|
HC RESERVOIR 20 MICRON
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$89.25
|
| Rate for Payer: Aetna Medicare |
$27.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.81
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$81.64
|
| Rate for Payer: BCN Commercial |
$81.64
|
| Rate for Payer: BCN Medicare Advantage |
$26.25
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$90.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.25
|
| Rate for Payer: Healthscope Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.94
|
| Rate for Payer: PACE SWMI |
$26.25
|
| Rate for Payer: PHP Commercial |
$89.25
|
| Rate for Payer: PHP Medicare Advantage |
$26.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.35
|
| Rate for Payer: Priority Health Medicare |
$26.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.04
|
| Rate for Payer: Railroad Medicare Medicare |
$26.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.40
|
| Rate for Payer: UHC Core |
$87.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.25
|
| Rate for Payer: UHC Medicare Advantage |
$27.04
|
| Rate for Payer: VA VA |
$26.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.75
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC RESERVOIR OUTLET Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000668
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC RESERVOIR TANDEM Y
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
27000667
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$25.50
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.38
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$27.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.50
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.10
|
| Rate for Payer: Priority Health Medicare |
$7.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.40
|
| Rate for Payer: UHC Core |
$25.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.72
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.50
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
IP
|
$825.00
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$503.17 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: BCBS Trust/PPO |
$637.56
|
| Rate for Payer: BCN Commercial |
$637.56
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.00
|
| Rate for Payer: UHC Core |
$688.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
|
HC RESERVOIR VEN STAND ALONE
|
Facility
|
OP
|
$825.00
|
|
| Hospital Charge Code |
27000653
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$195.94 |
| Max. Negotiated Rate |
$742.50 |
| Rate for Payer: Aetna Commercial |
$701.25
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.81
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$206.25
|
| Rate for Payer: BCBS Trust/PPO |
$641.44
|
| Rate for Payer: BCN Commercial |
$641.44
|
| Rate for Payer: BCN Medicare Advantage |
$206.25
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$709.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.25
|
| Rate for Payer: Healthscope Commercial |
$742.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$216.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$701.25
|
| Rate for Payer: PACE Senior Care Partners |
$195.94
|
| Rate for Payer: PACE SWMI |
$206.25
|
| Rate for Payer: PHP Commercial |
$701.25
|
| Rate for Payer: PHP Medicare Advantage |
$206.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.75
|
| Rate for Payer: Priority Health Medicare |
$206.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.17
|
| Rate for Payer: Railroad Medicare Medicare |
$206.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.00
|
| Rate for Payer: UHC Core |
$688.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.25
|
| Rate for Payer: UHC Medicare Advantage |
$212.44
|
| Rate for Payer: VA VA |
$206.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.75
|
|
|
HC RESPIRATORY ALLERGEN PROFILE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC RESPIRATORY ALLERGEN PROFILE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200121
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC RESPIRATORY FLOW VOLUME
|
Facility
|
OP
|
$174.91
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: Aetna Medicare |
$45.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.66
|
| Rate for Payer: BCBS Complete |
$216.20
|
| Rate for Payer: BCBS MAPPO |
$43.73
|
| Rate for Payer: BCBS Trust/PPO |
$135.99
|
| Rate for Payer: BCN Commercial |
$135.99
|
| Rate for Payer: BCN Medicare Advantage |
$43.73
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cofinity Commercial |
$150.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$157.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Mclaren Medicaid |
$205.90
|
| Rate for Payer: Meridian Medicaid |
$216.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.67
|
| Rate for Payer: PACE Senior Care Partners |
$41.54
|
| Rate for Payer: PACE SWMI |
$43.73
|
| Rate for Payer: PHP Commercial |
$148.67
|
| Rate for Payer: PHP Medicare Advantage |
$43.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.17
|
| Rate for Payer: Priority Health Medicare |
$43.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.68
|
| Rate for Payer: Railroad Medicare Medicare |
$43.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.92
|
| Rate for Payer: UHC Core |
$146.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.73
|
| Rate for Payer: UHC Medicare Advantage |
$45.04
|
| Rate for Payer: VA VA |
