|
HC INFUSION CATH LVL 4
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
IP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.98 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: BCBS Trust/PPO |
$485.98
|
| Rate for Payer: BCN Commercial |
$460.09
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health HMO/PPO |
$517.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 5
|
Facility
|
OP
|
$595.35
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$535.82 |
| Rate for Payer: Aetna Commercial |
$506.05
|
| Rate for Payer: Aetna Medicare |
$154.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$186.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$186.05
|
| Rate for Payer: BCBS Complete |
$238.14
|
| Rate for Payer: BCBS MAPPO |
$148.84
|
| Rate for Payer: BCBS Trust/PPO |
$489.44
|
| Rate for Payer: BCN Commercial |
$462.88
|
| Rate for Payer: BCN Medicare Advantage |
$148.84
|
| Rate for Payer: Cash Price |
$476.28
|
| Rate for Payer: Cofinity Commercial |
$512.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.84
|
| Rate for Payer: Healthscope Commercial |
$535.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$506.05
|
| Rate for Payer: Nomi Health Commercial |
$488.19
|
| Rate for Payer: PACE Senior Care Partners |
$141.40
|
| Rate for Payer: PACE SWMI |
$148.84
|
| Rate for Payer: PHP Commercial |
$506.05
|
| Rate for Payer: PHP Medicare Advantage |
$148.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.98
|
| Rate for Payer: Priority Health HMO/PPO |
$517.95
|
| Rate for Payer: Priority Health Medicare |
$150.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.88
|
| Rate for Payer: Railroad Medicare Medicare |
$148.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.91
|
| Rate for Payer: UHC Core |
$497.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.84
|
| Rate for Payer: UHC Exchange |
$148.84
|
| Rate for Payer: UHC Medicare Advantage |
$148.84
|
| Rate for Payer: VA VA |
$148.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.51
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
IP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$548.28 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: BCBS Trust/PPO |
$688.56
|
| Rate for Payer: BCN Commercial |
$651.86
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO |
$733.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.29
|
| Rate for Payer: UHC Core |
$704.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.63
|
|
|
HC INFUSION CATH LVL 8
|
Facility
|
OP
|
$843.51
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
27200309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.33 |
| Max. Negotiated Rate |
$759.16 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Medicare |
$219.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$263.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$263.60
|
| Rate for Payer: BCBS Complete |
$337.40
|
| Rate for Payer: BCBS MAPPO |
$210.88
|
| Rate for Payer: BCBS Trust/PPO |
$693.45
|
| Rate for Payer: BCN Commercial |
$655.83
|
| Rate for Payer: BCN Medicare Advantage |
$210.88
|
| Rate for Payer: Cash Price |
$674.81
|
| Rate for Payer: Cofinity Commercial |
$725.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$674.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.88
|
| Rate for Payer: Healthscope Commercial |
$759.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$632.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$716.98
|
| Rate for Payer: Nomi Health Commercial |
$691.68
|
| Rate for Payer: PACE Senior Care Partners |
$200.33
|
| Rate for Payer: PACE SWMI |
$210.88
|
| Rate for Payer: PHP Commercial |
$716.98
|
| Rate for Payer: PHP Medicare Advantage |
$210.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$548.28
|
| Rate for Payer: Priority Health HMO/PPO |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$212.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$565.15
|
| Rate for Payer: Railroad Medicare Medicare |
$210.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.29
|
| Rate for Payer: UHC Core |
$704.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.88
|
| Rate for Payer: UHC Exchange |
$210.88
|
| Rate for Payer: UHC Medicare Advantage |
$210.88
|
| Rate for Payer: VA VA |
$210.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$632.63
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
OP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$58.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.12
|
| Rate for Payer: BCBS Complete |
$89.76
|
| Rate for Payer: BCBS MAPPO |
$56.10
|
| Rate for Payer: BCBS Trust/PPO |
$184.48
|
| Rate for Payer: BCN Commercial |
$174.47
|
| Rate for Payer: BCN Medicare Advantage |
$56.10
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.10
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: PACE Senior Care Partners |
$53.30
|
| Rate for Payer: PACE SWMI |
$56.10
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: PHP Medicare Advantage |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO |
$195.23
|
| Rate for Payer: Priority Health Medicare |
$56.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.35
|
| Rate for Payer: Railroad Medicare Medicare |
