|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.96
|
| Rate for Payer: BCN Commercial |
$23.96
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.28
|
| Rate for Payer: UHC Core |
$25.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna Commercial |
$26.35
|
| Rate for Payer: Aetna Medicare |
$8.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.69
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$24.10
|
| Rate for Payer: BCN Commercial |
$24.10
|
| Rate for Payer: BCN Medicare Advantage |
$7.75
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$26.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.75
|
| Rate for Payer: Healthscope Commercial |
$27.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.25
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.35
|
| Rate for Payer: PACE Senior Care Partners |
$7.36
|
| Rate for Payer: PACE SWMI |
$7.75
|
| Rate for Payer: PHP Commercial |
$26.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.97
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.28
|
| Rate for Payer: UHC Core |
$25.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.75
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: VA VA |
$7.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.25
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$262.14
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$235.93 |
| Rate for Payer: Aetna Commercial |
$222.82
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: BCBS Trust/PPO |
$163.83
|
| Rate for Payer: BCBS Trust/PPO |
$202.58
|
| Rate for Payer: BCN Commercial |
$163.83
|
| Rate for Payer: BCN Commercial |
$202.58
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Healthscope Commercial |
$235.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$222.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.68
|
| Rate for Payer: UHC Core |
$218.89
|
| Rate for Payer: UHC Core |
$177.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Commercial |
$222.82
|
| Rate for Payer: Aetna Medicare |
$68.16
|
| Rate for Payer: Aetna Medicare |
$55.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.92
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Complete |
$104.86
|
| Rate for Payer: BCBS MAPPO |
$65.54
|
| Rate for Payer: BCBS MAPPO |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$164.83
|
| Rate for Payer: BCBS Trust/PPO |
$203.81
|
| Rate for Payer: BCN Commercial |
$203.81
|
| Rate for Payer: BCN Commercial |
$164.83
|
| Rate for Payer: BCN Medicare Advantage |
$53.00
|
| Rate for Payer: BCN Medicare Advantage |
$65.54
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$209.71
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.00
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Healthscope Commercial |
$235.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.82
|
| Rate for Payer: PACE Senior Care Partners |
$62.26
|
| Rate for Payer: PACE Senior Care Partners |
$50.35
|
| Rate for Payer: PACE SWMI |
$65.54
|
| Rate for Payer: PACE SWMI |
$53.00
|
| Rate for Payer: PHP Commercial |
$222.82
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: PHP Medicare Advantage |
$53.00
|
| Rate for Payer: PHP Medicare Advantage |
$65.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.06
|
| Rate for Payer: Priority Health Medicare |
$65.54
|
| Rate for Payer: Priority Health Medicare |
$53.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.30
|
| Rate for Payer: Railroad Medicare Medicare |
$65.54
|
| Rate for Payer: Railroad Medicare Medicare |
$53.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.56
|
| Rate for Payer: UHC Core |
$177.02
|
| Rate for Payer: UHC Core |
$218.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.54
|
| Rate for Payer: UHC Medicare Advantage |
$54.59
|
| Rate for Payer: UHC Medicare Advantage |
$67.50
|
| Rate for Payer: VA VA |
$65.54
|
| Rate for Payer: VA VA |
$53.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.60
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$542.64
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$330.96 |
| Max. Negotiated Rate |
$488.38 |
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: BCBS Trust/PPO |
$407.27
|
| Rate for Payer: BCBS Trust/PPO |
$419.35
|
| Rate for Payer: BCN Commercial |
$407.27
|
| Rate for Payer: BCN Commercial |
$419.35
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.76
|
| Rate for Payer: UHC Core |
$440.04
|
| Rate for Payer: UHC Core |
$453.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.98
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$474.30 |
| Rate for Payer: Aetna Commercial |
$447.95
|
| Rate for Payer: Aetna Commercial |
$461.24
|
| Rate for Payer: Aetna Medicare |
$137.02
|
| Rate for Payer: Aetna Medicare |
$141.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$164.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$164.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.58
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS Complete |
$254.50
|
| Rate for Payer: BCBS MAPPO |
$131.75
|
| Rate for Payer: BCBS MAPPO |
$135.66
|
| Rate for Payer: BCBS Trust/PPO |
$421.90
|
| Rate for Payer: BCBS Trust/PPO |
$409.74
|
| Rate for Payer: BCN Commercial |
$409.74
|
| Rate for Payer: BCN Commercial |
$421.90
|
| Rate for Payer: BCN Medicare Advantage |
$131.75
|
| Rate for Payer: BCN Medicare Advantage |
$135.66
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cash Price |
$434.11
|
| Rate for Payer: Cofinity Commercial |
$453.22
|
| Rate for Payer: Cofinity Commercial |
$466.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.66
|
| Rate for Payer: Healthscope Commercial |
$488.38
|
| Rate for Payer: Healthscope Commercial |
$474.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.98
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Mclaren Medicaid |
$242.38
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Medicaid |
$254.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$142.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$447.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$461.24
|
| Rate for Payer: PACE Senior Care Partners |
$125.16
|
| Rate for Payer: PACE Senior Care Partners |
$128.88
|
| Rate for Payer: PACE SWMI |
$135.66
|
| Rate for Payer: PACE SWMI |
$131.75
|
| Rate for Payer: PHP Commercial |
$461.24
|
| Rate for Payer: PHP Commercial |
$447.95
|
| Rate for Payer: PHP Medicare Advantage |
$131.75
|
| Rate for Payer: PHP Medicare Advantage |