$43.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
HC RESPIRATORY FLOW VOLUME
|
Facility
|
IP
|
$174.91
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
46000023
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$106.68 |
| Max. Negotiated Rate |
$157.42 |
| Rate for Payer: Aetna Commercial |
$148.67
|
| Rate for Payer: BCBS Trust/PPO |
$135.17
|
| Rate for Payer: BCN Commercial |
$135.17
|
| Rate for Payer: Cash Price |
$139.93
|
| Rate for Payer: Cofinity Commercial |
$150.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.93
|
| Rate for Payer: Healthscope Commercial |
$157.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.67
|
| Rate for Payer: PHP Commercial |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.92
|
| Rate for Payer: UHC Core |
$146.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
OP
|
$1,033.93
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$930.54 |
| Rate for Payer: Aetna Commercial |
$878.84
|
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: Aetna Medicare |
$268.82
|
| Rate for Payer: Aetna Medicare |
$660.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$794.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$794.06
|
| Rate for Payer: BCBS Complete |
$1,016.40
|
| Rate for Payer: BCBS Complete |
$413.57
|
| Rate for Payer: BCBS MAPPO |
$635.25
|
| Rate for Payer: BCBS MAPPO |
$258.48
|
| Rate for Payer: BCBS Trust/PPO |
$803.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,975.63
|
| Rate for Payer: BCN Commercial |
$1,975.63
|
| Rate for Payer: BCN Commercial |
$803.88
|
| Rate for Payer: BCN Medicare Advantage |
$258.48
|
| Rate for Payer: BCN Medicare Advantage |
$635.25
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$827.14
|
| Rate for Payer: Cofinity Commercial |
$2,185.26
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,032.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.25
|
| Rate for Payer: Healthscope Commercial |
$2,286.90
|
| Rate for Payer: Healthscope Commercial |
$930.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,905.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$271.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$667.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$730.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,159.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$878.84
|
| Rate for Payer: PACE Senior Care Partners |
$245.56
|
| Rate for Payer: PACE Senior Care Partners |
$603.49
|
| Rate for Payer: PACE SWMI |
$635.25
|
| Rate for Payer: PACE SWMI |
$258.48
|
| Rate for Payer: PHP Commercial |
$2,159.85
|
| Rate for Payer: PHP Commercial |
$878.84
|
| Rate for Payer: PHP Medicare Advantage |
$258.48
|
| Rate for Payer: PHP Medicare Advantage |
$635.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,778.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,210.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.52
|
| Rate for Payer: Priority Health Medicare |
$258.48
|
| Rate for Payer: Priority Health Medicare |
$635.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,549.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$630.59
|
| Rate for Payer: Railroad Medicare Medicare |
$635.25
|
| Rate for Payer: Railroad Medicare Medicare |
$258.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,236.08
|
| Rate for Payer: UHC Core |
$2,121.74
|
| Rate for Payer: UHC Core |
$863.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.25
|
| Rate for Payer: UHC Medicare Advantage |
$654.31
|
| Rate for Payer: UHC Medicare Advantage |
$266.24
|
| Rate for Payer: VA VA |
$258.48
|
| Rate for Payer: VA VA |
$635.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,905.75
|
|
|
HC RESPIRATORY MOTION SIMULATION
|
Facility
|
IP
|
$1,033.93
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
33300058
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$630.59 |
| Max. Negotiated Rate |
$930.54 |
| Rate for Payer: Aetna Commercial |
$878.84
|
| Rate for Payer: Aetna Commercial |
$2,159.85
|
| Rate for Payer: BCBS Trust/PPO |
$799.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,963.68
|
| Rate for Payer: BCN Commercial |
$799.02
|
| Rate for Payer: BCN Commercial |
$1,963.68
|
| Rate for Payer: Cash Price |
$2,032.80
|
| Rate for Payer: Cash Price |
$827.14
|
| Rate for Payer: Cofinity Commercial |
$2,185.26
|
| Rate for Payer: Cofinity Commercial |
$889.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,032.80
|
| Rate for Payer: Healthscope Commercial |
$2,286.90
|
| Rate for Payer: Healthscope Commercial |
$930.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,905.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$878.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,159.85
|
| Rate for Payer: PHP Commercial |
$2,159.85
|
| Rate for Payer: PHP Commercial |
$878.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,778.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$899.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,210.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,549.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$630.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,236.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.86
|
| Rate for Payer: UHC Core |
$863.33
|
| Rate for Payer: UHC Core |
$2,121.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,905.75
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS AG
|
Facility
|
OP
|
$99.60
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30600175
