|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
OP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$219.80 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: Aetna Medicare |
$240.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.22
|
| Rate for Payer: BCBS Complete |
$370.20
|
| Rate for Payer: BCBS MAPPO |
$231.37
|
| Rate for Payer: BCBS Trust/PPO |
$719.57
|
| Rate for Payer: BCN Commercial |
$719.57
|
| Rate for Payer: BCN Medicare Advantage |
$231.37
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.37
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PACE Senior Care Partners |
$219.80
|
| Rate for Payer: PACE SWMI |
$231.37
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: PHP Medicare Advantage |
$231.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.18
|
| Rate for Payer: Priority Health Medicare |
$231.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.46
|
| Rate for Payer: Railroad Medicare Medicare |
$231.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.43
|
| Rate for Payer: UHC Core |
$772.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.37
|
| Rate for Payer: UHC Medicare Advantage |
$238.31
|
| Rate for Payer: VA VA |
$231.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.12
|
|
|
HC OPEN HEART TEG
|
Facility
|
IP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$330.29 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: BCBS Trust/PPO |
$418.50
|
| Rate for Payer: BCN Commercial |
$418.50
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.56
|
| Rate for Payer: UHC Core |
$452.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.16
|
|
|
HC OPEN HEART TEG
|
Facility
|
OP
|
$541.54
|
|
| Hospital Charge Code |
27000199
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$487.39 |
| Rate for Payer: Aetna Commercial |
$460.31
|
| Rate for Payer: Aetna Medicare |
$140.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.23
|
| Rate for Payer: BCBS Complete |
$216.62
|
| Rate for Payer: BCBS MAPPO |
$135.38
|
| Rate for Payer: BCBS Trust/PPO |
$421.05
|
| Rate for Payer: BCN Commercial |
$421.05
|
| Rate for Payer: BCN Medicare Advantage |
$135.38
|
| Rate for Payer: Cash Price |
$433.23
|
| Rate for Payer: Cofinity Commercial |
$465.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.38
|
| Rate for Payer: Healthscope Commercial |
$487.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.31
|
| Rate for Payer: PACE Senior Care Partners |
$128.62
|
| Rate for Payer: PACE SWMI |
$135.38
|
| Rate for Payer: PHP Commercial |
$460.31
|
| Rate for Payer: PHP Medicare Advantage |
$135.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$471.14
|
| Rate for Payer: Priority Health Medicare |
$135.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.29
|
| Rate for Payer: Railroad Medicare Medicare |
$135.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.56
|
| Rate for Payer: UHC Core |
$452.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.38
|
| Rate for Payer: UHC Medicare Advantage |
$139.45
|
| Rate for Payer: VA VA |
$135.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.16
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
OP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$81.32 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: Aetna Medicare |
$89.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.99
|
| Rate for Payer: BCBS Complete |
$136.95
|
| Rate for Payer: BCBS MAPPO |
$85.60
|
| Rate for Payer: BCBS Trust/PPO |
$266.20
|
| Rate for Payer: BCN Commercial |
$266.20
|
| Rate for Payer: BCN Medicare Advantage |
$85.60
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.60
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PACE Senior Care Partners |
$81.32
|
| Rate for Payer: PACE SWMI |
$85.60
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: PHP Medicare Advantage |
$85.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.87
|
| Rate for Payer: Priority Health Medicare |
$85.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.82
|
| Rate for Payer: Railroad Medicare Medicare |
$85.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.29
|
| Rate for Payer: UHC Core |
$285.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.60
|
| Rate for Payer: UHC Medicare Advantage |
$88.16
|
| Rate for Payer: VA VA |
$85.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.78
|
|
|
HC OP FALSE LABOR 1ST HOUR
|
Facility
|
IP
|
$342.38
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900001
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$208.82 |
| Max. Negotiated Rate |
$308.14 |
| Rate for Payer: Aetna Commercial |
$291.02
|
| Rate for Payer: BCBS Trust/PPO |
$264.59
|
| Rate for Payer: BCN Commercial |
$264.59
|
| Rate for Payer: Cash Price |
$273.90
|
| Rate for Payer: Cofinity Commercial |
$294.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.90
|
| Rate for Payer: Healthscope Commercial |
$308.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.02
|
| Rate for Payer: PHP Commercial |
$291.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.29
|
| Rate for Payer: UHC Core |
$285.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.78
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: BCBS Trust/PPO |
$146.42
|
| Rate for Payer: BCN Commercial |
$146.42
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.73
|
| Rate for Payer: UHC Core |
$158.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC OP FALSE LABOR SUB HOURS
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS S4005
|
| Hospital Charge Code |
72900002
|
|
Hospital Revenue Code
|
729
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna Medicare |
$49.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.21
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: BCBS MAPPO |
$47.37
|
| Rate for Payer: BCBS Trust/PPO |
$147.31
|
| Rate for Payer: BCN Commercial |
$147.31
|
| Rate for Payer: BCN Medicare Advantage |
$47.37
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.37
