|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
IP
|
$3,801.67
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,471.09 |
| Max. Negotiated Rate |
$3,421.50 |
| Rate for Payer: Aetna Commercial |
$3,231.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,103.30
|
| Rate for Payer: BCN Commercial |
$2,937.93
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cofinity Commercial |
$3,269.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.34
|
| Rate for Payer: Healthscope Commercial |
$3,421.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,231.42
|
| Rate for Payer: Nomi Health Commercial |
$3,117.37
|
| Rate for Payer: PHP Commercial |
$3,231.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,471.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,307.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,547.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,345.47
|
| Rate for Payer: UHC Core |
$3,174.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.25
|
|
|
HC IR VENOGRAM RENAL BILAT SELECT
|
Facility
|
OP
|
$3,801.67
|
|
|
Service Code
|
CPT 75833
|
| Hospital Charge Code |
32000207
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$902.90 |
| Max. Negotiated Rate |
$3,421.50 |
| Rate for Payer: Aetna Commercial |
$3,231.42
|
| Rate for Payer: Aetna Medicare |
$988.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,188.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,188.02
|
| Rate for Payer: BCBS Complete |
$2,341.27
|
| Rate for Payer: BCBS MAPPO |
$950.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,125.35
|
| Rate for Payer: BCN Commercial |
$2,955.80
|
| Rate for Payer: BCN Medicare Advantage |
$950.42
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cash Price |
$3,041.34
|
| Rate for Payer: Cofinity Commercial |
$3,269.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,041.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.42
|
| Rate for Payer: Healthscope Commercial |
$3,421.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,851.25
|
| Rate for Payer: Mclaren Medicaid |
$2,229.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.94
|
| Rate for Payer: Meridian Medicaid |
$2,341.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,092.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,231.42
|
| Rate for Payer: Nomi Health Commercial |
$3,117.37
|
| Rate for Payer: PACE Senior Care Partners |
$902.90
|
| Rate for Payer: PACE SWMI |
$950.42
|
| Rate for Payer: PHP Commercial |
$3,231.42
|
| Rate for Payer: PHP Medicare Advantage |
$950.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,229.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,471.09
|
| Rate for Payer: Priority Health HMO/PPO |
$3,307.45
|
| Rate for Payer: Priority Health Medicare |
$959.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,547.12
|
| Rate for Payer: Railroad Medicare Medicare |
$950.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,345.47
|
| Rate for Payer: UHC Core |
$3,174.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$950.42
|
| Rate for Payer: UHC Exchange |
$950.42
|
| Rate for Payer: UHC Medicare Advantage |
$950.42
|
| Rate for Payer: UHCCP Medicaid |
$2,229.63
|
| Rate for Payer: VA VA |
$950.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,851.25
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
OP
|
$3,570.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$847.92 |
| Max. Negotiated Rate |
$3,213.15 |
| Rate for Payer: Aetna Commercial |
$3,034.64
|
| Rate for Payer: Aetna Medicare |
$928.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,115.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,115.68
|
| Rate for Payer: BCBS Complete |
$2,341.27
|
| Rate for Payer: BCBS MAPPO |
$892.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,935.04
|
| Rate for Payer: BCN Commercial |
$2,775.81
|
| Rate for Payer: BCN Medicare Advantage |
$892.54
|
| Rate for Payer: Cash Price |
$2,856.14
|
| Rate for Payer: Cash Price |
$2,856.14
|
| Rate for Payer: Cofinity Commercial |
$3,070.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$892.54
|
| Rate for Payer: Healthscope Commercial |
$3,213.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.63
|
| Rate for Payer: Mclaren Medicaid |
$2,229.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.17
|
| Rate for Payer: Meridian Medicaid |
$2,341.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,026.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.64
|
| Rate for Payer: Nomi Health Commercial |
$2,927.54
|
| Rate for Payer: PACE Senior Care Partners |
$847.92
|
| Rate for Payer: PACE SWMI |
$892.54
|
| Rate for Payer: PHP Commercial |
$3,034.64
|
| Rate for Payer: PHP Medicare Advantage |
$892.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,229.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.61
|
| Rate for Payer: Priority Health HMO/PPO |
$3,106.05
|
| Rate for Payer: Priority Health Medicare |
$901.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,392.01
|
| Rate for Payer: Railroad Medicare Medicare |
$892.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,141.75
|
| Rate for Payer: UHC Core |
$2,981.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$892.54
|
| Rate for Payer: UHC Exchange |
$892.54
|
| Rate for Payer: UHC Medicare Advantage |
$892.54
|
| Rate for Payer: UHCCP Medicaid |
$2,229.63
|
| Rate for Payer: VA VA |
$892.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.63
|
|
|
HC IR VENOGRAM RENAL UNI SELECT
|
Facility
|
IP
|
$3,570.17
|
|
|
Service Code
|
CPT 75831
|
| Hospital Charge Code |
32000322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,320.61 |
| Max. Negotiated Rate |
$3,213.15 |
| Rate for Payer: Aetna Commercial |
$3,034.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.33
|
| Rate for Payer: BCN Commercial |
$2,759.03
|
| Rate for Payer: Cash Price |
$2,856.14
|
| Rate for Payer: Cofinity Commercial |
$3,070.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,856.14
|
| Rate for Payer: Healthscope Commercial |
