|
HC OPTISON 3RD ML
|
Facility
|
OP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
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 3RD ML
|
Facility
|
IP
|
$89.76
|
|
|
Service Code
|
HCPCS Q9956
|
| Hospital Charge Code |
63600170
|
|
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 OP VISIT LEVEL 1
|
Facility
|
OP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$139.18 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: Aetna Medicare |
$40.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.33
|
| Rate for Payer: BCBS Complete |
$61.86
|
| Rate for Payer: BCBS MAPPO |
$38.66
|
| Rate for Payer: BCBS Trust/PPO |
$120.24
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$120.24
|
| Rate for Payer: BCN Medicare Advantage |
$38.66
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.66
|
| Rate for Payer: Healthscope Commercial |
$139.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.45
|
| Rate for Payer: PACE Senior Care Partners |
$36.73
|
| Rate for Payer: PACE SWMI |
$38.66
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: PHP Medicare Advantage |
$38.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$38.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.32
|
| Rate for Payer: Railroad Medicare Medicare |
$38.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.66
|
| Rate for Payer: UHC Medicare Advantage |
$39.82
|
| Rate for Payer: VA VA |
$38.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 1
|
Facility
|
IP
|
$154.65
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$139.18 |
| Rate for Payer: Aetna Commercial |
$131.45
|
| Rate for Payer: BCBS Trust/PPO |
$119.51
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: Cash Price |
$123.72
|
| Rate for Payer: Cofinity Commercial |
$133.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.72
|
| Rate for Payer: Healthscope Commercial |
$139.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.45
|
| Rate for Payer: PHP Commercial |
$131.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.09
|
| Rate for Payer: UHC Core |
$129.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.99
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
OP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: Aetna Medicare |
$45.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.40
|
| Rate for Payer: BCBS Complete |
$69.64
|
| Rate for Payer: BCBS MAPPO |
$43.52
|
| Rate for Payer: BCBS Trust/PPO |
$135.35
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$135.35
|
| Rate for Payer: BCN Medicare Advantage |
$43.52
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.52
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.98
|
| Rate for Payer: PACE Senior Care Partners |
$41.35
|
| Rate for Payer: PACE SWMI |
$43.52
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: PHP Medicare Advantage |
$43.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.46
|
| Rate for Payer: Priority Health Medicare |
$43.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.18
|
| Rate for Payer: Railroad Medicare Medicare |
$43.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.52
|
| Rate for Payer: UHC Medicare Advantage |
$44.83
|
| Rate for Payer: VA VA |
$43.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 2
|
Facility
|
IP
|
$174.09
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$156.68 |
| Rate for Payer: Aetna Commercial |
$147.98
|
| Rate for Payer: BCBS Trust/PPO |
$134.54
|
| Rate for Payer: BCN Commercial |
$134.54
|
| Rate for Payer: Cash Price |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$149.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.27
|
| Rate for Payer: Healthscope Commercial |
$156.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.98
|
| Rate for Payer: PHP Commercial |
$147.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.20
|
| Rate for Payer: UHC Core |
$145.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.57
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
OP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: Aetna Medicare |
$54.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.02
|
| Rate for Payer: BCBS Complete |
$84.50
|
| Rate for Payer: BCBS MAPPO |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$164.25
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$164.25
|
| Rate for Payer: BCN Medicare Advantage |
$52.81
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.81
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.56
|
| Rate for Payer: PACE Senior Care Partners |
$50.17
|
| Rate for Payer: PACE SWMI |
$52.81
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: PHP Medicare Advantage |
$52.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.79
|
| Rate for Payer: Priority Health Medicare |
$52.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.84
|
| Rate for Payer: Railroad Medicare Medicare |
$52.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.81
|
| Rate for Payer: UHC Medicare Advantage |
$54.40
|
| Rate for Payer: VA VA |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 3
|
Facility
|
IP
|
$211.25
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000026
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$190.12 |
| Rate for Payer: Aetna Commercial |
$179.56
|
| Rate for Payer: BCBS Trust/PPO |
$163.25
|
| Rate for Payer: BCN Commercial |
$163.25
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cofinity Commercial |
$181.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.00
|
| Rate for Payer: Healthscope Commercial |
$190.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.56
|
| Rate for Payer: PHP Commercial |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.90
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.44
