|
HC PROCESS FEE
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.25
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$9.00
|
| Rate for Payer: BCBS Trust/PPO |
$27.99
|
| Rate for Payer: BCN Commercial |
$27.99
|
| Rate for Payer: BCN Medicare Advantage |
$9.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PACE Senior Care Partners |
$8.55
|
| Rate for Payer: PACE SWMI |
$9.00
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: PHP Medicare Advantage |
$9.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Medicare |
$9.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.96
|
| Rate for Payer: Railroad Medicare Medicare |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.68
|
| Rate for Payer: UHC Core |
$30.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.00
|
| Rate for Payer: UHC Medicare Advantage |
$9.27
|
| Rate for Payer: VA VA |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC PROCESS FEE
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
30000106
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$27.82
|
| Rate for Payer: BCN Commercial |
$27.82
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.80
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.60
|
| Rate for Payer: PHP Commercial |
$30.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.68
|
| Rate for Payer: UHC Core |
$30.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.00
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
IP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$695.10 |
| Max. Negotiated Rate |
$1,025.72 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: BCBS Trust/PPO |
$880.75
|
| Rate for Payer: BCN Commercial |
$880.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$991.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,002.93
|
| Rate for Payer: UHC Core |
$951.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.77
|
|
|
HC PROCTOSIGMOIDOSCOY RIGID DX
|
Facility
|
OP
|
$1,139.69
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
76100185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.68 |
| Max. Negotiated Rate |
$1,025.72 |
| Rate for Payer: Aetna Commercial |
$968.74
|
| Rate for Payer: Aetna Medicare |
$296.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.15
|
| Rate for Payer: BCBS Complete |
$629.53
|
| Rate for Payer: BCBS MAPPO |
$284.92
|
| Rate for Payer: BCBS Trust/PPO |
$886.11
|
| Rate for Payer: BCN Commercial |
$886.11
|
| Rate for Payer: BCN Medicare Advantage |
$284.92
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cash Price |
$911.75
|
| Rate for Payer: Cofinity Commercial |
$980.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$911.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.92
|
| Rate for Payer: Healthscope Commercial |
$1,025.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$854.77
|
| Rate for Payer: Mclaren Medicaid |
$599.55
|
| Rate for Payer: Meridian Medicaid |
$629.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$968.74
|
| Rate for Payer: PACE Senior Care Partners |
$270.68
|
| Rate for Payer: PACE SWMI |
$284.92
|
| Rate for Payer: PHP Commercial |
$968.74
|
| Rate for Payer: PHP Medicare Advantage |
$284.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$991.53
|
| Rate for Payer: Priority Health Medicare |
$284.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$695.10
|
| Rate for Payer: Railroad Medicare Medicare |
$284.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,002.93
|
| Rate for Payer: UHC Core |
$951.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.92
|
| Rate for Payer: UHC Medicare Advantage |
$293.47
|
| Rate for Payer: VA VA |
$284.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$854.77
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.81
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: BCN Commercial |
$29.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Senior Care Partners |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.87
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.25
|
| Rate for Payer: UHC Core |
$31.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.73
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.34
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY 2 OR MORE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$29.20
|
| Rate for Payer: BCN Commercial |
$29.20
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.25
|
| Rate for Payer: UHC Core |
$31.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.34
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
IP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: BCBS Trust/PPO |
$29.20
|
| Rate for Payer: BCN Commercial |
$29.20
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.25
|
| Rate for Payer: UHC Core |
$31.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.34
|
|
|
HC PROF SVC ALLERGEN IMMUNOTHERAPY SINGLE INJECT
|
Facility
|
OP
|
$37.78
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
51000081
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.81
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: BCBS MAPPO |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: BCN Commercial |
$29.37
|
| Rate for Payer: BCN Medicare Advantage |
$9.44
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.44
|
| Rate for Payer: Healthscope Commercial |
$34.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.34
|
| Rate for Payer: Mclaren Medicaid |
$31.16
|
| Rate for Payer: Meridian Medicaid |
$32.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.11
|
| Rate for Payer: PACE Senior Care Partners |
$8.97
|
| Rate for Payer: PACE SWMI |
$9.44
|
| Rate for Payer: PHP Commercial |
$32.11
|
| Rate for Payer: PHP Medicare Advantage |
$9.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.87
|
| Rate for Payer: Priority Health Medicare |
$9.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.25
|
| Rate for Payer: UHC Core |
$31.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$9.73
|
| Rate for Payer: VA VA |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.34
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
OP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$69.27 |
| Rate for Payer: Aetna Commercial |
$65.42
|
| Rate for Payer: Aetna Medicare |
$20.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.05
|
| Rate for Payer: BCBS Complete |
$16.16
|
| Rate for Payer: BCBS MAPPO |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$59.84
|
| Rate for Payer: BCN Commercial |
$59.84
|
| Rate for Payer: BCN Medicare Advantage |
$19.24
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$66.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$69.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.73
|
| Rate for Payer: Mclaren Medicaid |
$15.39
|
| Rate for Payer: Meridian Medicaid |
$16.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: PACE Senior Care Partners |
$18.28
|
| Rate for Payer: PACE SWMI |
$19.24
|
| Rate for Payer: PHP Commercial |
$65.42
|
| Rate for Payer: PHP Medicare Advantage |
$19.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.96
|
| Rate for Payer: Priority Health Medicare |
$19.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.94
|