$3,213.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,677.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,034.64
|
| Rate for Payer: Nomi Health Commercial |
$2,927.54
|
| Rate for Payer: PHP Commercial |
$3,034.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.61
|
| Rate for Payer: Priority Health HMO/PPO |
$3,106.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,392.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,141.75
|
| Rate for Payer: UHC Core |
$2,981.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,677.63
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
OP
|
$1,208.35
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.98 |
| Max. Negotiated Rate |
$1,087.52 |
| Rate for Payer: Aetna Commercial |
$1,027.10
|
| Rate for Payer: Aetna Medicare |
$314.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$377.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$377.61
|
| Rate for Payer: BCBS Complete |
$678.18
|
| Rate for Payer: BCBS MAPPO |
$302.09
|
| Rate for Payer: BCBS Trust/PPO |
$993.38
|
| Rate for Payer: BCN Commercial |
$939.49
|
| Rate for Payer: BCN Medicare Advantage |
$302.09
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cofinity Commercial |
$1,039.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.09
|
| Rate for Payer: Healthscope Commercial |
$1,087.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.26
|
| Rate for Payer: Mclaren Medicaid |
$645.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.19
|
| Rate for Payer: Meridian Medicaid |
$678.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.10
|
| Rate for Payer: Nomi Health Commercial |
$990.85
|
| Rate for Payer: PACE Senior Care Partners |
$286.98
|
| Rate for Payer: PACE SWMI |
$302.09
|
| Rate for Payer: PHP Commercial |
$1,027.10
|
| Rate for Payer: PHP Medicare Advantage |
$302.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,051.26
|
| Rate for Payer: Priority Health Medicare |
$305.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$809.59
|
| Rate for Payer: Railroad Medicare Medicare |
$302.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.35
|
| Rate for Payer: UHC Core |
$1,008.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.09
|
| Rate for Payer: UHC Exchange |
$302.09
|
| Rate for Payer: UHC Medicare Advantage |
$302.09
|
| Rate for Payer: UHCCP Medicaid |
$645.84
|
| Rate for Payer: VA VA |
$302.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.26
|
|
|
HC IR Z ABSCESS PERIANAL
|
Facility
|
IP
|
$1,208.35
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
36100369
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$785.43 |
| Max. Negotiated Rate |
$1,087.52 |
| Rate for Payer: Aetna Commercial |
$1,027.10
|
| Rate for Payer: BCBS Trust/PPO |
$986.38
|
| Rate for Payer: BCN Commercial |
$933.81
|
| Rate for Payer: Cash Price |
$966.68
|
| Rate for Payer: Cofinity Commercial |
$1,039.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.68
|
| Rate for Payer: Healthscope Commercial |
$1,087.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$906.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,027.10
|
| Rate for Payer: Nomi Health Commercial |
$990.85
|
| Rate for Payer: PHP Commercial |
$1,027.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$785.43
|
| Rate for Payer: Priority Health HMO/PPO |
$1,051.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$809.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.35
|
| Rate for Payer: UHC Core |
$1,008.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$906.26
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
OP
|
$161.36
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$145.22 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$41.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.42
|
| Rate for Payer: BCBS Complete |
$25.77
|
| Rate for Payer: BCBS MAPPO |
$40.34
|
| Rate for Payer: BCBS Trust/PPO |
$132.65
|
| Rate for Payer: BCN Commercial |
$125.46
|
| Rate for Payer: BCN Medicare Advantage |
$40.34
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cofinity Commercial |
$138.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.34
|
| Rate for Payer: Healthscope Commercial |
$145.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.02
|
| Rate for Payer: Mclaren Medicaid |
$24.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.36
|
| Rate for Payer: Meridian Medicaid |
$25.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.16
|
| Rate for Payer: Nomi Health Commercial |
$132.32
|
| Rate for Payer: PACE Senior Care Partners |
$38.32
|
| Rate for Payer: PACE SWMI |
$40.34
|
| Rate for Payer: PHP Commercial |
$137.16
|
| Rate for Payer: PHP Medicare Advantage |
$40.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.88
|
| Rate for Payer: Priority Health HMO/PPO |
$140.38
|
| Rate for Payer: Priority Health Medicare |
$40.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.11
|
| Rate for Payer: Railroad Medicare Medicare |
$40.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.00
|
| Rate for Payer: UHC Core |
$134.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.34
|
| Rate for Payer: UHC Exchange |
$40.34
|
| Rate for Payer: UHC Medicare Advantage |
$40.34
|
| Rate for Payer: UHCCP Medicaid |
$24.54
|
| Rate for Payer: VA VA |
$40.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.02
|
|
|
HC ISCHEMIA MODIFIED ALBUMIN
|
Facility
|
IP
|
$161.36
|
|
|
Service Code
|
CPT 82045
|
| Hospital Charge Code |
30100076
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$104.88 |
| Max. Negotiated Rate |
$145.22 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: BCBS Trust/PPO |
$131.72
|
| Rate for Payer: BCN Commercial |
$124.70
|
| Rate for Payer: Cash Price |
$129.09
|
| Rate for Payer: Cofinity Commercial |
$138.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.09
|
| Rate for Payer: Healthscope Commercial |
$145.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.16
|
| Rate for Payer: Nomi Health Commercial |
$132.32
|