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$84.66
|
| Rate for Payer: Aetna Medicare |
$25.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.12
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS MAPPO |
$24.90
|
| Rate for Payer: BCBS Trust/PPO |
$77.44
|
| Rate for Payer: BCN Commercial |
$77.44
|
| Rate for Payer: BCN Medicare Advantage |
$24.90
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.90
|
| Rate for Payer: Healthscope Commercial |
$89.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.70
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Meridian Medicaid |
$10.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.66
|
| Rate for Payer: PACE SWMI |
$24.90
|
| Rate for Payer: PHP Commercial |
$84.66
|
| Rate for Payer: PHP Medicare Advantage |
$24.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.65
|
| Rate for Payer: Priority Health Medicare |
$24.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.75
|
| Rate for Payer: Railroad Medicare Medicare |
$24.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.65
|
| Rate for Payer: UHC Core |
$83.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.90
|
| Rate for Payer: UHC Medicare Advantage |
$25.65
|
| Rate for Payer: VA VA |
$24.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.70
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS AG
|
Facility
|
IP
|
$99.60
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30600175
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$84.66
|
| Rate for Payer: BCBS Trust/PPO |
$76.97
|
| Rate for Payer: BCN Commercial |
$76.97
|
| Rate for Payer: Cash Price |
$79.68
|
| Rate for Payer: Cofinity Commercial |
$85.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.68
|
| Rate for Payer: Healthscope Commercial |
$89.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.66
|
| Rate for Payer: PHP Commercial |
$84.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.65
|
| Rate for Payer: UHC Core |
$83.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.70
|
|
|
HC RESPIRATORY VIRAL ID
|
Facility
|
IP
|
$71.80
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
30600182
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$64.62 |
| Rate for Payer: Aetna Commercial |
$61.03
|
| Rate for Payer: BCBS Trust/PPO |
$55.49
|
| Rate for Payer: BCN Commercial |
$55.49
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$61.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.44
|
| Rate for Payer: Healthscope Commercial |
$64.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.03
|
| Rate for Payer: PHP Commercial |
$61.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.18
|
| Rate for Payer: UHC Core |
$59.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.85
|
|
|
HC RESPIRATORY VIRAL ID
|
Facility
|
OP
|
$71.80
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
30600182
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$64.62 |
| Rate for Payer: Aetna Commercial |
$61.03
|
| Rate for Payer: Aetna Medicare |
$18.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.44
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$55.82
|
| Rate for Payer: BCN Commercial |
$55.82
|
| Rate for Payer: BCN Medicare Advantage |
$17.95
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$61.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.95
|
| Rate for Payer: Healthscope Commercial |
$64.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.85
|
| Rate for Payer: Mclaren Medicaid |
$9.90
|
| Rate for Payer: Meridian Medicaid |
$10.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.03
|
| Rate for Payer: PACE Senior Care Partners |
$17.05
|
| Rate for Payer: PACE SWMI |
$17.95
|
| Rate for Payer: PHP Commercial |
$61.03
|
| Rate for Payer: PHP Medicare Advantage |
$17.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.47
|
| Rate for Payer: Priority Health Medicare |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.79
|
| Rate for Payer: Railroad Medicare Medicare |
$17.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.18
|
| Rate for Payer: UHC Core |
$59.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.95
|
| Rate for Payer: UHC Medicare Advantage |
$18.49
|
| Rate for Payer: VA VA |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.85
|
|
|
HC RESPIRATORY VIRAL PANEL
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87300
|
| Hospital Charge Code |
30600134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: Aetna Medicare |
$17.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.56
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.65
|
| Rate for Payer: BCN Commercial |
$53.65
|
| Rate for Payer: BCN Medicare Advantage |
$17.25
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Mclaren Medicaid |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$9.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PACE Senior Care Partners |
$16.39
|
| Rate for Payer: PACE SWMI |
$17.25
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Medicare |
$17.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.25
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: VA VA |
$17.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC RESPIRATORY VIRAL PANEL
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87300
|
| Hospital Charge Code |
30600134
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Aetna Commercial |
$58.65
|
| Rate for Payer: BCBS Trust/PPO |
$53.32
|
