCBS Trust/PPO |
$41.62
|
| Rate for Payer: BCN Commercial |
$41.62
|
| Rate for Payer: Cash Price |
$43.09
|
| Rate for Payer: Cofinity Commercial |
$46.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$48.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.78
|
| Rate for Payer: PHP Commercial |
$45.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.40
|
| Rate for Payer: UHC Core |
$44.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.40
|
|
|
HC LITHOTRIPSY
|
Facility
|
OP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$664.08 |
| Max. Negotiated Rate |
$2,516.52 |
| Rate for Payer: Aetna Commercial |
$2,376.71
|
| Rate for Payer: Aetna Medicare |
$726.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$873.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$873.79
|
| Rate for Payer: BCBS Complete |
$1,118.45
|
| Rate for Payer: BCBS MAPPO |
$699.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.99
|
| Rate for Payer: BCN Commercial |
$2,173.99
|
| Rate for Payer: BCN Medicare Advantage |
$699.03
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$2,404.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,236.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.03
|
| Rate for Payer: Healthscope Commercial |
$2,516.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,097.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$733.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$803.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: PACE Senior Care Partners |
$664.08
|
| Rate for Payer: PACE SWMI |
$699.03
|
| Rate for Payer: PHP Commercial |
$2,376.71
|
| Rate for Payer: PHP Medicare Advantage |
$699.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.63
|
| Rate for Payer: Priority Health Medicare |
$699.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,705.36
|
| Rate for Payer: Railroad Medicare Medicare |
$699.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,460.59
|
| Rate for Payer: UHC Core |
$2,334.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.03
|
| Rate for Payer: UHC Medicare Advantage |
$720.00
|
| Rate for Payer: VA VA |
$699.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,097.10
|
|
|
HC LITHOTRIPSY
|
Facility
|
IP
|
$2,796.13
|
|
| Hospital Charge Code |
36000072
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.36 |
| Max. Negotiated Rate |
$2,516.52 |
| Rate for Payer: Aetna Commercial |
$2,376.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.85
|
| Rate for Payer: BCN Commercial |
$2,160.85
|
| Rate for Payer: Cash Price |
$2,236.90
|
| Rate for Payer: Cofinity Commercial |
$2,404.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,236.90
|
| Rate for Payer: Healthscope Commercial |
$2,516.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,097.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,376.71
|
| Rate for Payer: PHP Commercial |
$2,376.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,432.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,705.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,460.59
|
| Rate for Payer: UHC Core |
$2,334.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,097.10
|
|
|
HC LIVER BIOPSY
|
Facility
|
OP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$344.37 |
| Max. Negotiated Rate |
$1,304.99 |
| Rate for Payer: Aetna Commercial |
$1,232.49
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$453.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$453.12
|
| Rate for Payer: BCBS Complete |
$580.00
|
| Rate for Payer: BCBS MAPPO |
$362.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.37
|
| Rate for Payer: BCN Commercial |
$1,127.37
|
| Rate for Payer: BCN Medicare Advantage |
$362.50
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,246.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.50
|
| Rate for Payer: Healthscope Commercial |
$1,304.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: PACE Senior Care Partners |
$344.37
|
| Rate for Payer: PACE SWMI |
$362.50
|
| Rate for Payer: PHP Commercial |
$1,232.49
|
| Rate for Payer: PHP Medicare Advantage |
$362.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.49
|
| Rate for Payer: Priority Health Medicare |
$362.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$884.35
|
| Rate for Payer: Railroad Medicare Medicare |
$362.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.99
|
| Rate for Payer: UHC Core |
$1,210.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.50
|
| Rate for Payer: UHC Medicare Advantage |
$373.37
|
| Rate for Payer: VA VA |
$362.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.49
|
|
|
HC LIVER BIOPSY
|
Facility
|
IP
|
$1,449.99
|
|
| Hospital Charge Code |
36000073
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$884.35 |
| Max. Negotiated Rate |
$1,304.99 |
| Rate for Payer: Aetna Commercial |
$1,232.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,120.55
|
| Rate for Payer: BCN Commercial |
$1,120.55
|
| Rate for Payer: Cash Price |
$1,159.99
|
| Rate for Payer: Cofinity Commercial |
