|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
IP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.59 |
| Max. Negotiated Rate |
$193.28 |
| Rate for Payer: Aetna Commercial |
$182.54
|
| Rate for Payer: BCBS Trust/PPO |
$175.30
|
| Rate for Payer: BCN Commercial |
$165.96
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$184.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Healthscope Commercial |
$193.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: Nomi Health Commercial |
$176.09
|
| Rate for Payer: PHP Commercial |
$182.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: Priority Health HMO/PPO |
$186.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.98
|
| Rate for Payer: UHC Core |
$179.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.06
|
|
|
HC FNA BX EACH ADDL US GUIDE
|
Facility
|
OP
|
$214.75
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
36100555
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$193.28 |
| Rate for Payer: Aetna Commercial |
$182.54
|
| Rate for Payer: Aetna Medicare |
$55.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.11
|
| Rate for Payer: BCBS Complete |
$85.90
|
| Rate for Payer: BCBS MAPPO |
$53.69
|
| Rate for Payer: BCBS Trust/PPO |
$176.55
|
| Rate for Payer: BCN Commercial |
$166.97
|
| Rate for Payer: BCN Medicare Advantage |
$53.69
|
| Rate for Payer: Cash Price |
$171.80
|
| Rate for Payer: Cofinity Commercial |
$184.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.69
|
| Rate for Payer: Healthscope Commercial |
$193.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: Nomi Health Commercial |
$176.09
|
| Rate for Payer: PACE Senior Care Partners |
$51.00
|
| Rate for Payer: PACE SWMI |
$53.69
|
| Rate for Payer: PHP Commercial |
$182.54
|
| Rate for Payer: PHP Medicare Advantage |
$53.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.59
|
| Rate for Payer: Priority Health HMO/PPO |
$186.83
|
| Rate for Payer: Priority Health Medicare |
$54.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.88
|
| Rate for Payer: Railroad Medicare Medicare |
$53.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.98
|
| Rate for Payer: UHC Core |
$179.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.69
|
| Rate for Payer: UHC Exchange |
$53.69
|
| Rate for Payer: UHC Medicare Advantage |
$53.69
|
| Rate for Payer: VA VA |
$53.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.06
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
OP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.35 |
| Max. Negotiated Rate |
$1,024.49 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: Aetna Medicare |
$295.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$355.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$355.73
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$284.58
|
| Rate for Payer: BCBS Trust/PPO |
$935.81
|
| Rate for Payer: BCN Commercial |
$885.04
|
| Rate for Payer: BCN Medicare Advantage |
$284.58
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$978.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.58
|
| Rate for Payer: Healthscope Commercial |
$1,024.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.74
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.81
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: Nomi Health Commercial |
$933.42
|
| Rate for Payer: PACE Senior Care Partners |
$270.35
|
| Rate for Payer: PACE SWMI |
$284.58
|
| Rate for Payer: PHP Commercial |
$967.57
|
| Rate for Payer: PHP Medicare Advantage |
$284.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: Priority Health HMO/PPO |
$990.34
|
| Rate for Payer: Priority Health Medicare |
$287.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.67
|
| Rate for Payer: Railroad Medicare Medicare |
$284.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.72
|
| Rate for Payer: UHC Core |
$950.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.58
|
| Rate for Payer: UHC Exchange |
$284.58
|
| Rate for Payer: UHC Medicare Advantage |
$284.58
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$284.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.74
|
|
|
HC FNA BX W/O IMG 1ST LESION
|
Facility
|
IP
|
$1,138.32
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
76100423
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$739.91 |
| Max. Negotiated Rate |
$1,024.49 |
| Rate for Payer: Aetna Commercial |
$967.57
|
| Rate for Payer: BCBS Trust/PPO |
$929.21
|
| Rate for Payer: BCN Commercial |
$879.69
|
| Rate for Payer: Cash Price |
$910.66
|
| Rate for Payer: Cofinity Commercial |
$978.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.66
|
| Rate for Payer: Healthscope Commercial |
$1,024.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.57
|
| Rate for Payer: Nomi Health Commercial |
$933.42
|
| Rate for Payer: PHP Commercial |
$967.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.91
|
| Rate for Payer: Priority Health HMO/PPO |
