|
HC PURAPLY AM 4X3 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$280.50
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600183
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$252.45 |
| Rate for Payer: Aetna Commercial |
$238.42
|
| Rate for Payer: Aetna Medicare |
$72.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.66
|
| Rate for Payer: BCBS Complete |
$112.20
|
| Rate for Payer: BCBS MAPPO |
$70.12
|
| Rate for Payer: BCBS Trust/PPO |
$218.09
|
| Rate for Payer: BCN Commercial |
$218.09
|
| Rate for Payer: BCN Medicare Advantage |
$70.12
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cofinity Commercial |
$241.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.12
|
| Rate for Payer: Healthscope Commercial |
$252.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.42
|
| Rate for Payer: PACE Senior Care Partners |
$66.62
|
| Rate for Payer: PACE SWMI |
$70.12
|
| Rate for Payer: PHP Commercial |
$238.42
|
| Rate for Payer: PHP Medicare Advantage |
$70.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.04
|
| Rate for Payer: Priority Health Medicare |
$70.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.08
|
| Rate for Payer: Railroad Medicare Medicare |
$70.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.84
|
| Rate for Payer: UHC Core |
$234.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.12
|
| Rate for Payer: UHC Medicare Advantage |
$72.23
|
| Rate for Payer: VA VA |
$70.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.38
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600186
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$57.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.85
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS MAPPO |
$55.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.30
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: BCN Medicare Advantage |
$55.08
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.08
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PACE Senior Care Partners |
$52.33
|
| Rate for Payer: PACE SWMI |
$55.08
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: PHP Medicare Advantage |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$55.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: Railroad Medicare Medicare |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$56.73
|
| Rate for Payer: VA VA |
$55.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
OP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: Aetna Medicare |
$57.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.85
|
| Rate for Payer: BCBS Complete |
$88.13
|
| Rate for Payer: BCBS MAPPO |
$55.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.30
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: BCN Medicare Advantage |
$55.08
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.08
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PACE Senior Care Partners |
$52.33
|
| Rate for Payer: PACE SWMI |
$55.08
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: PHP Medicare Advantage |
$55.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Medicare |
$55.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: Railroad Medicare Medicare |
$55.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.08
|
| Rate for Payer: UHC Medicare Advantage |
$56.73
|
| Rate for Payer: VA VA |
$55.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 4X4 PER SQ CM EXTRA FENESTRATED
|
Facility
|
IP
|
$220.32
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600184
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.37 |
| Max. Negotiated Rate |
$198.29 |
| Rate for Payer: Aetna Commercial |
$187.27
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: Cash Price |
$176.26
|
| Rate for Payer: Cofinity Commercial |
$189.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.26
|
| Rate for Payer: Healthscope Commercial |
$198.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.27
|
| Rate for Payer: PHP Commercial |
$187.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Core |
$183.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.24
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
OP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Aetna Commercial |
$129.68
|
| Rate for Payer: Aetna Medicare |
$39.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.68
|
| Rate for Payer: BCBS Complete |
$61.03
|
| Rate for Payer: BCBS MAPPO |
$38.14
|
| Rate for Payer: BCBS Trust/PPO |
$118.62
|
| Rate for Payer: BCN Commercial |
$118.62
|
| Rate for Payer: BCN Medicare Advantage |
$38.14
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.14
|
| Rate for Payer: Healthscope Commercial |
$137.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: PACE Senior Care Partners |
$36.24
|
| Rate for Payer: PACE SWMI |
$38.14
|
| Rate for Payer: PHP Commercial |
$129.68
|
| Rate for Payer: PHP Medicare Advantage |
$38.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.74
|
| Rate for Payer: Priority Health Medicare |
$38.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.05
|
| Rate for Payer: Railroad Medicare Medicare |
$38.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.26
|
| Rate for Payer: UHC Core |
$127.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.14
|
| Rate for Payer: UHC Medicare Advantage |
$39.29
|
| Rate for Payer: VA VA |
$38.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.43
|
|
|
HC PURAPLY AM 5X5 PER SQ CM
|
Facility
|
IP
|
