|
HC HEAVY METAL MERCURY
|
Facility
|
IP
|
$26.61
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
30100293
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$23.95 |
| Rate for Payer: Aetna Commercial |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$21.72
|
| Rate for Payer: BCN Commercial |
$20.56
|
| Rate for Payer: Cash Price |
$21.29
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.29
|
| Rate for Payer: Healthscope Commercial |
$23.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.62
|
| Rate for Payer: Nomi Health Commercial |
$21.82
|
| Rate for Payer: PHP Commercial |
$22.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.30
|
| Rate for Payer: Priority Health HMO/PPO |
$23.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.42
|
| Rate for Payer: UHC Core |
$22.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.96
|
|
|
HC HEAVY METAL PANEL CADMIUM LEVEL
|
Facility
|
IP
|
$38.67
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.14 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna Commercial |
$32.87
|
| Rate for Payer: BCBS Trust/PPO |
$31.57
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.94
|
| Rate for Payer: Healthscope Commercial |
$34.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.87
|
| Rate for Payer: Nomi Health Commercial |
$31.71
|
| Rate for Payer: PHP Commercial |
$32.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.14
|
| Rate for Payer: Priority Health HMO/PPO |
$33.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.03
|
| Rate for Payer: UHC Core |
$32.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC HEAVY METAL PANEL CADMIUM LEVEL
|
Facility
|
OP
|
$38.67
|
|
|
Service Code
|
CPT 82300
|
| Hospital Charge Code |
30100125
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$34.80 |
| Rate for Payer: Aetna Commercial |
$32.87
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$17.95
|
| Rate for Payer: BCBS MAPPO |
$9.67
|
| Rate for Payer: BCBS Trust/PPO |
$31.79
|
| Rate for Payer: BCN Commercial |
$30.07
|
| Rate for Payer: BCN Medicare Advantage |
$9.67
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cash Price |
$30.94
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.67
|
| Rate for Payer: Healthscope Commercial |
$34.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$17.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: Meridian Medicaid |
$17.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.87
|
| Rate for Payer: Nomi Health Commercial |
$31.71
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.67
|
| Rate for Payer: PHP Commercial |
$32.87
|
| Rate for Payer: PHP Medicare Advantage |
$9.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.14
|
| Rate for Payer: Priority Health HMO/PPO |
$33.64
|
| Rate for Payer: Priority Health Medicare |
$9.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.03
|
| Rate for Payer: UHC Core |
$32.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.67
|
| Rate for Payer: UHC Exchange |
$9.67
|
| Rate for Payer: UHC Medicare Advantage |
$9.67
|
| Rate for Payer: UHCCP Medicaid |
$17.09
|
| Rate for Payer: VA VA |
$9.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC HEAVY METAL PANEL LEAD
|
Facility
|
IP
|
$19.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$16.16
|
| Rate for Payer: BCN Commercial |
$15.30
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Nomi Health Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health HMO/PPO |
$17.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.42
|
| Rate for Payer: UHC Core |
$16.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.85
|
|
|
HC HEAVY METAL PANEL LEAD
|
Facility
|
OP
|
$19.80
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
30100276
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$17.82 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.19
|
| Rate for Payer: BCBS Complete |
$9.19
|
| Rate for Payer: BCBS MAPPO |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.28
|
| Rate for Payer: BCN Commercial |
$15.39
|
| Rate for Payer: BCN Medicare Advantage |
$4.95
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cash Price |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.95
|
| Rate for Payer: Healthscope Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.85
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.20
|
| Rate for Payer: Meridian Medicaid |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.83
|
| Rate for Payer: Nomi Health Commercial |
$16.24
|
| Rate for Payer: PACE Senior Care Partners |
$4.70
|
| Rate for Payer: PACE SWMI |
$4.95
|
| Rate for Payer: PHP Commercial |
$16.83
|
| Rate for Payer: PHP Medicare Advantage |
$4.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.87
|
| Rate for Payer: Priority Health HMO/PPO |
$17.23
|
| Rate for Payer: Priority Health Medicare |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.27
|
| Rate for Payer: Railroad Medicare Medicare |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.42
|
| Rate for Payer: UHC Core |
$16.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.95
|
| Rate for Payer: UHC Exchange |
$4.95
|
| Rate for Payer: UHC Medicare Advantage |
$4.95
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$4.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.85
|
|
|
HC HEAVY METAL SCREEN URINE
|
Facility
|
IP
|
$31.21
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.29 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.48
|
| Rate for Payer: BCN Commercial |
$24.12
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC HEAVY METAL SCREEN URINE
|
Facility
|
OP
|
$31.21
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
30100109
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$28.09 |
| Rate for Payer: Aetna Commercial |
$26.53
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.75
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$7.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.66
|
| Rate for Payer: BCN Commercial |
$24.27
|
| Rate for Payer: BCN Medicare Advantage |
$7.80
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Cofinity Commercial |
$26.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.80
|
| Rate for Payer: Healthscope Commercial |
$28.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.41
|
| Rate for Payer: Mclaren Medicaid |
$13.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Medicaid |
$14.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.53
|
| Rate for Payer: Nomi Health Commercial |
$25.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.41
|
| Rate for Payer: PACE SWMI |
$7.80
|
| Rate for Payer: PHP Commercial |
$26.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.29
|
| Rate for Payer: Priority Health HMO/PPO |
$27.15
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.46