$990.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,001.72
|
| Rate for Payer: UHC Core |
$950.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.74
|
|
|
HC FNA IMED EVAL
|
Facility
|
OP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$130.10 |
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.34
|
| Rate for Payer: BCBS Complete |
$130.10
|
| Rate for Payer: BCBS MAPPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$61.41
|
| Rate for Payer: BCN Commercial |
$58.08
|
| Rate for Payer: BCN Medicare Advantage |
$18.68
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.68
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Mclaren Medicaid |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.61
|
| Rate for Payer: Meridian Medicaid |
$130.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: PACE Senior Care Partners |
$17.74
|
| Rate for Payer: PACE SWMI |
$18.68
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: PHP Medicare Advantage |
$18.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO |
$64.99
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.74
|
| Rate for Payer: UHC Core |
$62.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.68
|
| Rate for Payer: UHC Exchange |
$18.68
|
| Rate for Payer: UHC Medicare Advantage |
$18.68
|
| Rate for Payer: UHCCP Medicaid |
$123.89
|
| Rate for Payer: VA VA |
$18.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC FNA IMED EVAL
|
Facility
|
IP
|
$74.70
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
31100006
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$63.49
|
| Rate for Payer: BCBS Trust/PPO |
$60.98
|
| Rate for Payer: BCN Commercial |
$57.73
|
| Rate for Payer: Cash Price |
$59.76
|
| Rate for Payer: Cofinity Commercial |
$64.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$67.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.49
|
| Rate for Payer: Nomi Health Commercial |
$61.25
|
| Rate for Payer: PHP Commercial |
$63.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO |
$64.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.74
|
| Rate for Payer: UHC Core |
$62.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.02
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
OP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: Aetna Medicare |
$5.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.15
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS MAPPO |
$5.72
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCN Commercial |
$17.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.72
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.72
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: PACE Senior Care Partners |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.72
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: PHP Medicare Advantage |
$5.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$5.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.14
|
| Rate for Payer: UHC Core |
$19.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.72
|
| Rate for Payer: UHC Exchange |
$5.72
|
| Rate for Payer: UHC Medicare Advantage |
$5.72
|
| Rate for Payer: VA VA |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HC FNA IMMEDIATE EVAL ADDITIONAL
|
Facility
|
IP
|
$22.89
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
31000002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna Commercial |
$19.46
|
| Rate for Payer: BCBS Trust/PPO |
$18.69
|
| Rate for Payer: BCN Commercial |
$17.69
|
| Rate for Payer: Cash Price |
$18.31
|
| Rate for Payer: Cofinity Commercial |
$19.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.31
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.46
|
| Rate for Payer: Nomi Health Commercial |
$18.77
|
| Rate for Payer: PHP Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.88
|
| Rate for Payer: Priority Health HMO/PPO |
$19.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.14
|
| Rate for Payer: UHC Core |
$19.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.17
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
OP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$38.63 |
| Max. Negotiated Rate |
$199.62 |
| Rate for Payer: Aetna Commercial |
$188.53
|
| Rate for Payer: Aetna Medicare |
$57.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.31
|
| Rate for Payer: BCBS Complete |
$40.56
|
| Rate for Payer: BCBS MAPPO |
$55.45
|
| Rate for Payer: BCBS Trust/PPO |
$182.34
|
| Rate for Payer: BCN Commercial |
$172.45
|
| Rate for Payer: BCN Medicare Advantage |
$55.45
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$190.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.45
|
| Rate for Payer: Healthscope Commercial |
$199.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.35
|
| Rate for Payer: Mclaren Medicaid |
$38.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.22
|
| Rate for Payer: Meridian Medicaid |