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
IP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.03 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$234.44
|
| Rate for Payer: BCN Commercial |
$234.44
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.86
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 4
|
Facility
|
OP
|
$303.37
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
51000030
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.05 |
| Max. Negotiated Rate |
$273.03 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$78.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.80
|
| Rate for Payer: BCBS Complete |
$121.35
|
| Rate for Payer: BCBS MAPPO |
$75.84
|
| Rate for Payer: BCBS Trust/PPO |
$235.87
|
| Rate for Payer: BCCCP Commercial |
$72.85
|
| Rate for Payer: BCN Commercial |
$235.87
|
| Rate for Payer: BCN Medicare Advantage |
$75.84
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.84
|
| Rate for Payer: Healthscope Commercial |
$273.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.86
|
| Rate for Payer: PACE Senior Care Partners |
$72.05
|
| Rate for Payer: PACE SWMI |
$75.84
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: PHP Medicare Advantage |
$75.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.93
|
| Rate for Payer: Priority Health Medicare |
$75.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.03
|
| Rate for Payer: Railroad Medicare Medicare |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.97
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.84
|
| Rate for Payer: UHC Medicare Advantage |
$78.12
|
| Rate for Payer: VA VA |
$75.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.53
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
IP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.08 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: BCBS Trust/PPO |
$390.37
|
| Rate for Payer: BCN Commercial |
$390.37
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.37
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC OP VISIT LEVEL 5
|
Facility
|
OP
|
$505.14
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000037
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$454.63 |
| Rate for Payer: Aetna Commercial |
$429.37
|
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$202.06
|
| Rate for Payer: BCBS MAPPO |
$126.28
|
| Rate for Payer: BCBS Trust/PPO |
$392.75
|
| Rate for Payer: BCN Commercial |
$392.75
|
| Rate for Payer: BCN Medicare Advantage |
$126.28
|
| Rate for Payer: Cash Price |
$404.11
|
| Rate for Payer: Cofinity Commercial |
$434.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.28
|
| Rate for Payer: Healthscope Commercial |
$454.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$378.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$429.37
|
| Rate for Payer: PACE Senior Care Partners |
$119.97
|
| Rate for Payer: PACE SWMI |
$126.28
|
| Rate for Payer: PHP Commercial |
$429.37
|
| Rate for Payer: PHP Medicare Advantage |
$126.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$353.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.47
|
| Rate for Payer: Priority Health Medicare |
$126.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$308.08
|
| Rate for Payer: Railroad Medicare Medicare |
$126.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.52
|
| Rate for Payer: UHC Core |
$421.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.28
|
| Rate for Payer: UHC Medicare Advantage |
$130.07
|
| Rate for Payer: VA VA |
$126.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$378.86
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
IP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$104.10
|
| Rate for Payer: BCN Commercial |
$104.10
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORAL CHEMO ADMINISTRATION
|
Facility
|
OP
|
$134.71
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000089
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$121.24 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.10
|
| Rate for Payer: BCBS Complete |
$53.88
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$104.74
|
| Rate for Payer: BCCCP Commercial |
$22.00
|
| Rate for Payer: BCN Commercial |
$104.74
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cash Price |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$115.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.20
|
| Rate for Payer: Priority Health Medicare |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.16
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.68
|
| Rate for Payer: UHC Medicare Advantage |
$34.69
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.03
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC ORCHARD GRASS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200052
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.19
|
| Rate for Payer: BCN Commercial |
$57.19
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.12
|
| Rate for Payer: UHC Core |
$61.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.50
|
|
|
HC ORGANIC ACIDS SCREEN URINE
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
30100372
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$19.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.12
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$18.50
|
| Rate for Payer: BCBS Trust/PPO |
$57.54
|
| Rate for Payer: BCN Commercial |
$57.54
|
| Rate for Payer: BCN Medicare Advantage |
$18.50
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.50
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PACE Senior Care Partners |
$17.58
|
| Rate for Payer: PACE SWMI |
$18.50
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Medicare Advantage |