$135.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$242.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$458.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.10
|
| Rate for Payer: Priority Health Medicare |
$135.66
|
| Rate for Payer: Priority Health Medicare |
$131.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.96
|
| Rate for Payer: Railroad Medicare Medicare |
$135.66
|
| Rate for Payer: Railroad Medicare Medicare |
$131.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.76
|
| Rate for Payer: UHC Core |
$453.10
|
| Rate for Payer: UHC Core |
$440.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.75
|
| Rate for Payer: UHC Medicare Advantage |
$135.70
|
| Rate for Payer: UHC Medicare Advantage |
$139.73
|
| Rate for Payer: VA VA |
$131.75
|
| Rate for Payer: VA VA |
$135.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.98
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.25
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$52.87
|
| Rate for Payer: BCN Commercial |
$52.87
|
| Rate for Payer: BCN Medicare Advantage |
$17.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.00
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PACE Senior Care Partners |
$16.15
|
| Rate for Payer: PACE SWMI |
$17.00
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: PHP Medicare Advantage |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.00
|
| Rate for Payer: UHC Medicare Advantage |
$17.51
|
| Rate for Payer: VA VA |
$17.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.47 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna Commercial |
$57.80
|
| Rate for Payer: BCBS Trust/PPO |
$52.55
|
| Rate for Payer: BCN Commercial |
$52.55
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$58.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.40
|
| Rate for Payer: Healthscope Commercial |
$61.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.80
|
| Rate for Payer: PHP Commercial |
$57.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.84
|
| Rate for Payer: UHC Core |
$56.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.00
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: Aetna Medicare |
$20.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.00
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$62.20
|
| Rate for Payer: BCN Commercial |
$62.20
|
| Rate for Payer: BCN Medicare Advantage |
$20.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PACE Senior Care Partners |
$19.00
|
| Rate for Payer: PACE SWMI |
$20.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: PHP Medicare Advantage |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.60
|
| Rate for Payer: Priority Health Medicare |
$20.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.79
|
| Rate for Payer: Railroad Medicare Medicare |
$20.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.40
|
| Rate for Payer: UHC Core |
$66.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.00
|
| Rate for Payer: UHC Medicare Advantage |
$20.60
|
| Rate for Payer: VA VA |
$20.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$68.00
|
| Rate for Payer: BCBS Trust/PPO |
$61.82
|
| Rate for Payer: BCN Commercial |
$61.82
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$68.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.00
|
| Rate for Payer: Healthscope Commercial |
$72.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.00
|
| Rate for Payer: PHP Commercial |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.40
|
| Rate for Payer: UHC Core |
$66.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.00
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$131.74 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$166.92
|
| Rate for Payer: BCN Commercial |
$166.92
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Healthscope Commercial |
$194.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: PHP Commercial |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.08
|
| Rate for Payer: UHC Core |
$180.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.00
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Medicare |
$56.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.50
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$54.00
|
| Rate for Payer: BCBS Trust/PPO |
$167.94
|
| Rate for Payer: BCN Commercial |
$167.94
|
| Rate for Payer: BCN Medicare Advantage |
$54.00
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$185.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.00
|
| Rate for Payer: Healthscope Commercial |
$194.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.60
|
| Rate for Payer: PACE Senior Care Partners |
$51.30
|
| Rate for Payer: PACE SWMI |
$54.00
|
| Rate for Payer: PHP Commercial |
$183.60
|
| Rate for Payer: PHP Medicare Advantage |
$54.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$187.92
|
| Rate for Payer: Priority Health Medicare |
$54.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.74
|
| Rate for Payer: Railroad Medicare Medicare |
$54.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.08
|
| Rate for Payer: UHC Core |
$180.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.00
|
| Rate for Payer: UHC Medicare Advantage |
$55.62
|
| Rate for Payer: VA VA |
$54.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.00
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna Medicare |
$63.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.88
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$61.50
|
| Rate for Payer: BCBS Trust/PPO |
$191.26
|
| Rate for Payer: BCN Commercial |
$191.26
|
| Rate for Payer: BCN Medicare Advantage |
$61.50
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.50
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PACE Senior Care Partners |
$58.42
|
| Rate for Payer: PACE SWMI |
$61.50
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: PHP Medicare Advantage |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.02
|
| Rate for Payer: Priority Health Medicare |
$61.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.04
|
| Rate for Payer: Railroad Medicare Medicare |
$61.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.48
|
| Rate for Payer: UHC Core |
$205.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.50
|
| Rate for Payer: UHC Medicare Advantage |
$63.34
|
| Rate for Payer: VA VA |
$61.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.04 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: BCBS Trust/PPO |
$190.11
|
| Rate for Payer: BCN Commercial |
$190.11
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.10