$40.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: Nomi Health Commercial |
$181.88
|
| Rate for Payer: PACE Senior Care Partners |
$52.68
|
| Rate for Payer: PACE SWMI |
$55.45
|
| Rate for Payer: PHP Commercial |
$188.53
|
| Rate for Payer: PHP Medicare Advantage |
$55.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: Priority Health HMO/PPO |
$192.97
|
| Rate for Payer: Priority Health Medicare |
$56.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.61
|
| Rate for Payer: Railroad Medicare Medicare |
$55.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.18
|
| Rate for Payer: UHC Core |
$185.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.45
|
| Rate for Payer: UHC Exchange |
$55.45
|
| Rate for Payer: UHC Medicare Advantage |
$55.45
|
| Rate for Payer: UHCCP Medicaid |
$38.63
|
| Rate for Payer: VA VA |
$55.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.35
|
|
|
HC FNA INTERPRETATION & REPORT
|
Facility
|
IP
|
$221.80
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
31100007
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$144.17 |
| Max. Negotiated Rate |
$199.62 |
| Rate for Payer: Aetna Commercial |
$188.53
|
| Rate for Payer: BCBS Trust/PPO |
$181.06
|
| Rate for Payer: BCN Commercial |
$171.41
|
| Rate for Payer: Cash Price |
$177.44
|
| Rate for Payer: Cofinity Commercial |
$190.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.44
|
| Rate for Payer: Healthscope Commercial |
$199.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.53
|
| Rate for Payer: Nomi Health Commercial |
$181.88
|
| Rate for Payer: PHP Commercial |
$188.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.17
|
| Rate for Payer: Priority Health HMO/PPO |
$192.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.18
|
| Rate for Payer: UHC Core |
$185.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.35
|
|
|
HC FOLATE SERUM
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$48.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$10.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$11.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.61
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$10.63
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FOLATE SERUM
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
30100204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
IP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.21 |
| Max. Negotiated Rate |
$450.29 |
| Rate for Payer: Aetna Commercial |
$425.27
|
| Rate for Payer: BCBS Trust/PPO |
$408.41
|
| Rate for Payer: BCN Commercial |
$386.65
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$430.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Healthscope Commercial |
$450.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: PHP Commercial |
$425.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health HMO/PPO |
$435.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.28
|
| Rate for Payer: UHC Core |
$417.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.24
|
|
|
HC FOLEY INSERT BY PHYSICIAN
|
Facility
|
OP
|
$500.32
|
|
| Hospital Charge Code |
45000041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$450.29 |
| Rate for Payer: Aetna Commercial |
$425.27
|
| Rate for Payer: Aetna Medicare |
$130.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.35
|
| Rate for Payer: BCBS Complete |
$200.13
|
| Rate for Payer: BCBS MAPPO |
$125.08
|
| Rate for Payer: BCBS Trust/PPO |
$411.31
|
| Rate for Payer: BCN Commercial |
$389.00
|
| Rate for Payer: BCN Medicare Advantage |
$125.08
|
| Rate for Payer: Cash Price |
$400.26
|
| Rate for Payer: Cofinity Commercial |
$430.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.08
|
| Rate for Payer: Healthscope Commercial |
$450.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.27
|
| Rate for Payer: Nomi Health Commercial |
$410.26
|
| Rate for Payer: PACE Senior Care Partners |
$118.83
|
| Rate for Payer: PACE SWMI |
$125.08
|
| Rate for Payer: PHP Commercial |
$425.27
|
| Rate for Payer: PHP Medicare Advantage |
$125.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.21
|
| Rate for Payer: Priority Health HMO/PPO |
$435.28
|
| Rate for Payer: Priority Health Medicare |
$126.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.21
|
| Rate for Payer: Railroad Medicare Medicare |
$125.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.28
|
| Rate for Payer: UHC Core |
$417.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.08
|
| Rate for Payer: UHC Exchange |
$125.08
|
| Rate for Payer: UHC Medicare Advantage |
$125.08
|
| Rate for Payer: VA VA |
$125.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.24
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
OP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.48
|
| Rate for Payer: BCBS Complete |
$14.11
|
| Rate for Payer: BCBS MAPPO |
$16.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.89
|
| Rate for Payer: BCN Commercial |
$50.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.39