$56.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.47
|
| Rate for Payer: UHC Core |
$187.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.10
|
| Rate for Payer: UHC Exchange |
$56.10
|
| Rate for Payer: UHC Medicare Advantage |
$56.10
|
| Rate for Payer: VA VA |
$56.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.30
|
|
|
HC INGESTION CHALLENGE TEST EA ADDL 60 MIN
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
CPT 95079
|
| Hospital Charge Code |
51000115
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.86 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: BCBS Trust/PPO |
$183.18
|
| Rate for Payer: BCN Commercial |
$173.42
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.74
|
| Rate for Payer: Nomi Health Commercial |
$184.01
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.86
|
| Rate for Payer: Priority Health HMO/PPO |
$195.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.47
|
| Rate for Payer: UHC Core |
$187.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.30
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
OP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.62 |
| Max. Negotiated Rate |
$1,286.99 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: Aetna Medicare |
$371.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$446.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$446.87
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$357.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.59
|
| Rate for Payer: BCN Commercial |
$1,111.82
|
| Rate for Payer: BCN Medicare Advantage |
$357.50
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.50
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.49
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.37
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PACE Senior Care Partners |
$339.62
|
| Rate for Payer: PACE SWMI |
$357.50
|
| Rate for Payer: PHP Commercial |
$1,215.49
|
| Rate for Payer: PHP Medicare Advantage |
$357.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,244.09
|
| Rate for Payer: Priority Health Medicare |
$361.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.09
|
| Rate for Payer: Railroad Medicare Medicare |
$357.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.39
|
| Rate for Payer: UHC Core |
$1,194.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.50
|
| Rate for Payer: UHC Exchange |
$357.50
|
| Rate for Payer: UHC Medicare Advantage |
$357.50
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$357.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.49
|
|
|
HC INGESTION CHALLENGE TEST INIT 120 MIN
|
Facility
|
IP
|
$1,429.99
|
|
|
Service Code
|
CPT 95076
|
| Hospital Charge Code |
51000114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$929.49 |
| Max. Negotiated Rate |
$1,286.99 |
| Rate for Payer: Aetna Commercial |
$1,215.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,167.30
|
| Rate for Payer: BCN Commercial |
$1,105.10
|
| Rate for Payer: Cash Price |
$1,143.99
|
| Rate for Payer: Cofinity Commercial |
$1,229.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,143.99
|
| Rate for Payer: Healthscope Commercial |
$1,286.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,072.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,215.49
|
| Rate for Payer: Nomi Health Commercial |
$1,172.59
|
| Rate for Payer: PHP Commercial |
$1,215.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$929.49
|
| Rate for Payer: Priority Health HMO/PPO |
$1,244.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$958.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,258.39
|
| Rate for Payer: UHC Core |
$1,194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,072.49
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
OP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$445.54 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: Aetna Medicare |
$128.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.70
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$123.76
|
| Rate for Payer: BCBS Trust/PPO |
$406.98
|
| Rate for Payer: BCN Commercial |
$384.90
|
| Rate for Payer: BCN Medicare Advantage |
$123.76
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.76
|
| Rate for Payer: Healthscope Commercial |
$445.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.29
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.95
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PACE Senior Care Partners |
$117.57
|
| Rate for Payer: PACE SWMI |
$123.76
|
| Rate for Payer: PHP Commercial |
$420.79
|
| Rate for Payer: PHP Medicare Advantage |
$123.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO |
$430.69
|
| Rate for Payer: Priority Health Medicare |
$125.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: Railroad Medicare Medicare |
$123.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.64
|
| Rate for Payer: UHC Core |
$413.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.76
|
| Rate for Payer: UHC Exchange |
$123.76
|
| Rate for Payer: UHC Medicare Advantage |
$123.76
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$123.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.29
|
|
|
HC INHALATION BRONCHIAL CHALLENGE TESTING
|
Facility
|
IP
|
$495.05
|