| Rate for Payer: Railroad Medicare Medicare |
$19.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.73
|
| Rate for Payer: UHC Core |
$64.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.24
|
| Rate for Payer: UHC Medicare Advantage |
$19.82
|
| Rate for Payer: VA VA |
$19.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.73
|
|
|
HC PROGESTERONE LEVEL
|
Facility
|
IP
|
$76.97
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
30100400
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.94 |
| Max. Negotiated Rate |
$69.27 |
| Rate for Payer: Aetna Commercial |
$65.42
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: Cash Price |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$66.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.58
|
| Rate for Payer: Healthscope Commercial |
$69.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.42
|
| Rate for Payer: PHP Commercial |
$65.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.73
|
| Rate for Payer: UHC Core |
$64.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.73
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.63
|
| Rate for Payer: BCBS Complete |
$15.02
|
| Rate for Payer: BCBS MAPPO |
$18.10
|
| Rate for Payer: BCBS Trust/PPO |
$56.31
|
| Rate for Payer: BCN Commercial |
$56.31
|
| Rate for Payer: BCN Medicare Advantage |
$18.10
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.32
|
| Rate for Payer: Mclaren Medicaid |
$14.30
|
| Rate for Payer: Meridian Medicaid |
$15.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PACE Senior Care Partners |
$17.20
|
| Rate for Payer: PACE SWMI |
$18.10
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: PHP Medicare Advantage |
$18.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.01
|
| Rate for Payer: Priority Health Medicare |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.17
|
| Rate for Payer: Railroad Medicare Medicare |
$18.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.73
|
| Rate for Payer: UHC Core |
$60.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.10
|
| Rate for Payer: UHC Medicare Advantage |
$18.65
|
| Rate for Payer: VA VA |
$18.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.32
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$72.42
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
30100402
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$65.18 |
| Rate for Payer: Aetna Commercial |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$55.97
|
| Rate for Payer: BCN Commercial |
$55.97
|
| Rate for Payer: Cash Price |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.94
|
| Rate for Payer: Healthscope Commercial |
$65.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.56
|
| Rate for Payer: PHP Commercial |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.73
|
| Rate for Payer: UHC Core |
$60.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.32
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
IP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.70 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: BCBS Trust/PPO |
$99.71
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: PHP Commercial |
$109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.55
|
| Rate for Payer: UHC Core |
$107.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC PROLONGED E/M BEFORE/AFTER DIRECT CARE 1ST HR
|
Facility
|
OP
|
$129.03
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$116.13 |
| Rate for Payer: Aetna Commercial |
$109.68
|
| Rate for Payer: Aetna Medicare |
$33.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.32
|
| Rate for Payer: BCBS Complete |
$51.61
|
| Rate for Payer: BCBS MAPPO |
$32.26
|
| Rate for Payer: BCBS Trust/PPO |
$100.32
|
| Rate for Payer: BCN Commercial |
$100.32
|
| Rate for Payer: BCN Medicare Advantage |
$32.26
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$116.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.68
|
| Rate for Payer: PACE Senior Care Partners |
$30.64
|
| Rate for Payer: PACE SWMI |
$32.26
|
| Rate for Payer: PHP Commercial |
$109.68
|
| Rate for Payer: PHP Medicare Advantage |
$32.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.26
|
| Rate for Payer: Priority Health Medicare |
$32.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.70
|
| Rate for Payer: Railroad Medicare Medicare |
$32.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.55
|
| Rate for Payer: UHC Core |
$107.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.26
|
| Rate for Payer: UHC Medicare Advantage |
$33.23
|
| Rate for Payer: VA VA |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.77
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.67
|
| Rate for Payer: BCN Commercial |
$22.67
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.93
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC PROLONGED OUTPATIENT OFFICE VISIT
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
HCPCS G2212
|
| Hospital Charge Code |
51000098
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$11.73
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCN Commercial |
$22.80
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.93
|
| Rate for Payer: PACE Senior Care Partners |
$6.97
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.55
|
| Rate for Payer: VA VA |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC PROPOXYPHENE URINE
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.44
|
| 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 Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| 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 PROPOXYPHENE URINE
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100055
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| 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 |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$7.90
|
| Rate for Payer: BCBS Trust/PPO |
$24.58
|
| 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 |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| 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 |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| 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 Medicare Advantage |
$8.14
|
| Rate for Payer: VA VA |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.51 |
| 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 |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$7.90
|
| Rate for Payer: BCBS Trust/PPO |
$24.58
|
| 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 |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.88
|
| 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 |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| 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 Medicare Advantage |
$8.14
|
| Rate for Payer: VA VA |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC PROPOXYPHENE URINE CMPT
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100056
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$24.44
|
| 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 Multiplan/Beech St/PHCS |
$26.88
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.29
|
| 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 PRO PREDICT 6 MP COMPONENT.