$1,246.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.99
|
| Rate for Payer: Healthscope Commercial |
$1,304.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.49
|
| Rate for Payer: PHP Commercial |
$1,232.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$884.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.99
|
| Rate for Payer: UHC Core |
$1,210.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.49
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
OP
|
$55.49
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.34
|
| Rate for Payer: BCBS Complete |
$11.27
|
| Rate for Payer: BCBS MAPPO |
$13.87
|
| Rate for Payer: BCBS Trust/PPO |
$43.14
|
| Rate for Payer: BCN Commercial |
$43.14
|
| Rate for Payer: BCN Medicare Advantage |
$13.87
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$47.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.87
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.62
|
| Rate for Payer: Mclaren Medicaid |
$10.74
|
| Rate for Payer: Meridian Medicaid |
$11.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.17
|
| Rate for Payer: PACE Senior Care Partners |
$13.18
|
| Rate for Payer: PACE SWMI |
$13.87
|
| Rate for Payer: PHP Commercial |
$47.17
|
| Rate for Payer: PHP Medicare Advantage |
$13.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.28
|
| Rate for Payer: Priority Health Medicare |
$13.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.83
|
| Rate for Payer: UHC Core |
$46.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.87
|
| Rate for Payer: UHC Medicare Advantage |
$14.29
|
| Rate for Payer: VA VA |
$13.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.62
|
|
|
HC LIVER KIDNEY MICROSOME ANTIBODY
|
Facility
|
IP
|
$55.49
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
30200208
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.84 |
| Max. Negotiated Rate |
$49.94 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: BCBS Trust/PPO |
$42.88
|
| Rate for Payer: BCN Commercial |
$42.88
|
| Rate for Payer: Cash Price |
$44.39
|
| Rate for Payer: Cofinity Commercial |
$47.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.39
|
| Rate for Payer: Healthscope Commercial |
$49.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.17
|
| Rate for Payer: PHP Commercial |
$47.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.83
|
| Rate for Payer: UHC Core |
$46.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.62
|
|
|
HC LOBSTER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC LOBSTER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200045
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
OP
|
$94.48
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$85.03 |
| Rate for Payer: Aetna Commercial |
$80.31
|
| Rate for Payer: Aetna Medicare |
$24.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.52
|
| Rate for Payer: BCBS Complete |
$37.79
|
| Rate for Payer: BCBS MAPPO |
$23.62
|
| Rate for Payer: BCBS Trust/PPO |
$73.46
|
| Rate for Payer: BCN Commercial |
$73.46
|
| Rate for Payer: BCN Medicare Advantage |
$23.62
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cofinity Commercial |
$81.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$85.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.31
|
| Rate for Payer: PACE Senior Care Partners |
$22.44
|
| Rate for Payer: PACE SWMI |
$23.62
|
| Rate for Payer: PHP Commercial |
$80.31
|
| Rate for Payer: PHP Medicare Advantage |
$23.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.20
|
| Rate for Payer: Priority Health Medicare |
$23.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.62
|
| Rate for Payer: Railroad Medicare Medicare |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.14
|
| Rate for Payer: UHC Core |
$78.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.62
|
| Rate for Payer: UHC Medicare Advantage |
$24.33
|
| Rate for Payer: VA VA |
$23.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.86
|
|
|
HC LOCAL ANES ADDL 15 MIN
|
Facility
|
IP
|
$94.48
|
|
| Hospital Charge Code |
37000009
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$85.03 |
| Rate for Payer: Aetna Commercial |
$80.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.01
|
| Rate for Payer: BCN Commercial |
$73.01
|
| Rate for Payer: Cash Price |
$75.58
|
| Rate for Payer: Cofinity Commercial |
$81.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.58
|
| Rate for Payer: Healthscope Commercial |
$85.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.31
|
| Rate for Payer: PHP Commercial |
$80.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.14
|
| Rate for Payer: UHC Core |
$78.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.86
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
IP
|
$342.78
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$209.06 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Aetna Commercial |
$291.36
|
| Rate for Payer: BCBS Trust/PPO |
$264.90
|
| Rate for Payer: BCN Commercial |
$264.90
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$294.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Healthscope Commercial |