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PACE Senior Care Partners |
$45.00
|
| Rate for Payer: PACE SWMI |
$47.37
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: PHP Medicare Advantage |
$47.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.84
|
| Rate for Payer: Priority Health Medicare |
$47.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.56
|
| Rate for Payer: Railroad Medicare Medicare |
$47.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.73
|
| Rate for Payer: UHC Core |
$158.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.37
|
| Rate for Payer: UHC Medicare Advantage |
$48.79
|
| Rate for Payer: VA VA |
$47.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$590.99 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: BCBS Trust/PPO |
$748.84
|
| Rate for Payer: BCN Commercial |
$748.84
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$843.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.72
|
| Rate for Payer: UHC Core |
$809.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OP HEMODIALYSIS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
88100001
|
|
Hospital Revenue Code
|
820
|
| Min. Negotiated Rate |
$230.14 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$251.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$302.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$302.81
|
| Rate for Payer: BCBS Complete |
$481.33
|
| Rate for Payer: BCBS MAPPO |
$242.25
|
| Rate for Payer: BCBS Trust/PPO |
$753.40
|
| Rate for Payer: BCN Commercial |
$753.40
|
| Rate for Payer: BCN Medicare Advantage |
$242.25
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.25
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$726.75
|
| Rate for Payer: Mclaren Medicaid |
$458.41
|
| Rate for Payer: Meridian Medicaid |
$481.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$823.65
|
| Rate for Payer: PACE Senior Care Partners |
$230.14
|
| Rate for Payer: PACE SWMI |
$242.25
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$242.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$843.03
|
| Rate for Payer: Priority Health Medicare |
$242.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.99
|
| Rate for Payer: Railroad Medicare Medicare |
$242.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.72
|
| Rate for Payer: UHC Core |
$809.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.25
|
| Rate for Payer: UHC Medicare Advantage |
$249.52
|
| Rate for Payer: VA VA |
$242.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC OPIATE URIN
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.81
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$74.17
|
| Rate for Payer: BCN Commercial |
$74.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.66
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$24.57
|
| Rate for Payer: VA VA |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC OPIATE URIN
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.73
|
| Rate for Payer: BCN Commercial |
$73.73
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.91
|
| Rate for Payer: BCN Commercial |
$47.91
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC OPIATE URINE CONFIRM
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
30100579
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$52.70
|
| Rate for Payer: Aetna Medicare |
$16.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.38
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$15.50
|
| Rate for Payer: BCBS Trust/PPO |
$48.20
|
| Rate for Payer: BCN Commercial |
$48.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.50
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$53.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.50
|
| Rate for Payer: Healthscope Commercial |
$55.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.72
|
| Rate for Payer: PACE SWMI |
$15.50
|
| Rate for Payer: PHP Commercial |
$52.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.94
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.81
|
| Rate for Payer: Railroad Medicare Medicare |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.56
|
| Rate for Payer: UHC Core |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.50
|
| Rate for Payer: UHC Medicare Advantage |
$15.96
|
| Rate for Payer: VA VA |
$15.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.50
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$23.65
|
| Rate for Payer: BCN Commercial |
$23.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC OPIOID DRUG PANEL URIN
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
30100645
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$27.54 |
| Rate for Payer: Aetna Commercial |
$26.01
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.56
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS MAPPO |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Medicare Advantage |
$7.65
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cash Price |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.95
|
| Rate for Payer: Mclaren Medicaid |
$9.30
|
| Rate for Payer: Meridian Medicaid |
$9.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.01
|
| Rate for Payer: PACE Senior Care Partners |
$7.27
|
| Rate for Payer: PACE SWMI |
$7.65
|
| Rate for Payer: PHP Commercial |
$26.01
|
| Rate for Payer: PHP Medicare Advantage |
$7.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.62
|
| Rate for Payer: Priority Health Medicare |
$7.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.93
|
| Rate for Payer: UHC Core |
$25.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.65
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: VA VA |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.95
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
IP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$58.18 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: BCBS Trust/PPO |
$73.73
|
| Rate for Payer: BCN Commercial |
$73.73
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC OPIOID DRUG PANEL URN.