| Rate for Payer: PHP Commercial |
$137.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.88
|
| Rate for Payer: Priority Health HMO/PPO |
$140.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.00
|
| Rate for Payer: UHC Core |
$134.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.02
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: BCBS Trust/PPO |
$45.01
|
| Rate for Payer: BCN Commercial |
$42.61
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC ISLET ANTIGEN 2 ANTIBODY
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
30200412
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.23
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$13.78
|
| Rate for Payer: BCBS Trust/PPO |
$45.33
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$13.78
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Mclaren Medicaid |
$17.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PACE Senior Care Partners |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.78
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Medicare |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.78
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: VA VA |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.14
|
| Rate for Payer: BCBS Complete |
$127.47
|
| Rate for Payer: BCBS MAPPO |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$84.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.31
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.31
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$127.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.31
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Medicare |
$27.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.31
|
| Rate for Payer: UHC Exchange |
$27.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.31
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$27.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC ISOAGGLUTININ TITER ANTI A
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$89.17
|
| Rate for Payer: BCN Commercial |
$84.42
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$127.47 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: Aetna Medicare |
$28.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.14
|
| Rate for Payer: BCBS Complete |
$127.47
|
| Rate for Payer: BCBS MAPPO |
$27.31
|
| Rate for Payer: BCBS Trust/PPO |
$89.81
|
| Rate for Payer: BCN Commercial |
$84.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.31
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.31
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$127.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PACE Senior Care Partners |
$25.94
|
| Rate for Payer: PACE SWMI |
$27.31
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Medicare |
$27.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: Railroad Medicare Medicare |
$27.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.31
|
| Rate for Payer: UHC Exchange |
$27.31
|
| Rate for Payer: UHC Medicare Advantage |
$27.31
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$27.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC ISOAGGLUTININ TITER ANTI B
|
Facility
|
IP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200346
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$71.01 |
| Max. Negotiated Rate |
$98.32 |
| Rate for Payer: Aetna Commercial |
$92.85
|
| Rate for Payer: BCBS Trust/PPO |
$89.17
|
| Rate for Payer: BCN Commercial |
$84.42
|
| Rate for Payer: Cash Price |
$87.39
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.39
|
| Rate for Payer: Healthscope Commercial |
$98.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.85
|
| Rate for Payer: Nomi Health Commercial |
$89.58
|
| Rate for Payer: PHP Commercial |
$92.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.01
|
| Rate for Payer: Priority Health HMO/PPO |
$95.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.13
|
| Rate for Payer: UHC Core |
$91.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.93
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
IP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.43 |
| Max. Negotiated Rate |
$143.21 |
| Rate for Payer: Aetna Commercial |
$135.25
|
| Rate for Payer: BCBS Trust/PPO |
$129.89
|
| Rate for Payer: BCN Commercial |
$122.97
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Healthscope Commercial |
$143.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: PHP Commercial |
$135.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: Priority Health HMO/PPO |
$138.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.03
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.34
|
|
|
HC ISOPROPANOL LVL
|
Facility
|
OP
|
$159.12
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
30100580
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$143.21 |
| Rate for Payer: Aetna Commercial |
$135.25
|
| Rate for Payer: Aetna Medicare |
$41.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.72
|
| Rate for Payer: BCBS Complete |
$63.65
|
| Rate for Payer: BCBS MAPPO |
$39.78
|
| Rate for Payer: BCBS Trust/PPO |
$130.81
|
| Rate for Payer: BCN Commercial |
$123.72
|
| Rate for Payer: BCN Medicare Advantage |
$39.78
|
| Rate for Payer: Cash Price |
$127.30
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.78
|
| Rate for Payer: Healthscope Commercial |
$143.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.25
|
| Rate for Payer: Nomi Health Commercial |
$130.48
|
| Rate for Payer: PACE Senior Care Partners |
$37.79
|
| Rate for Payer: PACE SWMI |
$39.78
|
| Rate for Payer: PHP Commercial |
$135.25
|
| Rate for Payer: PHP Medicare Advantage |
$39.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.43
|
| Rate for Payer: Priority Health HMO/PPO |
$138.43
|
| Rate for Payer: Priority Health Medicare |
$40.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.61
|
| Rate for Payer: Railroad Medicare Medicare |
$39.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.03
|
| Rate for Payer: UHC Core |