$152.57
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$137.31 |
| Rate for Payer: Aetna Commercial |
$129.68
|
| Rate for Payer: BCBS Trust/PPO |
$117.91
|
| Rate for Payer: BCN Commercial |
$117.91
|
| Rate for Payer: Cash Price |
$122.06
|
| Rate for Payer: Cofinity Commercial |
$131.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.06
|
| Rate for Payer: Healthscope Commercial |
$137.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.68
|
| Rate for Payer: PHP Commercial |
$129.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.26
|
| Rate for Payer: UHC Core |
$127.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.43
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
OP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: Aetna Medicare |
$45.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.51
|
| Rate for Payer: BCBS Complete |
$69.77
|
| Rate for Payer: BCBS MAPPO |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$135.61
|
| Rate for Payer: BCN Commercial |
$135.61
|
| Rate for Payer: BCN Medicare Advantage |
$43.60
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.60
|
| Rate for Payer: Healthscope Commercial |
$156.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: PACE Senior Care Partners |
$41.42
|
| Rate for Payer: PACE SWMI |
$43.60
|
| Rate for Payer: PHP Commercial |
$148.26
|
| Rate for Payer: PHP Medicare Advantage |
$43.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.75
|
| Rate for Payer: Priority Health Medicare |
$43.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.38
|
| Rate for Payer: Railroad Medicare Medicare |
$43.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.49
|
| Rate for Payer: UHC Core |
$145.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.60
|
| Rate for Payer: UHC Medicare Advantage |
$44.91
|
| Rate for Payer: VA VA |
$43.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.82
|
|
|
HC PURAPLY AM 6X9 PER SQ CM
|
Facility
|
IP
|
$174.42
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
63600118
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.38 |
| Max. Negotiated Rate |
$156.98 |
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: BCBS Trust/PPO |
$134.79
|
| Rate for Payer: BCN Commercial |
$134.79
|
| Rate for Payer: Cash Price |
$139.54
|
| Rate for Payer: Cofinity Commercial |
$150.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.54
|
| Rate for Payer: Healthscope Commercial |
$156.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.26
|
| Rate for Payer: PHP Commercial |
$148.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.49
|
| Rate for Payer: UHC Core |
$145.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.82
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
IP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$146.62 |
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: BCBS Trust/PPO |
$125.90
|
| Rate for Payer: BCN Commercial |
$125.90
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$140.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Healthscope Commercial |
$146.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.36
|
| Rate for Payer: UHC Core |
$136.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.18
|
|
|
HC PURE TONE AUDIOMETRY AIR
|
Facility
|
OP
|
$162.91
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
47100009
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.69 |
| Max. Negotiated Rate |
$146.62 |
| Rate for Payer: Aetna Commercial |
$138.47
|
| Rate for Payer: Aetna Medicare |
$42.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.91
|
| Rate for Payer: BCBS Complete |
$87.99
|
| Rate for Payer: BCBS MAPPO |
$40.73
|
| Rate for Payer: BCBS Trust/PPO |
$126.66
|
| Rate for Payer: BCN Commercial |
$126.66
|
| Rate for Payer: BCN Medicare Advantage |
$40.73
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cash Price |
$130.33
|
| Rate for Payer: Cofinity Commercial |
$140.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$146.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.18
|
| Rate for Payer: Mclaren Medicaid |
$83.80
|
| Rate for Payer: Meridian Medicaid |
$87.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.47
|
| Rate for Payer: PACE Senior Care Partners |
$38.69
|
| Rate for Payer: PACE SWMI |
$40.73
|
| Rate for Payer: PHP Commercial |
$138.47
|
| Rate for Payer: PHP Medicare Advantage |
$40.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.73
|
| Rate for Payer: Priority Health Medicare |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.36
|
| Rate for Payer: Railroad Medicare Medicare |
$40.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.36
|
| Rate for Payer: UHC Core |
$136.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.73
|
| Rate for Payer: UHC Medicare Advantage |
$41.95
|
| Rate for Payer: VA VA |
$40.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.18
|
|
|
HC PV JAK2V617F
|
Facility
|
OP
|
$323.05
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$67.65 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$274.59
|
| Rate for Payer: Aetna Medicare |
$83.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.95
|
| Rate for Payer: BCBS Complete |
$71.03
|
| Rate for Payer: BCBS MAPPO |
$80.76
|
| Rate for Payer: BCBS Trust/PPO |
$251.17
|
| Rate for Payer: BCN Commercial |
$251.17
|
| Rate for Payer: BCN Medicare Advantage |
$80.76
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cofinity Commercial |