| Rate for Payer: BCN Commercial |
$53.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$59.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.20
|
| Rate for Payer: Healthscope Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.65
|
| Rate for Payer: PHP Commercial |
$58.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.72
|
| Rate for Payer: UHC Core |
$57.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.75
|
|
|
HC RESP SYNCTIAL VIRUS IG PER 50 MG
|
Facility
|
OP
|
$4,931.74
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
63600156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$250.68 |
| Max. Negotiated Rate |
$4,438.57 |
| Rate for Payer: Aetna Commercial |
$4,191.98
|
| Rate for Payer: Aetna Medicare |
$1,282.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,541.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,541.17
|
| Rate for Payer: BCBS Complete |
$263.22
|
| Rate for Payer: BCBS MAPPO |
$1,232.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,834.43
|
| Rate for Payer: BCN Commercial |
$3,834.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,232.94
|
| Rate for Payer: Cash Price |
$3,945.39
|
| Rate for Payer: Cash Price |
$3,945.39
|
| Rate for Payer: Cofinity Commercial |
$4,241.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,945.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,232.94
|
| Rate for Payer: Healthscope Commercial |
$4,438.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,698.80
|
| Rate for Payer: Mclaren Medicaid |
$250.68
|
| Rate for Payer: Meridian Medicaid |
$263.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,294.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,417.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,191.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,171.29
|
| Rate for Payer: PACE SWMI |
$1,232.94
|
| Rate for Payer: PHP Commercial |
$4,191.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,232.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,290.61
|
| Rate for Payer: Priority Health Medicare |
$1,232.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,007.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,232.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,339.93
|
| Rate for Payer: UHC Core |
$4,118.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,232.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.92
|
| Rate for Payer: VA VA |
$1,232.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,698.80
|
|
|
HC RESP SYNCTIAL VIRUS IG PER 50 MG
|
Facility
|
IP
|
$4,931.74
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
63600156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,007.87 |
| Max. Negotiated Rate |
$4,438.57 |
| Rate for Payer: Aetna Commercial |
$4,191.98
|
| Rate for Payer: BCBS Trust/PPO |
$3,811.25
|
| Rate for Payer: BCN Commercial |
$3,811.25
|
| Rate for Payer: Cash Price |
$3,945.39
|
| Rate for Payer: Cofinity Commercial |
$4,241.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,945.39
|
| Rate for Payer: Healthscope Commercial |
$4,438.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,698.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,191.98
|
| Rate for Payer: PHP Commercial |
$4,191.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,452.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,290.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,007.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,339.93
|
| Rate for Payer: UHC Core |
$4,118.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,698.80
|
|
|
HC RESP SYNCYTIAL VIRUS W/OPTIC
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna Commercial |
$18.70
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.88
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS MAPPO |
$5.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Medicare Advantage |
$5.50
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.50
|
| Rate for Payer: Healthscope Commercial |
$19.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.50
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Meridian Medicaid |
$10.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.70
|
| Rate for Payer: PACE Senior Care Partners |
$5.22
|
| Rate for Payer: PACE SWMI |
$5.50
|
| Rate for Payer: PHP Commercial |
$18.70
|
| Rate for Payer: PHP Medicare Advantage |
$5.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.14
|
| Rate for Payer: Priority Health Medicare |
$5.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.36
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: VA VA |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.50
|
|
|
HC RESP SYNCYTIAL VIRUS W/OPTIC
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
30000172
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Aetna Commercial |
$18.70
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$19.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.70
|
| Rate for Payer: PHP Commercial |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.36
|
| Rate for Payer: UHC Core |
$18.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.50
|
|
|
HC RESP VIRAL PANEL BORDETELLA
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600189
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.58
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC RESP VIRAL PANEL BORDETELLA
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600189
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