|
|
Service Code
|
CPT 95070
|
| Hospital Charge Code |
46000028
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$321.78 |
| Max. Negotiated Rate |
$445.54 |
| Rate for Payer: Aetna Commercial |
$420.79
|
| Rate for Payer: BCBS Trust/PPO |
$404.11
|
| Rate for Payer: BCN Commercial |
$382.57
|
| Rate for Payer: Cash Price |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.04
|
| Rate for Payer: Healthscope Commercial |
$445.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.79
|
| Rate for Payer: Nomi Health Commercial |
$405.94
|
| Rate for Payer: PHP Commercial |
$420.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.78
|
| Rate for Payer: Priority Health HMO/PPO |
$430.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.64
|
| Rate for Payer: UHC Core |
$413.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.29
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
OP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$19.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.95
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS MAPPO |
$18.36
|
| Rate for Payer: BCBS Trust/PPO |
$60.38
|
| Rate for Payer: BCN Commercial |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$18.36
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Mclaren Medicaid |
$11.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.28
|
| Rate for Payer: Meridian Medicaid |
$11.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PACE Senior Care Partners |
$17.44
|
| Rate for Payer: PACE SWMI |
$18.36
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: PHP Medicare Advantage |
$18.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Medicare |
$18.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: Railroad Medicare Medicare |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.36
|
| Rate for Payer: UHC Exchange |
$18.36
|
| Rate for Payer: UHC Medicare Advantage |
$18.36
|
| Rate for Payer: UHCCP Medicaid |
$11.27
|
| Rate for Payer: VA VA |
$18.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC INHIBIN A, TUMOR MARKER, S
|
Facility
|
IP
|
$73.44
|
|
|
Service Code
|
CPT 86336
|
| Hospital Charge Code |
30200460
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$66.10 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.95
|
| Rate for Payer: BCN Commercial |
$56.75
|
| Rate for Payer: Cash Price |
$58.75
|
| Rate for Payer: Cofinity Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.75
|
| Rate for Payer: Healthscope Commercial |
$66.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.42
|
| Rate for Payer: Nomi Health Commercial |
$60.22
|
| Rate for Payer: PHP Commercial |
$62.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.74
|
| Rate for Payer: Priority Health HMO/PPO |
$63.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.63
|
| Rate for Payer: UHC Core |
$61.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.08
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
OP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.86 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.61
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$12.48
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$38.83
|
| Rate for Payer: BCN Medicare Advantage |
$12.48
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.48
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.11
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PACE Senior Care Partners |
$11.86
|
| Rate for Payer: PACE SWMI |
$12.48
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: PHP Medicare Advantage |
$12.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: Railroad Medicare Medicare |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.48
|
| Rate for Payer: UHC Exchange |
$12.48
|
| Rate for Payer: UHC Medicare Advantage |
$12.48
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$12.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
HC INHIBIN B, CMPT
|
Facility
|
IP
|
$49.94
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100693
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$40.77
|
| Rate for Payer: BCN Commercial |
$38.59
|
| Rate for Payer: Cash Price |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$42.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.45
|
| Rate for Payer: Nomi Health Commercial |
$40.95
|
| Rate for Payer: PHP Commercial |
$42.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.46
|
| Rate for Payer: Priority Health HMO/PPO |
$43.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.95
|
| Rate for Payer: UHC Core |
$41.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
IP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: BCBS Trust/PPO |
$147.69
|
| Rate for Payer: BCN Commercial |
$139.82
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO |
$157.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.22
|
| Rate for Payer: UHC Core |
$151.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.70
|
|
|
HC INITIAL PREV PHYS EXAM, FIRST 12MOS MEDICARE ENROLLMENT
|
Facility
|
OP
|
$180.93
|
|
|
Service Code
|
CPT G0402
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$153.79
|
| Rate for Payer: Aetna Medicare |
$47.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.54
|