$277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.76
|
| Rate for Payer: Healthscope Commercial |
$290.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.29
|
| Rate for Payer: Mclaren Medicaid |
$67.65
|
| Rate for Payer: Meridian Medicaid |
$71.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.59
|
| Rate for Payer: PACE Senior Care Partners |
$76.72
|
| Rate for Payer: PACE SWMI |
$80.76
|
| Rate for Payer: PHP Commercial |
$274.59
|
| Rate for Payer: PHP Medicare Advantage |
$80.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.05
|
| Rate for Payer: Priority Health Medicare |
$80.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.03
|
| Rate for Payer: Railroad Medicare Medicare |
$80.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.28
|
| Rate for Payer: UHC Core |
$269.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.76
|
| Rate for Payer: UHC Medicare Advantage |
$83.19
|
| Rate for Payer: VA VA |
$80.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.29
|
|
|
HC PV JAK2V617F
|
Facility
|
IP
|
$323.05
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$197.03 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$274.59
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: Cash Price |
$258.44
|
| Rate for Payer: Cofinity Commercial |
$277.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.44
|
| Rate for Payer: Healthscope Commercial |
$290.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.59
|
| Rate for Payer: PHP Commercial |
$274.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.28
|
| Rate for Payer: UHC Core |
$269.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.29
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.72 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: BCBS Trust/PPO |
$71.87
|
| Rate for Payer: BCN Commercial |
$71.87
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.84
|
| Rate for Payer: UHC Core |
$77.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.75
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$83.70 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.06
|
| Rate for Payer: BCBS Complete |
$7.32
|
| Rate for Payer: BCBS MAPPO |
$23.25
|
| Rate for Payer: BCBS Trust/PPO |
$72.31
|
| Rate for Payer: BCN Commercial |
$72.31
|
| Rate for Payer: BCN Medicare Advantage |
$23.25
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.25
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.75
|
| Rate for Payer: Mclaren Medicaid |
$6.97
|
| Rate for Payer: Meridian Medicaid |
$7.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.05
|
| Rate for Payer: PACE Senior Care Partners |
$22.09
|
| Rate for Payer: PACE SWMI |
$23.25
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: PHP Medicare Advantage |
$23.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.91
|
| Rate for Payer: Priority Health Medicare |
$23.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Railroad Medicare Medicare |
$23.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.84
|
| Rate for Payer: UHC Core |
$77.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.25
|
| Rate for Payer: UHC Medicare Advantage |
$23.95
|
| Rate for Payer: VA VA |
$23.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.75
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$10.69
|
| Rate for Payer: Meridian Medicaid |
$11.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.96 |
| Max. Negotiated Rate |
$300.98 |
| Rate for Payer: Aetna Commercial |
$284.26
|
| Rate for Payer: BCBS Trust/PPO |
$258.44
|
| Rate for Payer: BCN Commercial |
$258.44
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$287.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.54
|
| Rate for Payer: Healthscope Commercial |
$300.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: PHP Commercial |
$284.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.29
|
| Rate for Payer: UHC Core |
$279.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.82
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$334.42
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.42 |
| Max. Negotiated Rate |
$300.98 |
| Rate for Payer: Aetna Commercial |
$284.26
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.51
|
| Rate for Payer: BCBS Complete |
$133.77
|
| Rate for Payer: BCBS MAPPO |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$260.01
|
| Rate for Payer: BCN Commercial |
$260.01
|
| Rate for Payer: BCN Medicare Advantage |
$83.60
|
| Rate for Payer: Cash Price |
$267.54
|
| Rate for Payer: Cofinity Commercial |
$287.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.60
|
| Rate for Payer: Healthscope Commercial |
$300.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.26
|
| Rate for Payer: PACE Senior Care Partners |
$79.42
|
| Rate for Payer: PACE SWMI |
$83.60
|
| Rate for Payer: PHP Commercial |
$284.26
|
| Rate for Payer: PHP Medicare Advantage |
$83.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.95
|
| Rate for Payer: Priority Health Medicare |
$83.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.96
|
| Rate for Payer: Railroad Medicare Medicare |
$83.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.29
|
| Rate for Payer: UHC Core |
$279.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.60
|
| Rate for Payer: UHC Medicare Advantage |
$86.11
|
| Rate for Payer: VA VA |
$83.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.82
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.68 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: Aetna Commercial |