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna Commercial |
$249.05
|
| Rate for Payer: Aetna Medicare |
$76.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.56
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS MAPPO |
$73.25
|
| Rate for Payer: BCBS Trust/PPO |
$227.81
|
| Rate for Payer: BCN Commercial |
$227.81
|
| Rate for Payer: BCN Medicare Advantage |
$73.25
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$251.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.25
|
| Rate for Payer: Healthscope Commercial |
$263.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.75
|
| Rate for Payer: Mclaren Medicaid |
$17.78
|
| Rate for Payer: Meridian Medicaid |
$18.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: PACE Senior Care Partners |
$69.59
|
| Rate for Payer: PACE SWMI |
$73.25
|
| Rate for Payer: PHP Commercial |
$249.05
|
| Rate for Payer: PHP Medicare Advantage |
$73.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.91
|
| Rate for Payer: Priority Health Medicare |
$73.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.70
|
| Rate for Payer: Railroad Medicare Medicare |
$73.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.84
|
| Rate for Payer: UHC Core |
$244.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.25
|
| Rate for Payer: UHC Medicare Advantage |
$75.45
|
| Rate for Payer: VA VA |
$73.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.75
|
|
|
HC PRO PREDICT 6 MP COMPONENT.
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100629
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$178.70 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna Commercial |
$249.05
|
| Rate for Payer: BCBS Trust/PPO |
$226.43
|
| Rate for Payer: BCN Commercial |
$226.43
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$251.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.40
|
| Rate for Payer: Healthscope Commercial |
$263.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.05
|
| Rate for Payer: PHP Commercial |
$249.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.84
|
| Rate for Payer: UHC Core |
$244.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.75
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
IP
|
$117.68
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$71.77 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$100.03
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Cofinity Commercial |
$101.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$105.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.03
|
| Rate for Payer: PHP Commercial |
$100.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.56
|
| Rate for Payer: UHC Core |
$98.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.26
|
|
|
HC PROSTHETIC TRNG INITIAL EACH 15 MIN
|
Facility
|
OP
|
$117.68
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
42000040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$105.91 |
| Rate for Payer: Aetna Commercial |
$100.03
|
| Rate for Payer: Aetna Medicare |
$30.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.78
|
| Rate for Payer: BCBS Complete |
$47.07
|
| Rate for Payer: BCBS MAPPO |
$29.42
|
| Rate for Payer: BCBS Trust/PPO |
$91.50
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: BCN Medicare Advantage |
$29.42
|
| Rate for Payer: Cash Price |
$94.14
|
| Rate for Payer: Cofinity Commercial |
$101.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.42
|
| Rate for Payer: Healthscope Commercial |
$105.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.03
|
| Rate for Payer: PACE Senior Care Partners |
$27.95
|
| Rate for Payer: PACE SWMI |
$29.42
|
| Rate for Payer: PHP Commercial |
$100.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.38
|
| Rate for Payer: Priority Health Medicare |
$29.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.77
|
| Rate for Payer: Railroad Medicare Medicare |
$29.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.56
|
| Rate for Payer: UHC Core |
$98.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.42
|
| Rate for Payer: UHC Medicare Advantage |
$30.30
|
| Rate for Payer: VA VA |
$29.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.26
|
|
|
HC PROTEGE RX STENT
|
Facility
|
IP
|
$4,482.37
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27800062
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,733.80 |
| Max. Negotiated Rate |
$4,034.13 |
| Rate for Payer: Aetna Commercial |
$3,810.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,463.98
|
| Rate for Payer: BCN Commercial |
$3,463.98
|
| Rate for Payer: Cash Price |
$3,585.90
|
| Rate for Payer: Cofinity Commercial |
$3,854.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,585.90
|
| Rate for Payer: Healthscope Commercial |
$4,034.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,361.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,810.01
|
| Rate for Payer: PHP Commercial |
$3,810.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,137.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,899.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,733.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,944.49
|
| Rate for Payer: UHC Core |
$3,742.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,361.78
|
|