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.39
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Mclaren Medicaid |
$13.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.21
|
| Rate for Payer: Meridian Medicaid |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PACE Senior Care Partners |
$15.57
|
| Rate for Payer: PACE SWMI |
$16.39
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: PHP Medicare Advantage |
$16.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.03
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.68
|
| Rate for Payer: UHC Core |
$54.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.39
|
| Rate for Payer: UHC Exchange |
$16.39
|
| Rate for Payer: UHC Medicare Advantage |
$16.39
|
| Rate for Payer: UHCCP Medicaid |
$13.43
|
| Rate for Payer: VA VA |
$16.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC FOLLICLE STIM HORMONE (FSH)
|
Facility
|
IP
|
$65.55
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
30100230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$58.99 |
| Rate for Payer: Aetna Commercial |
$55.72
|
| Rate for Payer: BCBS Trust/PPO |
$53.51
|
| Rate for Payer: BCN Commercial |
$50.66
|
| Rate for Payer: Cash Price |
$52.44
|
| Rate for Payer: Cofinity Commercial |
$56.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.44
|
| Rate for Payer: Healthscope Commercial |
$58.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.72
|
| Rate for Payer: Nomi Health Commercial |
$53.75
|
| Rate for Payer: PHP Commercial |
$55.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.61
|
| Rate for Payer: Priority Health HMO/PPO |
$57.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.68
|
| Rate for Payer: UHC Core |
$54.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.16
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC FOOD ALLERGY PROFILE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200070
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
IP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.66 |
| Max. Negotiated Rate |
$585.23 |
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: BCBS Trust/PPO |
$530.80
|
| Rate for Payer: BCN Commercial |
$502.51
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Healthscope Commercial |
$585.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: Nomi Health Commercial |
$533.21
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health HMO/PPO |
$565.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$435.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.22
|
| Rate for Payer: UHC Core |
$542.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
|
HC FOREARM/ARM CUFFS FREE MOTIO
|
Facility
|
OP
|
$650.25
|
|
|
Service Code
|
HCPCS L3720
|
| Hospital Charge Code |
27400049
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$585.23 |
| Rate for Payer: Aetna Commercial |
$552.71
|
| Rate for Payer: Aetna Medicare |
$169.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.20
|
| Rate for Payer: BCBS Complete |
$260.10
|
| Rate for Payer: BCBS MAPPO |
$162.56
|
| Rate for Payer: BCBS Trust/PPO |
$534.57
|
| Rate for Payer: BCN Commercial |
$505.57
|
| Rate for Payer: BCN Medicare Advantage |
$162.56
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cofinity Commercial |
$559.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.56
|
| Rate for Payer: Healthscope Commercial |
$585.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.71
|
| Rate for Payer: Nomi Health Commercial |
$533.21
|
| Rate for Payer: PACE Senior Care Partners |
$154.43
|
| Rate for Payer: PACE SWMI |
$162.56
|
| Rate for Payer: PHP Commercial |
$552.71
|
| Rate for Payer: PHP Medicare Advantage |
$162.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.66
|
| Rate for Payer: Priority Health HMO/PPO |
$565.72
|
| Rate for Payer: Priority Health Medicare |
$164.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$435.67
|
| Rate for Payer: Railroad Medicare Medicare |
$162.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.22
|
| Rate for Payer: UHC Core |
$542.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.56
|
| Rate for Payer: UHC Exchange |
$162.56
|
| Rate for Payer: UHC Medicare Advantage |
$162.56
|
| Rate for Payer: VA VA |
$162.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.69
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$281.59
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: Aetna Medicare |
$73.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.00
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.50
|
| Rate for Payer: BCN Commercial |
$218.94
|
| Rate for Payer: BCN Medicare Advantage |
$70.40
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.40
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.92
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PACE Senior Care Partners |
$66.88
|
| Rate for Payer: PACE SWMI |
$70.40