$308.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.36
|
| Rate for Payer: PHP Commercial |
$291.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.65
|
| Rate for Payer: UHC Core |
$286.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.08
|
|
|
HC LOCAL ANES INIT 30 MIN
|
Facility
|
OP
|
$342.78
|
|
| Hospital Charge Code |
37000010
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$81.41 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Aetna Commercial |
$291.36
|
| Rate for Payer: Aetna Medicare |
$89.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.12
|
| Rate for Payer: BCBS Complete |
$137.11
|
| Rate for Payer: BCBS MAPPO |
$85.70
|
| Rate for Payer: BCBS Trust/PPO |
$266.51
|
| Rate for Payer: BCN Commercial |
$266.51
|
| Rate for Payer: BCN Medicare Advantage |
$85.70
|
| Rate for Payer: Cash Price |
$274.22
|
| Rate for Payer: Cofinity Commercial |
$294.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.70
|
| Rate for Payer: Healthscope Commercial |
$308.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.36
|
| Rate for Payer: PACE Senior Care Partners |
$81.41
|
| Rate for Payer: PACE SWMI |
$85.70
|
| Rate for Payer: PHP Commercial |
$291.36
|
| Rate for Payer: PHP Medicare Advantage |
$85.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$298.22
|
| Rate for Payer: Priority Health Medicare |
$85.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$209.06
|
| Rate for Payer: Railroad Medicare Medicare |
$85.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.65
|
| Rate for Payer: UHC Core |
$286.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.70
|
| Rate for Payer: UHC Medicare Advantage |
$88.27
|
| Rate for Payer: VA VA |
$85.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.08
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
OP
|
$202.77
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$182.49 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Medicare |
$52.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.37
|
| Rate for Payer: BCBS Complete |
$81.11
|
| Rate for Payer: BCBS MAPPO |
$50.69
|
| Rate for Payer: BCBS Trust/PPO |
$157.65
|
| Rate for Payer: BCN Commercial |
$157.65
|
| Rate for Payer: BCN Medicare Advantage |
$50.69
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.69
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.35
|
| Rate for Payer: PACE Senior Care Partners |
$48.16
|
| Rate for Payer: PACE SWMI |
$50.69
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Medicare Advantage |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.41
|
| Rate for Payer: Priority Health Medicare |
$50.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.67
|
| Rate for Payer: Railroad Medicare Medicare |
$50.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Core |
$169.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.69
|
| Rate for Payer: UHC Medicare Advantage |
$52.21
|
| Rate for Payer: VA VA |
$50.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
|
|
HC LOCALIZATION CLIP
|
Facility
|
IP
|
$202.77
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$123.67 |
| Max. Negotiated Rate |
$182.49 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: BCBS Trust/PPO |
$156.70
|
| Rate for Payer: BCN Commercial |
$156.70
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.35
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Core |
$169.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$37.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.00
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$111.96
|
| Rate for Payer: BCN Commercial |
$111.96
|
| Rate for Payer: BCN Medicare Advantage |
$36.00
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: PACE Senior Care Partners |
$34.20
|
| Rate for Payer: PACE SWMI |
$36.00
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: PHP Medicare Advantage |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.28
|
| Rate for Payer: Priority Health Medicare |
$36.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.83
|
| Rate for Payer: Railroad Medicare Medicare |
$36.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.72
|
| Rate for Payer: UHC Core |
$120.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.00
|
| Rate for Payer: UHC Medicare Advantage |
$37.08
|
| Rate for Payer: VA VA |
$36.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
|
HC LOCALIZATION DEVICE LEVEL 1
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
27800350
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$87.83 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: BCBS Trust/PPO |
$111.28
|
| Rate for Payer: BCN Commercial |
$111.28
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$123.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$129.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.40
|
| Rate for Payer: PHP Commercial |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.72
|
| Rate for Payer: UHC Core |
$120.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.00
|
|
