|
HC HEMO CMS INITIAL COMP
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$367.34
|
| Rate for Payer: BCN Commercial |
$347.76
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEMO CMS INITIAL COMP
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500001
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.62
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$112.50
|
| Rate for Payer: BCBS Trust/PPO |
$369.94
|
| Rate for Payer: BCN Commercial |
$349.88
|
| Rate for Payer: BCN Medicare Advantage |
$112.50
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$387.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.50
|
| Rate for Payer: Healthscope Commercial |
$405.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.50
|
| Rate for Payer: Nomi Health Commercial |
$369.00
|
| Rate for Payer: PACE Senior Care Partners |
$106.88
|
| Rate for Payer: PACE SWMI |
$112.50
|
| Rate for Payer: PHP Commercial |
$382.50
|
| Rate for Payer: PHP Medicare Advantage |
$112.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health HMO/PPO |
$391.50
|
| Rate for Payer: Priority Health Medicare |
$113.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$301.50
|
| Rate for Payer: Railroad Medicare Medicare |
$112.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.00
|
| Rate for Payer: UHC Core |
$375.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.50
|
| Rate for Payer: UHC Exchange |
$112.50
|
| Rate for Payer: UHC Medicare Advantage |
$112.50
|
| Rate for Payer: VA VA |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.50
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| 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 |
$61.66
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$58.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.75
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$64.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$67.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| 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 |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Medicare |
$18.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.25
|
| 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 Exchange |
$18.75
|
| Rate for Payer: UHC Medicare Advantage |
$18.75
|
| Rate for Payer: VA VA |
$18.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.25
|
|
|
HC HEMO CMS SUPP/SERV
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51500004
|
|
Hospital Revenue Code
|
515
|
| Min. Negotiated Rate |
$48.75 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$61.22
|
| 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 Commercial |
$63.75
|
| Rate for Payer: Nomi Health Commercial |
$61.50
|
| Rate for Payer: PHP Commercial |
$63.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health HMO/PPO |
$65.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.25
|
| 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 HEMOCONCENTRATOR
|
Facility
|
OP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: Aetna Medicare |
$60.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.88
|
| Rate for Payer: BCBS Complete |
$93.29
|
| Rate for Payer: BCBS MAPPO |
$58.31
|
| Rate for Payer: BCBS Trust/PPO |
$191.74
|
| Rate for Payer: BCN Commercial |
$181.34
|
| Rate for Payer: BCN Medicare Advantage |
$58.31
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.31
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$191.25
|
| Rate for Payer: PACE Senior Care Partners |
$55.39
|
| Rate for Payer: PACE SWMI |
$58.31
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: PHP Medicare Advantage |
$58.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: Priority Health HMO/PPO |
$202.91
|
| Rate for Payer: Priority Health Medicare |
$58.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.26
|
| Rate for Payer: Railroad Medicare Medicare |
$58.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.24
|
| Rate for Payer: UHC Core |
$194.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.31
|
| Rate for Payer: UHC Exchange |
$58.31
|
| Rate for Payer: UHC Medicare Advantage |
$58.31
|
| Rate for Payer: VA VA |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.92
|
|
|
HC HEMOCONCENTRATOR
|
Facility
|
IP
|
$233.23
|
|
| Hospital Charge Code |
27006703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$209.91 |
| Rate for Payer: Aetna Commercial |
$198.25
|
| Rate for Payer: BCBS Trust/PPO |
$190.39
|
| Rate for Payer: BCN Commercial |
$180.24
|
| Rate for Payer: Cash Price |
$186.58
|
| Rate for Payer: Cofinity Commercial |
$200.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.58
|
| Rate for Payer: Healthscope Commercial |
$209.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$191.25
|
| Rate for Payer: PHP Commercial |
$198.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.60
|
| Rate for Payer: Priority Health HMO/PPO |
$202.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.24
|
| Rate for Payer: UHC Core |
$194.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.92
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
IP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: BCBS Trust/PPO |
$209.82
|
| Rate for Payer: BCN Commercial |
$198.64
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO |
$223.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$214.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
HC HEMOCONCENTRATOR DHF
|
Facility
|
OP
|
$257.04
|
|
| Hospital Charge Code |
27000658
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$231.34 |
| Rate for Payer: Aetna Commercial |
$218.48
|
| Rate for Payer: Aetna Medicare |
$66.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.32
|
| Rate for Payer: BCBS Complete |
$102.82
|
| Rate for Payer: BCBS MAPPO |
$64.26
|
| Rate for Payer: BCBS Trust/PPO |
$211.31
|
| Rate for Payer: BCN Commercial |
$199.85
|
| Rate for Payer: BCN Medicare Advantage |
$64.26
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$221.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$231.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: PACE Senior Care Partners |
$61.05
|
| Rate for Payer: PACE SWMI |
$64.26
|
| Rate for Payer: PHP Commercial |
$218.48
|
| Rate for Payer: PHP Medicare Advantage |
$64.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO |
$223.62
|
| Rate for Payer: Priority Health Medicare |
$64.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.22
|
| Rate for Payer: Railroad Medicare Medicare |
$64.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.20
|
| Rate for Payer: UHC Core |
$214.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.26
|
| Rate for Payer: UHC Exchange |
