|
HC MINOR PROCEDURE W SEDATION
|
Facility
|
OP
|
$603.84
|
|
| Hospital Charge Code |
36000075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$143.41 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$513.26
|
| Rate for Payer: Aetna Medicare |
$157.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$188.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$188.70
|
| Rate for Payer: BCBS Complete |
$241.54
|
| Rate for Payer: BCBS MAPPO |
$150.96
|
| Rate for Payer: BCBS Trust/PPO |
$469.49
|
| Rate for Payer: BCN Commercial |
$469.49
|
| Rate for Payer: BCN Medicare Advantage |
$150.96
|
| Rate for Payer: Cash Price |
$483.07
|
| Rate for Payer: Cofinity Commercial |
$519.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$483.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.96
|
| Rate for Payer: Healthscope Commercial |
$543.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$452.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.26
|
| Rate for Payer: PACE Senior Care Partners |
$143.41
|
| Rate for Payer: PACE SWMI |
$150.96
|
| Rate for Payer: PHP Commercial |
$513.26
|
| Rate for Payer: PHP Medicare Advantage |
$150.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.34
|
| Rate for Payer: Priority Health Medicare |
$150.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$368.28
|
| Rate for Payer: Railroad Medicare Medicare |
$150.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.38
|
| Rate for Payer: UHC Core |
$504.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.96
|
| Rate for Payer: UHC Medicare Advantage |
$155.49
|
| Rate for Payer: VA VA |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$452.88
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
IP
|
$115.22
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: BCBS Trust/PPO |
$89.04
|
| Rate for Payer: BCN Commercial |
$89.04
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$99.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.18
|
| Rate for Payer: Healthscope Commercial |
$103.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.94
|
| Rate for Payer: PHP Commercial |
$97.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.39
|
| Rate for Payer: UHC Core |
$96.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.42
|
|
|
HC MITOTANE (LYSODREN)
|
Facility
|
OP
|
$115.22
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100731
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$103.70 |
| Rate for Payer: Aetna Commercial |
$97.94
|
| Rate for Payer: Aetna Medicare |
$29.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.01
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$28.80
|
| Rate for Payer: BCBS Trust/PPO |
$89.58
|
| Rate for Payer: BCN Commercial |
$89.58
|
| Rate for Payer: BCN Medicare Advantage |
$28.80
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cash Price |
$92.18
|
| Rate for Payer: Cofinity Commercial |
$99.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$103.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.42
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.94
|
| Rate for Payer: PACE Senior Care Partners |
$27.36
|
| Rate for Payer: PACE SWMI |
$28.80
|
| Rate for Payer: PHP Commercial |
$97.94
|
| Rate for Payer: PHP Medicare Advantage |
$28.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.24
|
| Rate for Payer: Priority Health Medicare |
$28.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.27
|
| Rate for Payer: Railroad Medicare Medicare |
$28.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.39
|
| Rate for Payer: UHC Core |
$96.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.80
|
| Rate for Payer: UHC Medicare Advantage |
$29.67
|
| Rate for Payer: VA VA |
$28.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.42
|
|
|
HC MMR VACCINE
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna Medicare |
$27.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.47
|
| Rate for Payer: BCBS Complete |
$42.84
|
| Rate for Payer: BCBS MAPPO |
$26.78
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: BCN Medicare Advantage |
$26.78
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.78
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PACE Senior Care Partners |
$25.44
|
| Rate for Payer: PACE SWMI |
$26.78
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: PHP Medicare Advantage |
$26.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Medicare |
$26.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$26.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.78
|
| Rate for Payer: UHC Medicare Advantage |
$27.58
|
| Rate for Payer: VA VA |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC MMR VACCINE
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
CPT 90707
|
| Hospital Charge Code |
63600027
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.32 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: BCBS Trust/PPO |
$82.77
|
| Rate for Payer: BCN Commercial |
$82.77
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.25
|
| Rate for Payer: UHC Core |
$89.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
OP
|
$50.59
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Aetna Commercial |
$43.00
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.81
|
| Rate for Payer: BCBS Complete |
$20.24
|
| Rate for Payer: BCBS MAPPO |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$39.33
|
| Rate for Payer: BCN Commercial |
$39.33
|
| Rate for Payer: BCN Medicare Advantage |
$12.65
|
| Rate for Payer: Cash Price |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$43.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.65