|
| Rate for Payer: UHC Core |
$26.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.80
|
| Rate for Payer: UHC Exchange |
$7.80
|
| Rate for Payer: UHC Medicare Advantage |
$7.80
|
| Rate for Payer: UHCCP Medicaid |
$13.72
|
| Rate for Payer: VA VA |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.41
|
|
|
HC HEINZ BODIES
|
Facility
|
IP
|
$27.95
|
|
|
Service Code
|
CPT 85441
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.17 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna Commercial |
$23.76
|
| Rate for Payer: BCBS Trust/PPO |
$22.82
|
| Rate for Payer: BCN Commercial |
$21.60
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cofinity Commercial |
$24.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.36
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.76
|
| Rate for Payer: Nomi Health Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.17
|
| Rate for Payer: Priority Health HMO/PPO |
$24.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.60
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.96
|
|
|
HC HEINZ BODIES
|
Facility
|
OP
|
$27.95
|
|
|
Service Code
|
CPT 85441
|
| Hospital Charge Code |
30000008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna Commercial |
$23.76
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.73
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$6.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.98
|
| Rate for Payer: BCN Commercial |
$21.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.99
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cash Price |
$22.36
|
| Rate for Payer: Cofinity Commercial |
$24.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$25.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.96
|
| Rate for Payer: Mclaren Medicaid |
$3.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.34
|
| Rate for Payer: Meridian Medicaid |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.76
|
| Rate for Payer: Nomi Health Commercial |
$22.92
|
| Rate for Payer: PACE Senior Care Partners |
$6.64
|
| Rate for Payer: PACE SWMI |
$6.99
|
| Rate for Payer: PHP Commercial |
$23.76
|
| Rate for Payer: PHP Medicare Advantage |
$6.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.17
|
| Rate for Payer: Priority Health HMO/PPO |
$24.32
|
| Rate for Payer: Priority Health Medicare |
$7.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.60
|
| Rate for Payer: UHC Core |
$23.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.99
|
| Rate for Payer: UHC Exchange |
$6.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.99
|
| Rate for Payer: UHCCP Medicaid |
$3.04
|
| Rate for Payer: VA VA |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.96
|
|
|
HC HELICOBACTER PYLORI DRUG ADMINISTRATION
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
30600224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$5.97
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$5.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$5.68
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC HELICOBACTER PYLORI DRUG ADMINISTRATION
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83014
|
| Hospital Charge Code |
30600224
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC HELICOBACTER PYLORI IGG
|
Facility
|
IP
|
$109.75
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
30200271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: BCBS Trust/PPO |
$89.59
|
| Rate for Payer: BCN Commercial |
$84.81
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO |
$95.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Core |
$91.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC HELICOBACTER PYLORI IGG
|
Facility
|
OP
|
$109.75
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
30200271
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$98.78 |
| Rate for Payer: Aetna Commercial |
$93.29
|
| Rate for Payer: Aetna Medicare |
$28.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.30
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS MAPPO |
$27.44
|
| Rate for Payer: BCBS Trust/PPO |
$90.23
|
| Rate for Payer: BCN Commercial |
$85.33
|
| Rate for Payer: BCN Medicare Advantage |
$27.44
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cash Price |
$87.80
|
| Rate for Payer: Cofinity Commercial |
$94.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.44
|
| Rate for Payer: Healthscope Commercial |
$98.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.31
|
| Rate for Payer: Mclaren Medicaid |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.81
|
| Rate for Payer: Meridian Medicaid |
$12.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.29
|
| Rate for Payer: Nomi Health Commercial |
$90.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.07
|
| Rate for Payer: PACE SWMI |
$27.44
|
| Rate for Payer: PHP Commercial |
$93.29
|
| Rate for Payer: PHP Medicare Advantage |
$27.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.34
|
| Rate for Payer: Priority Health HMO/PPO |
$95.48
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.53
|
| Rate for Payer: Railroad Medicare Medicare |
$27.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Core |
$91.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.44
|
| Rate for Payer: UHC Exchange |
$27.44
|
| Rate for Payer: UHC Medicare Advantage |
$27.44
|
| Rate for Payer: UHCCP Medicaid |
$12.18
|
| Rate for Payer: VA VA |
$27.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.31
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$101.44 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$127.39
|
| Rate for Payer: BCN Commercial |
$120.60
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.04
|
|
|
HC HELICO PYL BREATH TST NON RADIOACTIVE ISOTOPE
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 83013
|
| Hospital Charge Code |
30600223
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$51.14
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$121.34
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.04
|
| Rate for Payer: Mclaren Medicaid |
$48.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: Meridian Medicaid |
$51.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.44
|
| Rate for Payer: Priority Health HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.56
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.02
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: UHCCP Medicaid |
$48.70
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.04
|
|
|
HC HELMINTHO SETOMELANO IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
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 HELMINTHO SETOMELANO IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200088
|
|
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 HEMATOCRIT
|
Facility
|
OP
|
$23.87