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: PHP Medicare Advantage |
$70.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Medicare |
$71.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: Railroad Medicare Medicare |
$70.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.40
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$70.40
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$459.55
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.14 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$119.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.61
|
| Rate for Payer: BCBS Complete |
$183.82
|
| Rate for Payer: BCBS MAPPO |
$114.89
|
| Rate for Payer: BCBS Trust/PPO |
$377.80
|
| Rate for Payer: BCN Commercial |
$357.30
|
| Rate for Payer: BCN Medicare Advantage |
$114.89
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.89
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PACE Senior Care Partners |
$109.14
|
| Rate for Payer: PACE SWMI |
$114.89
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$114.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Medicare |
$116.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: Railroad Medicare Medicare |
$114.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.89
|
| Rate for Payer: UHC Exchange |
$114.89
|
| Rate for Payer: UHC Medicare Advantage |
$114.89
|
| Rate for Payer: VA VA |
$114.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$281.59
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
76100068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.03 |
| Max. Negotiated Rate |
$253.43 |
| Rate for Payer: Aetna Commercial |
$239.35
|
| Rate for Payer: BCBS Trust/PPO |
$229.86
|
| Rate for Payer: BCN Commercial |
$217.61
|
| Rate for Payer: Cash Price |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.27
|
| Rate for Payer: Healthscope Commercial |
$253.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.35
|
| Rate for Payer: Nomi Health Commercial |
$230.90
|
| Rate for Payer: PHP Commercial |
$239.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.03
|
| Rate for Payer: Priority Health HMO/PPO |
$244.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.80
|
| Rate for Payer: UHC Core |
$235.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.19
|
|
|
HC FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$459.55
|
|
| Hospital Charge Code |
45000042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.71 |
| Max. Negotiated Rate |
$413.60 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: BCBS Trust/PPO |
$375.13
|
| Rate for Payer: BCN Commercial |
$355.14
|
| Rate for Payer: Cash Price |
$367.64
|
| Rate for Payer: Cofinity Commercial |
$395.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.64
|
| Rate for Payer: Healthscope Commercial |
$413.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.62
|
| Rate for Payer: Nomi Health Commercial |
$376.83
|
| Rate for Payer: PHP Commercial |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.71
|
| Rate for Payer: Priority Health HMO/PPO |
$399.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.40
|
| Rate for Payer: UHC Core |
$383.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.66
|
|
|
HC FOREIGN BODY REMOVAL EAR
|
Facility
|
OP
|
$216.75
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
45000060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$195.07 |
| Rate for Payer: Aetna Commercial |
$184.24
|
| Rate for Payer: Aetna Medicare |
$56.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.73
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$54.19
|
| Rate for Payer: BCBS Trust/PPO |
$178.19
|
| Rate for Payer: BCN Commercial |
$168.52
|
| Rate for Payer: BCN Medicare Advantage |
$54.19
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cofinity Commercial |
$186.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.19
|
| Rate for Payer: Healthscope Commercial |
$195.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.56
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.90
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.24
|
| Rate for Payer: Nomi Health Commercial |
$177.74
|
| Rate for Payer: PACE Senior Care Partners |
$51.48
|
| Rate for Payer: PACE SWMI |
$54.19
|
| Rate for Payer: PHP Commercial |
$184.24
|
| Rate for Payer: PHP Medicare Advantage |
$54.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.89
|
| Rate for Payer: Priority Health HMO/PPO |
$188.57
|
| Rate for Payer: Priority Health Medicare |
$54.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.22
|
| Rate for Payer: Railroad Medicare Medicare |
$54.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.74
|
| Rate for Payer: UHC Core |
$180.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.19
|
| Rate for Payer: UHC Exchange |
$54.19
|
| Rate for Payer: UHC Medicare Advantage |
$54.19
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$54.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.56
|
|