|
| Rate for Payer: Healthscope Commercial |
$45.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.00
|
| Rate for Payer: PACE Senior Care Partners |
$12.02
|
| Rate for Payer: PACE SWMI |
$12.65
|
| Rate for Payer: PHP Commercial |
$43.00
|
| Rate for Payer: PHP Medicare Advantage |
$12.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.01
|
| Rate for Payer: Priority Health Medicare |
$12.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.52
|
| Rate for Payer: UHC Core |
$42.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.65
|
| Rate for Payer: UHC Medicare Advantage |
$13.03
|
| Rate for Payer: VA VA |
$12.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.94
|
|
|
HC MNT GROUP 2ND REFERRAL 30 MIN
|
Facility
|
IP
|
$50.59
|
|
|
Service Code
|
HCPCS G0271
|
| Hospital Charge Code |
94200009
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Aetna Commercial |
$43.00
|
| Rate for Payer: BCBS Trust/PPO |
$39.10
|
| Rate for Payer: BCN Commercial |
$39.10
|
| Rate for Payer: Cash Price |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$43.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.47
|
| Rate for Payer: Healthscope Commercial |
$45.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.00
|
| Rate for Payer: PHP Commercial |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.52
|
| Rate for Payer: UHC Core |
$42.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.94
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
OP
|
$59.34
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Aetna Commercial |
$50.44
|
| Rate for Payer: Aetna Medicare |
$15.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.54
|
| Rate for Payer: BCBS Complete |
$23.74
|
| Rate for Payer: BCBS MAPPO |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$46.14
|
| Rate for Payer: BCN Commercial |
$46.14
|
| Rate for Payer: BCN Medicare Advantage |
$14.84
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.84
|
| Rate for Payer: Healthscope Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.44
|
| Rate for Payer: PACE Senior Care Partners |
$14.09
|
| Rate for Payer: PACE SWMI |
$14.84
|
| Rate for Payer: PHP Commercial |
$50.44
|
| Rate for Payer: PHP Medicare Advantage |
$14.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.63
|
| Rate for Payer: Priority Health Medicare |
$14.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.19
|
| Rate for Payer: Railroad Medicare Medicare |
$14.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.22
|
| Rate for Payer: UHC Core |
$49.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.84
|
| Rate for Payer: UHC Medicare Advantage |
$15.28
|
| Rate for Payer: VA VA |
$14.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.50
|
|
|
HC MNT GROUP 30 MIN
|
Facility
|
IP
|
$59.34
|
|
|
Service Code
|
CPT 97804
|
| Hospital Charge Code |
94200004
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Aetna Commercial |
$50.44
|
| Rate for Payer: BCBS Trust/PPO |
$45.86
|
| Rate for Payer: BCN Commercial |
$45.86
|
| Rate for Payer: Cash Price |
$47.47
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.47
|
| Rate for Payer: Healthscope Commercial |
$53.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.44
|
| Rate for Payer: PHP Commercial |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.22
|
| Rate for Payer: UHC Core |
$49.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.50
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
OP
|
$135.94
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Aetna Commercial |
$115.55
|
| Rate for Payer: Aetna Medicare |
$35.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.48
|
| Rate for Payer: BCBS Complete |
$54.38
|
| Rate for Payer: BCBS MAPPO |
$33.98
|
| Rate for Payer: BCBS Trust/PPO |
$105.69
|
| Rate for Payer: BCN Commercial |
$105.69
|
| Rate for Payer: BCN Medicare Advantage |
$33.98
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$116.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.98
|
| Rate for Payer: Healthscope Commercial |
$122.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.55
|
| Rate for Payer: PACE Senior Care Partners |
$32.29
|
| Rate for Payer: PACE SWMI |
$33.98
|
| Rate for Payer: PHP Commercial |
$115.55
|
| Rate for Payer: PHP Medicare Advantage |
$33.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.27
|
| Rate for Payer: Priority Health Medicare |
$33.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.91
|
| Rate for Payer: Railroad Medicare Medicare |
$33.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.63
|
| Rate for Payer: UHC Core |
$113.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.98
|
| Rate for Payer: UHC Medicare Advantage |
$35.00
|
| Rate for Payer: VA VA |
$33.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.96
|
|
|
HC MNT INITIAL 15 MIN
|
Facility
|
IP
|
$135.94
|
|
|
Service Code
|
CPT 97802
|
| Hospital Charge Code |
94200002
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$122.35 |
| Rate for Payer: Aetna Commercial |
$115.55
|
| Rate for Payer: BCBS Trust/PPO |
$105.05
|
| Rate for Payer: BCN Commercial |
$105.05
|
| Rate for Payer: Cash Price |
$108.75
|
| Rate for Payer: Cofinity Commercial |
$116.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.75
|
| Rate for Payer: Healthscope Commercial |
$122.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.55
|
| Rate for Payer: PHP Commercial |
$115.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.63
|
| Rate for Payer: UHC Core |
$113.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.96
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