| Rate for Payer: BCBS Complete |
$95.86
|
| Rate for Payer: BCBS MAPPO |
$45.23
|
| Rate for Payer: BCBS Trust/PPO |
$148.74
|
| Rate for Payer: BCN Commercial |
$140.67
|
| Rate for Payer: BCN Medicare Advantage |
$45.23
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cash Price |
$144.74
|
| Rate for Payer: Cofinity Commercial |
$155.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.23
|
| Rate for Payer: Healthscope Commercial |
$162.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.70
|
| Rate for Payer: Mclaren Medicaid |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.49
|
| Rate for Payer: Meridian Medicaid |
$95.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.79
|
| Rate for Payer: Nomi Health Commercial |
$148.36
|
| Rate for Payer: PACE Senior Care Partners |
$42.97
|
| Rate for Payer: PACE SWMI |
$45.23
|
| Rate for Payer: PHP Commercial |
$153.79
|
| Rate for Payer: PHP Medicare Advantage |
$45.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO |
$157.41
|
| Rate for Payer: Priority Health Medicare |
$45.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.22
|
| Rate for Payer: Railroad Medicare Medicare |
$45.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.22
|
| Rate for Payer: UHC Core |
$151.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.23
|
| Rate for Payer: UHC Exchange |
$45.23
|
| Rate for Payer: UHC Medicare Advantage |
$45.23
|
| Rate for Payer: UHCCP Medicaid |
$91.29
|
| Rate for Payer: VA VA |
$45.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.70
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
OP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$521.71 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$181.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$181.15
|
| Rate for Payer: BCBS Complete |
$246.72
|
| Rate for Payer: BCBS MAPPO |
$144.92
|
| Rate for Payer: BCBS Trust/PPO |
$476.55
|
| Rate for Payer: BCN Commercial |
$450.70
|
| Rate for Payer: BCN Medicare Advantage |
$144.92
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.92
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.76
|
| Rate for Payer: Mclaren Medicaid |
$234.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.17
|
| Rate for Payer: Meridian Medicaid |
$246.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PACE Senior Care Partners |
$137.67
|
| Rate for Payer: PACE SWMI |
$144.92
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: PHP Medicare Advantage |
$144.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO |
$504.32
|
| Rate for Payer: Priority Health Medicare |
$146.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.39
|
| Rate for Payer: Railroad Medicare Medicare |
$144.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC Core |
$484.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.92
|
| Rate for Payer: UHC Exchange |
$144.92
|
| Rate for Payer: UHC Medicare Advantage |
$144.92
|
| Rate for Payer: UHCCP Medicaid |
$234.96
|
| Rate for Payer: VA VA |
$144.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.76
|
|
|
HC INITIATION PROLONGED INFUSION REQUIRING PUMP
|
Facility
|
IP
|
$579.68
|
|
|
Service Code
|
HCPCS C8957
|
| Hospital Charge Code |
26000012
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$376.79 |
| Max. Negotiated Rate |
$521.71 |
| Rate for Payer: Aetna Commercial |
$492.73
|
| Rate for Payer: BCBS Trust/PPO |
$473.19
|
| Rate for Payer: BCN Commercial |
$447.98
|
| Rate for Payer: Cash Price |
$463.74
|
| Rate for Payer: Cofinity Commercial |
$498.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$463.74
|
| Rate for Payer: Healthscope Commercial |
$521.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$434.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.73
|
| Rate for Payer: Nomi Health Commercial |
$475.34
|
| Rate for Payer: PHP Commercial |
$492.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.79
|
| Rate for Payer: Priority Health HMO/PPO |
$504.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.12
|
| Rate for Payer: UHC Core |
$484.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$434.76
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
IP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.06
|
| Rate for Payer: BCN Commercial |
$122.18
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: Priority Health HMO/PPO |
$137.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.13
|
| Rate for Payer: UHC Core |
$132.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.58
|
|
|
HC INITIAT MED TX IN ER
|
Facility
|
OP
|
$158.10
|
|
|
Service Code
|
HCPCS G2213
|
| Hospital Charge Code |
45000106
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$41.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.41
|
| Rate for Payer: BCBS Complete |
$63.24
|
| Rate for Payer: BCBS MAPPO |
$39.52
|
| Rate for Payer: BCBS Trust/PPO |
$129.97
|
| Rate for Payer: BCN Commercial |
$122.92
|
| Rate for Payer: BCN Medicare Advantage |
$39.52
|
| Rate for Payer: Cash Price |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$135.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.52
|
| Rate for Payer: Healthscope Commercial |
$142.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.38
|