$289.43
|
| Rate for Payer: BCBS Trust/PPO |
$263.15
|
| Rate for Payer: BCN Commercial |
$263.15
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.41
|
| Rate for Payer: Healthscope Commercial |
$306.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: PHP Commercial |
$289.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.65
|
| Rate for Payer: UHC Core |
$284.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.38
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$340.51
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.87 |
| Max. Negotiated Rate |
$306.46 |
| Rate for Payer: Aetna Commercial |
$289.43
|
| Rate for Payer: Aetna Medicare |
$88.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.41
|
| Rate for Payer: BCBS Complete |
$136.20
|
| Rate for Payer: BCBS MAPPO |
$85.13
|
| Rate for Payer: BCBS Trust/PPO |
$264.75
|
| Rate for Payer: BCN Commercial |
$264.75
|
| Rate for Payer: BCN Medicare Advantage |
$85.13
|
| Rate for Payer: Cash Price |
$272.41
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.13
|
| Rate for Payer: Healthscope Commercial |
$306.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.43
|
| Rate for Payer: PACE Senior Care Partners |
$80.87
|
| Rate for Payer: PACE SWMI |
$85.13
|
| Rate for Payer: PHP Commercial |
$289.43
|
| Rate for Payer: PHP Medicare Advantage |
$85.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.24
|
| Rate for Payer: Priority Health Medicare |
$85.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.68
|
| Rate for Payer: Railroad Medicare Medicare |
$85.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.65
|
| Rate for Payer: UHC Core |
$284.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.13
|
| Rate for Payer: UHC Medicare Advantage |
$87.68
|
| Rate for Payer: VA VA |
$85.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.38
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$144.91 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: BCBS Trust/PPO |
$183.62
|
| Rate for Payer: BCN Commercial |
$183.62
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.09
|
| Rate for Payer: UHC Core |
$198.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$61.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.25
|
| Rate for Payer: BCBS Complete |
$118.95
|
| Rate for Payer: BCBS MAPPO |
$59.40
|
| Rate for Payer: BCBS Trust/PPO |
$184.73
|
| Rate for Payer: BCN Commercial |
$184.73
|
| Rate for Payer: BCN Medicare Advantage |
$59.40
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.40
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Mclaren Medicaid |
$113.28
|
| Rate for Payer: Meridian Medicaid |
$118.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Senior Care Partners |
$56.43
|
| Rate for Payer: PACE SWMI |
$59.40
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$59.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.71
|
| Rate for Payer: Priority Health Medicare |
$59.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.91
|
| Rate for Payer: Railroad Medicare Medicare |
$59.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.09
|
| Rate for Payer: UHC Core |
$198.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.40
|
| Rate for Payer: UHC Medicare Advantage |
$61.18
|
| Rate for Payer: VA VA |
$59.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.09 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: BCBS Trust/PPO |
$124.29
|
| Rate for Payer: BCN Commercial |
$124.29
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$138.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.66
|
| Rate for Payer: Healthscope Commercial |
$144.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: PHP Commercial |
$136.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.53
|
| Rate for Payer: UHC Core |
$134.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.62
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$160.83
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$144.75 |
| Rate for Payer: Aetna Commercial |
$136.71
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.26
|
| Rate for Payer: BCBS Complete |
$77.49
|
| Rate for Payer: BCBS MAPPO |
$40.21
|
| Rate for Payer: BCBS Trust/PPO |
$125.05
|
| Rate for Payer: BCN Commercial |
$125.05
|
| Rate for Payer: BCN Medicare Advantage |
$40.21
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cash Price |
$128.66
|
| Rate for Payer: Cofinity Commercial |
$138.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.21
|
| Rate for Payer: Healthscope Commercial |
$144.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.62
|
| Rate for Payer: Mclaren Medicaid |
$73.80
|
| Rate for Payer: Meridian Medicaid |
$77.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.71
|
| Rate for Payer: PACE Senior Care Partners |
$38.20
|
| Rate for Payer: PACE SWMI |
$40.21
|
| Rate for Payer: PHP Commercial |
$136.71
|
| Rate for Payer: PHP Medicare Advantage |
$40.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.92
|
| Rate for Payer: Priority Health Medicare |
$40.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.09
|
| Rate for Payer: Railroad Medicare Medicare |
$40.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.53
|
| Rate for Payer: UHC Core |
$134.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.21
|
| Rate for Payer: UHC Medicare Advantage |
$41.41
|
| Rate for Payer: VA VA |
$40.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.62
|
|