$18.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.38
|
| Rate for Payer: Priority Health Medicare |
$18.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.13
|
| Rate for Payer: Railroad Medicare Medicare |
$18.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.12
|
| Rate for Payer: UHC Core |
$61.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.50
|
| Rate for Payer: UHC Medicare Advantage |
$19.06
|
| Rate for Payer: VA VA |
$18.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.50
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
OP
|
$29.58
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: Aetna Medicare |
$7.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.24
|
| Rate for Payer: BCBS Complete |
$11.83
|
| Rate for Payer: BCBS MAPPO |
$7.40
|
| Rate for Payer: BCBS Trust/PPO |
$23.00
|
| Rate for Payer: BCN Commercial |
$23.00
|
| Rate for Payer: BCN Medicare Advantage |
$7.40
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.40
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PACE Senior Care Partners |
$7.03
|
| Rate for Payer: PACE SWMI |
$7.40
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.73
|
| Rate for Payer: Priority Health Medicare |
$7.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.04
|
| Rate for Payer: Railroad Medicare Medicare |
$7.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.03
|
| Rate for Payer: UHC Core |
$24.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.40
|
| Rate for Payer: UHC Medicare Advantage |
$7.62
|
| Rate for Payer: VA VA |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.18
|
|
|
HC ORPHENADRINE INJECTION, PER 60MG
|
Facility
|
IP
|
$29.58
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
63600143
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$26.62 |
| Rate for Payer: Aetna Commercial |
$25.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.86
|
| Rate for Payer: BCN Commercial |
$22.86
|
| Rate for Payer: Cash Price |
$23.66
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.66
|
| Rate for Payer: Healthscope Commercial |
$26.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.14
|
| Rate for Payer: PHP Commercial |
$25.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.03
|
| Rate for Payer: UHC Core |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.18
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
OP
|
$120.85
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$108.76 |
| Rate for Payer: Aetna Commercial |
$102.72
|
| Rate for Payer: Aetna Medicare |
$31.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.77
|
| Rate for Payer: BCBS Complete |
$48.34
|
| Rate for Payer: BCBS MAPPO |
$30.21
|
| Rate for Payer: BCBS Trust/PPO |
$93.96
|
| Rate for Payer: BCN Commercial |
$93.96
|
| Rate for Payer: BCN Medicare Advantage |
$30.21
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$103.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$108.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.72
|
| Rate for Payer: PACE Senior Care Partners |
$28.70
|
| Rate for Payer: PACE SWMI |
$30.21
|
| Rate for Payer: PHP Commercial |
$102.72
|
| Rate for Payer: PHP Medicare Advantage |
$30.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.14
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.71
|
| Rate for Payer: Railroad Medicare Medicare |
$30.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.35
|
| Rate for Payer: UHC Core |
$100.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.21
|
| Rate for Payer: UHC Medicare Advantage |
$31.12
|
| Rate for Payer: VA VA |
$30.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.64
|
|
|
HC ORTHOPOX (AKA MONKEY)
|
Facility
|
IP
|
$120.85
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600334
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$108.76 |
| Rate for Payer: Aetna Commercial |
$102.72
|
| Rate for Payer: BCBS Trust/PPO |
$93.39
|
| Rate for Payer: BCN Commercial |
$93.39
|
| Rate for Payer: Cash Price |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$103.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.68
|
| Rate for Payer: Healthscope Commercial |
$108.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.72
|
| Rate for Payer: PHP Commercial |
$102.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.35
|
| Rate for Payer: UHC Core |
$100.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.64
|
|
|
HC ORTHOPOX DNA, PCR
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.81 |
| 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 |
$30.00
|
| 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: 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: 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 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 ORTHOPOX DNA, PCR
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 87593
|
| Hospital Charge Code |
30600332
|
|
Hospital Revenue Code
|
306
|
| 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 ORTHO/PROSTH MGMT SUBSEQ EA 15 MIN
|
Facility
|
IP
|
$126.91
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
42000056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Aetna Commercial |
$107.87
|
| Rate for Payer: BCBS Trust/PPO |
$98.08
|
| Rate for Payer: BCN Commercial |
$98.08
|
| Rate for Payer: Cash Price |
$101.53
|
| Rate for Payer: Cofinity Commercial |
$109.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.53
|
| Rate for Payer: Healthscope Commercial |
$114.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.87
|
| Rate for Payer: PHP Commercial |
$107.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.68
|
| Rate for Payer: UHC Core |
$105.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.18
|
|