| Rate for Payer: Nomi Health Commercial |
$129.64
|
| Rate for Payer: PACE Senior Care Partners |
$37.55
|
| Rate for Payer: PACE SWMI |
$39.52
|
| Rate for Payer: PHP Commercial |
$134.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.76
|
| Rate for Payer: Priority Health HMO/PPO |
$137.55
|
| Rate for Payer: Priority Health Medicare |
$39.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.93
|
| Rate for Payer: Railroad Medicare Medicare |
$39.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.13
|
| Rate for Payer: UHC Core |
$132.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.52
|
| Rate for Payer: UHC Exchange |
$39.52
|
| Rate for Payer: UHC Medicare Advantage |
$39.52
|
| Rate for Payer: VA VA |
$39.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.58
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
IP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: BCBS Trust/PPO |
$103.61
|
| Rate for Payer: BCN Commercial |
$98.09
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO |
$110.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.70
|
| Rate for Payer: UHC Core |
$105.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.20
|
|
|
HC INIT SUB PSYCH 1ST 30 MIN
|
Facility
|
OP
|
$126.93
|
|
|
Service Code
|
HCPCS G2214
|
| Hospital Charge Code |
76100344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$107.89
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.67
|
| Rate for Payer: BCBS Complete |
$68.81
|
| Rate for Payer: BCBS MAPPO |
$31.73
|
| Rate for Payer: BCBS Trust/PPO |
$104.35
|
| Rate for Payer: BCN Commercial |
$98.69
|
| Rate for Payer: BCN Medicare Advantage |
$31.73
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cash Price |
$101.54
|
| Rate for Payer: Cofinity Commercial |
$109.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.73
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.20
|
| Rate for Payer: Mclaren Medicaid |
$65.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.32
|
| Rate for Payer: Meridian Medicaid |
$68.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.89
|
| Rate for Payer: Nomi Health Commercial |
$104.08
|
| Rate for Payer: PACE Senior Care Partners |
$30.15
|
| Rate for Payer: PACE SWMI |
$31.73
|
| Rate for Payer: PHP Commercial |
$107.89
|
| Rate for Payer: PHP Medicare Advantage |
$31.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.50
|
| Rate for Payer: Priority Health HMO/PPO |
$110.43
|
| Rate for Payer: Priority Health Medicare |
$32.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.04
|
| Rate for Payer: Railroad Medicare Medicare |
$31.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.70
|
| Rate for Payer: UHC Core |
$105.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.73
|
| Rate for Payer: UHC Exchange |
$31.73
|
| Rate for Payer: UHC Medicare Advantage |
$31.73
|
| Rate for Payer: UHCCP Medicaid |
$65.53
|
| Rate for Payer: VA VA |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.20
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
OP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$868.02 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: Aetna Medicare |
$250.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.40
|
| Rate for Payer: BCBS Complete |
$385.79
|
| Rate for Payer: BCBS MAPPO |
$241.12
|
| Rate for Payer: BCBS Trust/PPO |
$792.89
|
| Rate for Payer: BCN Commercial |
$749.88
|
| Rate for Payer: BCN Medicare Advantage |
$241.12
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.12
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: PACE Senior Care Partners |
$229.06
|
| Rate for Payer: PACE SWMI |
$241.12
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: PHP Medicare Advantage |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO |
$839.09
|
| Rate for Payer: Priority Health Medicare |
$243.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.19
|
| Rate for Payer: Railroad Medicare Medicare |
$241.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.73
|
| Rate for Payer: UHC Core |
$805.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.12
|
| Rate for Payer: UHC Exchange |
$241.12
|
| Rate for Payer: UHC Medicare Advantage |
$241.12
|
| Rate for Payer: VA VA |
$241.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.35
|
|
|
HC INJ AIR CONTRAST PERITONEAL CAVITY
|
Facility
|
IP
|
$964.47
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
36100446
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$626.91 |
| Max. Negotiated Rate |
$868.02 |
| Rate for Payer: Aetna Commercial |
$819.80
|
| Rate for Payer: BCBS Trust/PPO |
$787.30
|
| Rate for Payer: BCN Commercial |
$745.34
|
| Rate for Payer: Cash Price |
$771.58
|
| Rate for Payer: Cofinity Commercial |
$829.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$771.58
|
| Rate for Payer: Healthscope Commercial |
$868.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.80
|
| Rate for Payer: Nomi Health Commercial |
$790.87
|
| Rate for Payer: PHP Commercial |
$819.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.91
|
| Rate for Payer: Priority Health HMO/PPO |
$839.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.73
|
| Rate for Payer: UHC Core |
$805.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.35
|
|