IP
|
$120.16
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$73.29 |
| Max. Negotiated Rate |
$108.14 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: BCBS Trust/PPO |
$92.86
|
| Rate for Payer: BCN Commercial |
$92.86
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$103.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.13
|
| Rate for Payer: Healthscope Commercial |
$108.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.14
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.74
|
| Rate for Payer: UHC Core |
$100.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.12
|
|
|
HC MNT REASSESS & INTERVENT 15 MIN
|
Facility
|
OP
|
$120.16
|
|
|
Service Code
|
CPT 97803
|
| Hospital Charge Code |
94200003
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$108.14 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Medicare |
$31.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.55
|
| Rate for Payer: BCBS Complete |
$48.06
|
| Rate for Payer: BCBS MAPPO |
$30.04
|
| Rate for Payer: BCBS Trust/PPO |
$93.42
|
| Rate for Payer: BCN Commercial |
$93.42
|
| Rate for Payer: BCN Medicare Advantage |
$30.04
|
| Rate for Payer: Cash Price |
$96.13
|
| Rate for Payer: Cofinity Commercial |
$103.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.04
|
| Rate for Payer: Healthscope Commercial |
$108.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.14
|
| Rate for Payer: PACE Senior Care Partners |
$28.54
|
| Rate for Payer: PACE SWMI |
$30.04
|
| Rate for Payer: PHP Commercial |
$102.14
|
| Rate for Payer: PHP Medicare Advantage |
$30.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.54
|
| Rate for Payer: Priority Health Medicare |
$30.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.29
|
| Rate for Payer: Railroad Medicare Medicare |
$30.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.74
|
| Rate for Payer: UHC Core |
$100.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.04
|
| Rate for Payer: UHC Medicare Advantage |
$30.94
|
| Rate for Payer: VA VA |
$30.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.12
|
|
|
HC MOG FACS, S
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$446.25
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.06
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$131.25
|
| Rate for Payer: BCBS Trust/PPO |
$408.19
|
| Rate for Payer: BCN Commercial |
$408.19
|
| Rate for Payer: BCN Medicare Advantage |
$131.25
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$451.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.25
|
| Rate for Payer: Healthscope Commercial |
$472.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.75
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: PACE Senior Care Partners |
$124.69
|
| Rate for Payer: PACE SWMI |
$131.25
|
| Rate for Payer: PHP Commercial |
$446.25
|
| Rate for Payer: PHP Medicare Advantage |
$131.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.75
|
| Rate for Payer: Priority Health Medicare |
$131.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.20
|
| Rate for Payer: Railroad Medicare Medicare |
$131.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.00
|
| Rate for Payer: UHC Core |
$438.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.25
|
| Rate for Payer: UHC Medicare Advantage |
$135.19
|
| Rate for Payer: VA VA |
$131.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.75
|
|
|
HC MOG FACS, S
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200476
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Commercial |
$446.25
|
| Rate for Payer: BCBS Trust/PPO |
$405.72
|
| Rate for Payer: BCN Commercial |
$405.72
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cofinity Commercial |
$451.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$420.00
|
| Rate for Payer: Healthscope Commercial |
$472.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$446.25
|
| Rate for Payer: PHP Commercial |
$446.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$456.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$320.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.00
|
| Rate for Payer: UHC Core |
$438.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.75
|
|
|
HC MOG FACS TITER, S
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.44
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.31
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.81
|
| Rate for Payer: PACE SWMI |
$18.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: PHP Medicare Advantage |
$18.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: Railroad Medicare Medicare |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC MOG FACS TITER, S
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200477
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.75
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.00
|
| Rate for Payer: UHC Core |
$62.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
OP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$102.47 |
| Max. Negotiated Rate |
$667.02 |
| Rate for Payer: Aetna Commercial |
$629.96
|
| Rate for Payer: Aetna Medicare |
$192.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$231.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$231.60
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$185.28
|
| Rate for Payer: BCBS Trust/PPO |
$576.23
|
| Rate for Payer: BCN Commercial |
$576.23
|
| Rate for Payer: BCN Medicare Advantage |
$185.28
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$637.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.28
|
| Rate for Payer: Healthscope Commercial |