$64.26
|
| Rate for Payer: UHC Medicare Advantage |
$64.26
|
| Rate for Payer: VA VA |
$64.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.78
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
OP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: Aetna Medicare |
$55.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.94
|
| Rate for Payer: BCBS Complete |
$85.68
|
| Rate for Payer: BCBS MAPPO |
$53.55
|
| Rate for Payer: BCBS Trust/PPO |
$176.09
|
| Rate for Payer: BCN Commercial |
$166.54
|
| Rate for Payer: BCN Medicare Advantage |
$53.55
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.55
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: PACE Senior Care Partners |
$50.87
|
| Rate for Payer: PACE SWMI |
$53.55
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: PHP Medicare Advantage |
$53.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health HMO/PPO |
$186.35
|
| Rate for Payer: Priority Health Medicare |
$54.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.51
|
| Rate for Payer: Railroad Medicare Medicare |
$53.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.50
|
| Rate for Payer: UHC Core |
$178.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.55
|
| Rate for Payer: UHC Exchange |
$53.55
|
| Rate for Payer: UHC Medicare Advantage |
$53.55
|
| Rate for Payer: VA VA |
$53.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.65
|
|
|
HC HEMOCONCENTRATOR LONG
|
Facility
|
IP
|
$214.20
|
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$139.23 |
| Max. Negotiated Rate |
$192.78 |
| Rate for Payer: Aetna Commercial |
$182.07
|
| Rate for Payer: BCBS Trust/PPO |
$174.85
|
| Rate for Payer: BCN Commercial |
$165.53
|
| Rate for Payer: Cash Price |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$184.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.36
|
| Rate for Payer: Healthscope Commercial |
$192.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.07
|
| Rate for Payer: Nomi Health Commercial |
$175.64
|
| Rate for Payer: PHP Commercial |
$182.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.23
|
| Rate for Payer: Priority Health HMO/PPO |
$186.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$143.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.50
|
| Rate for Payer: UHC Core |
$178.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.65
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| 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 |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$242.25
|
| Rate for Payer: BCBS Trust/PPO |
$796.61
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| 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 Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO |
$843.03
|
| Rate for Payer: Priority Health Medicare |
$244.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.23
|
| 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 Exchange |
$242.25
|
| Rate for Payer: UHC Medicare Advantage |
$242.25
|
| Rate for Payer: VA VA |
$242.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$726.75
|
|
|
HC HEMODIALYSIS NON-URGENT
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
88100003
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: BCBS Trust/PPO |
$790.99
|
| 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 Commercial |
$823.65
|
| Rate for Payer: Nomi Health Commercial |
$794.58
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health HMO/PPO |
$843.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.23
|
| 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 HEMOFILTRATION MONITORING HOUR
|
Facility
|
IP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$265.64 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: BCBS Trust/PPO |
$333.60
|
| Rate for Payer: BCN Commercial |
$315.82
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: Nomi Health Commercial |
$335.11
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health HMO/PPO |
$355.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.63
|
| Rate for Payer: UHC Core |
$341.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.50
|
|
|
HC HEMOFILTRATION MONITORING HOUR
|
Facility
|
OP
|
$408.67
|
|
| Hospital Charge Code |
27000114
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$97.06 |
| Max. Negotiated Rate |
$367.80 |
| Rate for Payer: Aetna Commercial |
$347.37
|
| Rate for Payer: Aetna Medicare |
$106.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.71
|
| Rate for Payer: BCBS Complete |
$163.47
|
| Rate for Payer: BCBS MAPPO |
$102.17
|
| Rate for Payer: BCBS Trust/PPO |
$335.97
|
| Rate for Payer: BCN Commercial |
$317.74
|
| Rate for Payer: BCN Medicare Advantage |
$102.17
|
| Rate for Payer: Cash Price |
$326.94
|
| Rate for Payer: Cofinity Commercial |
$351.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.17
|
| Rate for Payer: Healthscope Commercial |
$367.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.37
|
| Rate for Payer: Nomi Health Commercial |
$335.11
|
| Rate for Payer: PACE Senior Care Partners |
$97.06
|
| Rate for Payer: PACE SWMI |
$102.17
|
| Rate for Payer: PHP Commercial |
$347.37
|
| Rate for Payer: PHP Medicare Advantage |
$102.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.64
|
| Rate for Payer: Priority Health HMO/PPO |
$355.54
|
| Rate for Payer: Priority Health Medicare |
$103.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.81
|
| Rate for Payer: Railroad Medicare Medicare |
$102.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.63
|
| Rate for Payer: UHC Core |
$341.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.17
|
| Rate for Payer: UHC Exchange |
$102.17
|
| Rate for Payer: UHC Medicare Advantage |
$102.17
|
| Rate for Payer: VA VA |
$102.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.50
|
|
|
HC HEMOGLOBIN
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: BCBS MAPPO |
$7.90
|
| Rate for Payer: BCBS Trust/PPO |
$25.99
|
| Rate for Payer: BCN Commercial |
$24.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.90
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Mclaren Medicaid |
$1.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: Meridian Medicaid |
$1.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.90
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.90
|
| Rate for Payer: UHC Exchange |
$7.90
|
| Rate for Payer: UHC Medicare Advantage |
$7.90
|
| Rate for Payer: UHCCP Medicaid |
$1.71
|
| Rate for Payer: VA VA |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC HEMOGLOBIN
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
30500006
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.81