|
Facility
|
OP
|
$95.40
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100644
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$85.86 |
| Rate for Payer: Aetna Commercial |
$81.09
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.81
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$74.17
|
| Rate for Payer: BCN Commercial |
$74.17
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cash Price |
$76.32
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$85.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.55
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.09
|
| Rate for Payer: PACE Senior Care Partners |
$22.66
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$81.09
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.00
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.95
|
| Rate for Payer: UHC Core |
$79.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$24.57
|
| Rate for Payer: VA VA |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.55
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
IP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: BCBS Trust/PPO |
$71.62
|
| Rate for Payer: BCN Commercial |
$71.62
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.56
|
| Rate for Payer: UHC Core |
$77.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.51
|
|
|
HC OPIOID DRUG PANEL URN. CMPT
|
Facility
|
OP
|
$92.68
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$83.41 |
| Rate for Payer: Aetna Commercial |
$78.78
|
| Rate for Payer: Aetna Medicare |
$24.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.96
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$23.17
|
| Rate for Payer: BCBS Trust/PPO |
$72.06
|
| Rate for Payer: BCN Commercial |
$72.06
|
| Rate for Payer: BCN Medicare Advantage |
$23.17
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cash Price |
$74.14
|
| Rate for Payer: Cofinity Commercial |
$79.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.17
|
| Rate for Payer: Healthscope Commercial |
$83.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.51
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.01
|
| Rate for Payer: PACE SWMI |
$23.17
|
| Rate for Payer: PHP Commercial |
$78.78
|
| Rate for Payer: PHP Medicare Advantage |
$23.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.63
|
| Rate for Payer: Priority Health Medicare |
$23.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.53
|
| Rate for Payer: Railroad Medicare Medicare |
$23.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.56
|
| Rate for Payer: UHC Core |
$77.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.17
|
| Rate for Payer: UHC Medicare Advantage |
$23.87
|
| Rate for Payer: VA VA |
$23.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.51
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
OP
|
$60.71
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$54.64 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare |
$15.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.97
|
| Rate for Payer: BCBS Complete |
$24.28
|
| Rate for Payer: BCBS MAPPO |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$47.20
|
| Rate for Payer: BCN Commercial |
$47.20
|
| Rate for Payer: BCN Medicare Advantage |
$15.18
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$54.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.60
|
| Rate for Payer: PACE Senior Care Partners |
$14.42
|
| Rate for Payer: PACE SWMI |
$15.18
|
| Rate for Payer: PHP Commercial |
$51.60
|
| Rate for Payer: PHP Medicare Advantage |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.82
|
| Rate for Payer: Priority Health Medicare |
$15.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.03
|
| Rate for Payer: Railroad Medicare Medicare |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.42
|
| Rate for Payer: UHC Core |
$50.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.18
|
| Rate for Payer: UHC Medicare Advantage |
$15.63
|
| Rate for Payer: VA VA |
$15.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.53
|
|
|
HC OPSITE LGE SHEET
|
Facility
|
IP
|
$60.71
|
|
| Hospital Charge Code |
27000128
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$54.64 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: BCBS Trust/PPO |
$46.92
|
| Rate for Payer: BCN Commercial |
$46.92
|
| Rate for Payer: Cash Price |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.57
|
| Rate for Payer: Healthscope Commercial |
$54.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.60
|
| Rate for Payer: PHP Commercial |
$51.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.42
|
| Rate for Payer: UHC Core |
$50.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.53
|
|
|
HC OPTISON 1ST ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$23.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.05
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS MAPPO |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$22.44
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Senior Care Partners |
$21.32
|
| Rate for Payer: PACE SWMI |
$22.44
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Medicare |
$22.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.11
|
| Rate for Payer: VA VA |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
|
HC OPTISON 1ST ML
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.37
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
|
HC OPTISON 2ND ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: Aetna Medicare |
$23.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.05
|
| Rate for Payer: BCBS Complete |
$35.90
|
| Rate for Payer: BCBS MAPPO |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$69.79
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: BCN Medicare Advantage |
$22.44
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PACE Senior Care Partners |
$21.32
|
| Rate for Payer: PACE SWMI |
$22.44
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Medicare |
$22.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.11
|
| Rate for Payer: VA VA |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
|
HC OPTISON 2ND ML
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$76.30
|
| Rate for Payer: BCBS Trust/PPO |
$69.37
|
| Rate for Payer: BCN Commercial |
$69.37
|
| Rate for Payer: Cash Price |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.81
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.30
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.99
|
| Rate for Payer: UHC Core |
$74.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.32
|
|