$667.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.85
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: PACE Senior Care Partners |
$176.02
|
| Rate for Payer: PACE SWMI |
$185.28
|
| Rate for Payer: PHP Commercial |
$629.96
|
| Rate for Payer: PHP Medicare Advantage |
$185.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.78
|
| Rate for Payer: Priority Health Medicare |
$185.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.02
|
| Rate for Payer: Railroad Medicare Medicare |
$185.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.19
|
| Rate for Payer: UHC Core |
$618.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.28
|
| Rate for Payer: UHC Medicare Advantage |
$190.84
|
| Rate for Payer: VA VA |
$185.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.85
|
|
|
HC MONITOR DOWNLOAD
|
Facility
|
IP
|
$741.13
|
|
|
Service Code
|
CPT 94776
|
| Hospital Charge Code |
41000013
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$452.02 |
| Max. Negotiated Rate |
$667.02 |
| Rate for Payer: Aetna Commercial |
$629.96
|
| Rate for Payer: BCBS Trust/PPO |
$572.75
|
| Rate for Payer: BCN Commercial |
$572.75
|
| Rate for Payer: Cash Price |
$592.90
|
| Rate for Payer: Cofinity Commercial |
$637.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.90
|
| Rate for Payer: Healthscope Commercial |
$667.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$555.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.96
|
| Rate for Payer: PHP Commercial |
$629.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$652.19
|
| Rate for Payer: UHC Core |
$618.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$555.85
|
|
|
HC MONITORED EXERCISE
|
Facility
|
OP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$57.03 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$62.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.04
|
| Rate for Payer: BCBS Complete |
$91.01
|
| Rate for Payer: BCBS MAPPO |
$60.03
|
| Rate for Payer: BCBS Trust/PPO |
$186.70
|
| Rate for Payer: BCN Commercial |
$186.70
|
| Rate for Payer: BCN Medicare Advantage |
$60.03
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.03
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.10
|
| Rate for Payer: Mclaren Medicaid |
$86.68
|
| Rate for Payer: Meridian Medicaid |
$91.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PACE Senior Care Partners |
$57.03
|
| Rate for Payer: PACE SWMI |
$60.03
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: PHP Medicare Advantage |
$60.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.91
|
| Rate for Payer: Priority Health Medicare |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.46
|
| Rate for Payer: Railroad Medicare Medicare |
$60.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.31
|
| Rate for Payer: UHC Core |
$200.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.03
|
| Rate for Payer: UHC Medicare Advantage |
$61.83
|
| Rate for Payer: VA VA |
$60.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.10
|
|
|
HC MONITORED EXERCISE
|
Facility
|
IP
|
$240.13
|
|
|
Service Code
|
CPT 93798
|
| Hospital Charge Code |
94300001
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$146.46 |
| Max. Negotiated Rate |
$216.12 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: BCBS Trust/PPO |
$185.57
|
| Rate for Payer: BCN Commercial |
$185.57
|
| Rate for Payer: Cash Price |
$192.10
|
| Rate for Payer: Cofinity Commercial |
$206.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.10
|
| Rate for Payer: Healthscope Commercial |
$216.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.11
|
| Rate for Payer: PHP Commercial |
$204.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.31
|
| Rate for Payer: UHC Core |
$200.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.10
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$4.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC MONO SCREENING MONOSPOT
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
30200186
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC MORPHINE LVL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: Aetna Medicare |
$30.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.56
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$29.25
|
| Rate for Payer: BCBS Trust/PPO |
$90.97
|
| Rate for Payer: BCN Commercial |
$90.97
|
| Rate for Payer: BCN Medicare Advantage |
$29.25
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: PACE Senior Care Partners |
$27.79
|
| Rate for Payer: PACE SWMI |
$29.25
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: PHP Medicare Advantage |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Medicare |
$29.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.36
|
| Rate for Payer: Railroad Medicare Medicare |
$29.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.96
|
| Rate for Payer: UHC Core |
$97.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.25
|
| Rate for Payer: UHC Medicare Advantage |
$30.13
|
| Rate for Payer: VA VA |
$29.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.75
|
|
|
HC MORPHINE LVL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Commercial |
$99.45
|
| Rate for Payer: BCBS Trust/PPO |
$90.42
|
| Rate for Payer: BCN Commercial |
$90.42
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$100.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.60
|
| Rate for Payer: Healthscope Commercial |
$105.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.45
|
| Rate for Payer: PHP Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.96
|
| Rate for Payer: UHC Core |
$97.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.75
|
|