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
IP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: BCBS Trust/PPO |
$22.43
|
| Rate for Payer: BCN Commercial |
$21.24
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$22.53
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health HMO/PPO |
$23.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.18
|
| Rate for Payer: UHC Core |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.61
|
|
|
HC HEMOGLOBIN A2 AND F
|
Facility
|
OP
|
$27.48
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
30100624
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Aetna Commercial |
$23.36
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$13.71
|
| Rate for Payer: BCBS MAPPO |
$6.87
|
| Rate for Payer: BCBS Trust/PPO |
$22.59
|
| Rate for Payer: BCN Commercial |
$21.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.87
|
| Rate for Payer: Healthscope Commercial |
$24.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.61
|
| Rate for Payer: Mclaren Medicaid |
$13.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.21
|
| Rate for Payer: Meridian Medicaid |
$13.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$22.53
|
| Rate for Payer: PACE Senior Care Partners |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.87
|
| Rate for Payer: PHP Commercial |
$23.36
|
| Rate for Payer: PHP Medicare Advantage |
$6.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.86
|
| Rate for Payer: Priority Health HMO/PPO |
$23.91
|
| Rate for Payer: Priority Health Medicare |
$6.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.41
|
| Rate for Payer: Railroad Medicare Medicare |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.18
|
| Rate for Payer: UHC Core |
$22.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.87
|
| Rate for Payer: UHC Exchange |
$6.87
|
| Rate for Payer: UHC Medicare Advantage |
$6.87
|
| Rate for Payer: UHCCP Medicaid |
$13.06
|
| Rate for Payer: VA VA |
$6.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.61
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.34
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$79.83
|
| Rate for Payer: BCN Commercial |
$75.50
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.82
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.49
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PACE Senior Care Partners |
$23.06
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Commercial |
$82.54
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$24.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.28
|
| Rate for Payer: UHC Exchange |
$24.28
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.82
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100235
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.26
|
| Rate for Payer: BCN Commercial |
$75.04
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PHP Commercial |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.82
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
IP
|
$38.49
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.02 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.42
|
| Rate for Payer: BCN Commercial |
$29.75
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS, B
|
Facility
|
OP
|
$38.49
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100623
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$34.64 |
| Rate for Payer: Aetna Commercial |
$32.72
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.03
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCN Commercial |
$29.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.62
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cofinity Commercial |
$33.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.62
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.87
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.72
|
| Rate for Payer: Nomi Health Commercial |
$31.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.14
|
| Rate for Payer: PACE SWMI |
$9.62
|
| Rate for Payer: PHP Commercial |
$32.72
|
| Rate for Payer: PHP Medicare Advantage |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.02
|
| Rate for Payer: Priority Health HMO/PPO |
$33.49
|
| Rate for Payer: Priority Health Medicare |
$9.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.87
|
| Rate for Payer: UHC Core |
$32.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.62
|
| Rate for Payer: UHC Exchange |
$9.62
|
| Rate for Payer: UHC Medicare Advantage |
$9.62
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$9.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.87
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
OP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.34
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$79.83
|
| Rate for Payer: BCN Commercial |
$75.50
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.82
|
| Rate for Payer: Mclaren Medicaid |
$9.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.49
|
| Rate for Payer: Meridian Medicaid |
$9.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PACE Senior Care Partners |
$23.06
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Commercial |
$82.54
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Medicare |
$24.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.28
|
| Rate for Payer: UHC Exchange |
$24.28
|
| Rate for Payer: UHC Medicare Advantage |
$24.28
|
| Rate for Payer: UHCCP Medicaid |
$9.31
|
| Rate for Payer: VA VA |
$24.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.82
|
|
|
HC HEMOGLOBIN ELECTROPHORESIS CMP
|
Facility
|
IP
|
$97.10
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
30100236
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.12 |
| Max. Negotiated Rate |
$87.39 |
| Rate for Payer: Aetna Commercial |
$82.54
|
| Rate for Payer: BCBS Trust/PPO |
$79.26
|
| Rate for Payer: BCN Commercial |
$75.04
|
| Rate for Payer: Cash Price |
$77.68
|
| Rate for Payer: Cofinity Commercial |
$83.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.68
|
| Rate for Payer: Healthscope Commercial |
$87.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.54
|
| Rate for Payer: Nomi Health Commercial |
$79.62
|
| Rate for Payer: PHP Commercial |
$82.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.12
|
| Rate for Payer: Priority Health HMO/PPO |
$84.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.45
|
| Rate for Payer: UHC Core |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.82
|
|
|
HC HEM/ONC CMS COMP
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51500006
|
|
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
|
|