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.48
|
| Rate for Payer: UHC Core |
$205.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
HC POST-OP
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Medicare |
$4.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.54
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$4.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.43
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.21
|
| Rate for Payer: PACE SWMI |
$4.43
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: PHP Medicare Advantage |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.59
|
| Rate for Payer: UHC Core |
$14.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.56
|
| Rate for Payer: VA VA |
$4.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC POST-OP
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.59
|
| Rate for Payer: UHC Core |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
OP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.93 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: Aetna Medicare |
$98.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.32
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$94.66
|
| Rate for Payer: BCBS Trust/PPO |
$294.39
|
| Rate for Payer: BCN Commercial |
$294.39
|
| Rate for Payer: BCN Medicare Advantage |
$94.66
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.66
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PACE Senior Care Partners |
$89.93
|
| Rate for Payer: PACE SWMI |
$94.66
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: PHP Medicare Advantage |
$94.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.42
|
| Rate for Payer: Priority Health Medicare |
$94.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.93
|
| Rate for Payer: Railroad Medicare Medicare |
$94.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.20
|
| Rate for Payer: UHC Core |
$316.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.66
|
| Rate for Payer: UHC Medicare Advantage |
$97.50
|
| Rate for Payer: VA VA |
$94.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC POST TIBIAL NEUROSTIMULATION PERC NEEDLE ELECTRODE
|
Facility
|
IP
|
$378.64
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
76100208
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.93 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$321.84
|
| Rate for Payer: BCBS Trust/PPO |
$292.61
|
| Rate for Payer: BCN Commercial |
$292.61
|
| Rate for Payer: Cash Price |
$302.91
|
| Rate for Payer: Cofinity Commercial |
$325.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.91
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.84
|
| Rate for Payer: PHP Commercial |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.20
|
| Rate for Payer: UHC Core |
$316.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.98
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Meridian Medicaid |
$3.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC POTASSIUM LEVEL
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
30100396
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
OP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.69
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.60
|
|
|
HC POTASSIUM OTHER SOURCE
|
Facility
|
IP
|
$20.80
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
30100556
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$17.68
|
| Rate for Payer: BCBS Trust/PPO |
$16.07
|
| Rate for Payer: BCN Commercial |
$16.07
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$17.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.64
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.68
|
| Rate for Payer: PHP Commercial |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.60
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: BCBS Trust/PPO |
$27.98
|
| Rate for Payer: BCN Commercial |
$27.98
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$31.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Healthscope Commercial |
$32.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: PHP Commercial |
$30.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Core |
$30.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.15
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$36.20
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
30100397
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Commercial |
$30.77
|
| Rate for Payer: Aetna Medicare |
$9.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.31
|
| Rate for Payer: BCBS Complete |
$3.67
|
| Rate for Payer: BCBS MAPPO |
$9.05
|
| Rate for Payer: BCBS Trust/PPO |
$28.15
|
| Rate for Payer: BCN Commercial |
$28.15
|
| Rate for Payer: BCN Medicare Advantage |
$9.05
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cash Price |
$28.96
|
| Rate for Payer: Cofinity Commercial |
$31.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.05
|
| Rate for Payer: Healthscope Commercial |
$32.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.15
|
| Rate for Payer: Mclaren Medicaid |
$3.49
|
| Rate for Payer: Meridian Medicaid |
$3.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.77
|
| Rate for Payer: PACE Senior Care Partners |
$8.60
|
| Rate for Payer: PACE SWMI |
$9.05
|
| Rate for Payer: PHP Commercial |
$30.77
|
| Rate for Payer: PHP Medicare Advantage |
$9.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.49
|
| Rate for Payer: Priority Health Medicare |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.08
|
| Rate for Payer: Railroad Medicare Medicare |
$9.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.86
|
| Rate for Payer: UHC Core |
$30.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.05
|
| Rate for Payer: UHC Medicare Advantage |
$9.32
|
| Rate for Payer: VA VA |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.15
|
|
|
HC POUCH 1 PIECE OPEN END W/WAFER
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
27000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.12
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCBS Trust/PPO |
$7.78
|
| Rate for Payer: BCN Commercial |
$7.78
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$8.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.50
|
| Rate for Payer: PACE Senior Care Partners |
$2.38
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Commercial |
$8.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.80
|
| Rate for Payer: UHC Core |
$8.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.50
|
|