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.46
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS MAPPO |
$5.97
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: BCN Medicare Advantage |
$5.97
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Mclaren Medicaid |
$1.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.27
|
| Rate for Payer: Meridian Medicaid |
$1.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: PACE Senior Care Partners |
$5.67
|
| Rate for Payer: PACE SWMI |
$5.97
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: PHP Medicare Advantage |
$5.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health HMO/PPO |
$20.77
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.99
|
| Rate for Payer: Railroad Medicare Medicare |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.01
|
| Rate for Payer: UHC Core |
$19.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.97
|
| Rate for Payer: UHC Exchange |
$5.97
|
| Rate for Payer: UHC Medicare Advantage |
$5.97
|
| Rate for Payer: UHCCP Medicaid |
$1.71
|
| Rate for Payer: VA VA |
$5.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
|
|
HC HEMATOCRIT
|
Facility
|
IP
|
$23.87
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
30500005
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$19.49
|
| Rate for Payer: BCN Commercial |
$18.45
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health HMO/PPO |
$20.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.01
|
| Rate for Payer: UHC Core |
$19.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$47.26 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: Aetna Medicare |
$68.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.91
|
| Rate for Payer: BCBS Complete |
$49.62
|
| Rate for Payer: BCBS MAPPO |
$66.32
|
| Rate for Payer: BCBS Trust/PPO |
$218.10
|
| Rate for Payer: BCN Commercial |
$206.27
|
| Rate for Payer: BCN Medicare Advantage |
$66.32
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.32
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.98
|
| Rate for Payer: Mclaren Medicaid |
$47.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.64
|
| Rate for Payer: Meridian Medicaid |
$49.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$217.55
|
| Rate for Payer: PACE Senior Care Partners |
$63.01
|
| Rate for Payer: PACE SWMI |
$66.32
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: PHP Medicare Advantage |
$66.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health HMO/PPO |
$230.81
|
| Rate for Payer: Priority Health Medicare |
$66.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.75
|
| Rate for Payer: Railroad Medicare Medicare |
$66.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.46
|
| Rate for Payer: UHC Core |
$221.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.32
|
| Rate for Payer: UHC Exchange |
$66.32
|
| Rate for Payer: UHC Medicare Advantage |
$66.32
|
| Rate for Payer: UHCCP Medicaid |
$47.26
|
| Rate for Payer: VA VA |
$66.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.98
|
|
|
HC HEMOCHROMATOSIS GENE ANALYSIS
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
31000100
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$172.44 |
| Max. Negotiated Rate |
$238.77 |
| Rate for Payer: Aetna Commercial |
$225.50
|
| Rate for Payer: BCBS Trust/PPO |
$216.56
|
| Rate for Payer: BCN Commercial |
$205.02
|
| Rate for Payer: Cash Price |
$212.24
|
| Rate for Payer: Cofinity Commercial |
$228.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.24
|
| Rate for Payer: Healthscope Commercial |
$238.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.50
|
| Rate for Payer: Nomi Health Commercial |
$217.55
|
| Rate for Payer: PHP Commercial |
$225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.44
|
| Rate for Payer: Priority Health HMO/PPO |
$230.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.46
|
| Rate for Payer: UHC Core |
$221.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.98
|
|
|
HC HEMO CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$244.89
|
| Rate for Payer: BCN Commercial |
$231.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEMO CMS COMP
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500002
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.75
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$75.00
|
| Rate for Payer: BCBS Trust/PPO |
$246.63
|
| Rate for Payer: BCN Commercial |
$233.25
|
| Rate for Payer: BCN Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: PACE Senior Care Partners |
$71.25
|
| Rate for Payer: PACE SWMI |
$75.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: PHP Medicare Advantage |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Medicare |
$75.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.00
|
| Rate for Payer: Railroad Medicare Medicare |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.00
|
| Rate for Payer: UHC Exchange |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$75.00
|
| Rate for Payer: VA VA |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
HC HEMO CMS F/U
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: Aetna Medicare |
$32.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.06
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$31.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.76
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$97.19
|
| Rate for Payer: BCN Medicare Advantage |
$31.25
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.25
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: PACE Senior Care Partners |
$29.69
|
| Rate for Payer: PACE SWMI |
$31.25
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: PHP Medicare Advantage |
$31.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Medicare |
$31.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.75
|
| Rate for Payer: Railroad Medicare Medicare |
$31.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.25
|
| Rate for Payer: UHC Exchange |
$31.25
|
| Rate for Payer: UHC Medicare Advantage |
$31.25
|
| Rate for Payer: VA VA |
$31.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
|
HC HEMO CMS F/U
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51500003
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna Commercial |
$106.25
|
| Rate for Payer: BCBS Trust/PPO |
$102.04
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$107.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.00
|
| Rate for Payer: Healthscope Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.25
|
| Rate for Payer: Nomi Health Commercial |
$102.50
|
| Rate for Payer: PHP Commercial |
$106.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO |
$108.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$104.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.75
|
|