$132.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.78
|
| Rate for Payer: UHC Exchange |
$39.78
|
| Rate for Payer: UHC Medicare Advantage |
$39.78
|
| Rate for Payer: VA VA |
$39.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.34
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
OP
|
$2.40
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: Aetna Medicare |
$0.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.75
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Medicare Advantage |
$0.60
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.60
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: PACE Senior Care Partners |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.60
|
| Rate for Payer: PHP Commercial |
$2.04
|
| Rate for Payer: PHP Medicare Advantage |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health HMO/PPO |
$2.09
|
| Rate for Payer: Priority Health Medicare |
$0.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.61
|
| Rate for Payer: Railroad Medicare Medicare |
$0.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.11
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.60
|
| Rate for Payer: UHC Exchange |
$0.60
|
| Rate for Payer: UHC Medicare Advantage |
$0.60
|
| Rate for Payer: VA VA |
$0.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.80
|
|
|
HC ISOVUE 200M PER ML
|
Facility
|
IP
|
$2.40
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600033
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$1.96
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.92
|
| Rate for Payer: Healthscope Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.04
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: PHP Commercial |
$2.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.56
|
| Rate for Payer: Priority Health HMO/PPO |
$2.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.11
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.80
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
OP
|
$4.46
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Medicare Advantage |
$1.12
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.12
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: PACE Senior Care Partners |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.12
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.12
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.12
|
| Rate for Payer: VA VA |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
HC ISOVUE 200 PER ML
|
Facility
|
IP
|
$4.46
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
63600011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.01 |
| Rate for Payer: Aetna Commercial |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$3.64
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$3.57
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.79
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.90
|
| Rate for Payer: Priority Health HMO/PPO |
$3.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
IP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: PHP Commercial |
$1.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.26
|
| Rate for Payer: Priority Health HMO/PPO |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.71
|
| Rate for Payer: UHC Core |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.46
|
|
|
HC ISOVUE 300M PER ML
|
Facility
|
OP
|
$1.94
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.61
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.51
|
| Rate for Payer: BCN Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.49
|
| Rate for Payer: Healthscope Commercial |
$1.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.65
|
| Rate for Payer: Nomi Health Commercial |
$1.59
|
| Rate for Payer: PACE Senior Care Partners |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.49
|
| Rate for Payer: PHP Commercial |
$1.65
|
| Rate for Payer: PHP Medicare Advantage |
$0.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.26
|
| Rate for Payer: Priority Health HMO/PPO |
$1.69
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.71
|
| Rate for Payer: UHC Core |
$1.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.49
|
| Rate for Payer: UHC Exchange |
$0.49
|
| Rate for Payer: UHC Medicare Advantage |
$0.49
|
| Rate for Payer: VA VA |
$0.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.46
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
IP
|
$1.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.36
|
| Rate for Payer: BCN Commercial |
$1.29
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.37
|
| Rate for Payer: PHP Commercial |
$1.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.47
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.25
|
|
|
HC ISOVUE 300 PER ML
|
Facility
|
OP
|
$1.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.52
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: BCBS MAPPO |
$0.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.42
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.42
|
| Rate for Payer: Healthscope Commercial |
$1.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.42
|
| Rate for Payer: Nomi Health Commercial |
$1.37
|
| Rate for Payer: PACE Senior Care Partners |
$0.40
|
| Rate for Payer: PACE SWMI |
$0.42
|
| Rate for Payer: PHP Commercial |
$1.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1.45
|
| Rate for Payer: Priority Health Medicare |
$0.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.12
|
| Rate for Payer: Railroad Medicare Medicare |
$0.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.47
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.42
|
| Rate for Payer: UHC Exchange |
$0.42
|
| Rate for Payer: UHC Medicare Advantage |
$0.42
|
| Rate for Payer: VA VA |
$0.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.25
|
|
|
HC ISOVUE 370 PER ML
|
Facility
|
OP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.59
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.65
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.42
|
|
