|
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 |
$41.35
|
| 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 |
$41.35
|
|
|
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 A
|
Facility
|
OP
|
$109.24
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
30200345
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$98.32 |
| 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 |
$3.93
|
| 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 |
$3.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| 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 |
$3.75
|
| 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 |
$3.75
|
| Rate for Payer: VA VA |
$27.31
|
| 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 |
$3.75 |
| Max. Negotiated Rate |
$98.32 |
| 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 |
$3.93
|
| 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 |
$3.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.68
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| 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 |
$3.75
|
| 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 |
$3.75
|
| 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 |
$49.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.73
|
| 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 |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.67
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| 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 |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$4.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.35
|
| 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 |
$1.11
|
| Rate for Payer: PHP Commercial |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| 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 |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.92
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.35
|
|
|
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 |
$3.35
|
| 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 |
$3.35
|
|
|
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 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 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
|
IP
|
$1.90
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: BCBS Trust/PPO |
$1.55
|
| Rate for Payer: BCN Commercial |
$1.47
|
| 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: Healthscope Commercial |
$1.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.61
|
| Rate for Payer: Nomi Health Commercial |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.67
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
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 |
$1.61
|
| 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 |
$1.43
|
| 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 |
$1.61
|
| 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 |
$1.61
|
| 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 |
$1.43
|
|
|
HC IUD REMOVAL
|
Facility
|
IP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.10 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: BCBS Trust/PPO |
$262.60
|
| Rate for Payer: BCN Commercial |
$248.60
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO |
$279.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.09
|
| Rate for Payer: UHC Core |
$268.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUD REMOVAL
|
Facility
|
OP
|
$321.69
|
|
|
Service Code
|
HCPCS 58301
|
| Hospital Charge Code |
45000086
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$289.52 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna Medicare |
$83.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.53
|
| Rate for Payer: BCBS Complete |
$230.94
|
| Rate for Payer: BCBS MAPPO |
$80.42
|
| Rate for Payer: BCBS Trust/PPO |
$264.46
|
| Rate for Payer: BCN Commercial |
$250.11
|
| Rate for Payer: BCN Medicare Advantage |
$80.42
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cash Price |
$257.35
|
| Rate for Payer: Cofinity Commercial |
$276.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.42
|
| Rate for Payer: Healthscope Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.27
|
| Rate for Payer: Mclaren Medicaid |
$219.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.44
|
| Rate for Payer: Meridian Medicaid |
$230.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.44
|
| Rate for Payer: Nomi Health Commercial |
$263.79
|
| Rate for Payer: PACE Senior Care Partners |
$76.40
|
| Rate for Payer: PACE SWMI |
$80.42
|
| Rate for Payer: PHP Commercial |
$273.44
|
| Rate for Payer: PHP Medicare Advantage |
$80.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.10
|
| Rate for Payer: Priority Health HMO/PPO |
$279.87
|
| Rate for Payer: Priority Health Medicare |
$81.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.53
|
| Rate for Payer: Railroad Medicare Medicare |
$80.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.09
|
| Rate for Payer: UHC Core |
$268.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.42
|
| Rate for Payer: UHC Exchange |
$80.42
|
| Rate for Payer: UHC Medicare Advantage |
$80.42
|
| Rate for Payer: UHCCP Medicaid |
$219.93
|
| Rate for Payer: VA VA |
$80.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.27
|
|
|
HC IUPC ASSIST
|
Facility
|
OP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Medicare |
$31.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.41
|
| Rate for Payer: BCBS Complete |
$47.89
|
| Rate for Payer: BCBS MAPPO |
$29.93
|
| Rate for Payer: BCBS Trust/PPO |
$98.42
|
| Rate for Payer: BCN Commercial |
$93.08
|
| Rate for Payer: BCN Medicare Advantage |
$29.93
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.93
|
| Rate for Payer: Healthscope Commercial |
$107.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: PACE Senior Care Partners |
$28.43
|
| Rate for Payer: PACE SWMI |
$29.93
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: PHP Medicare Advantage |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health HMO/PPO |
$104.16
|
| Rate for Payer: Priority Health Medicare |
$30.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.21
|
| Rate for Payer: Railroad Medicare Medicare |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.35
|
| Rate for Payer: UHC Core |
$99.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.93
|
| Rate for Payer: UHC Exchange |
$29.93
|
| Rate for Payer: UHC Medicare Advantage |
$29.93
|
| Rate for Payer: VA VA |
$29.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
HC IUPC ASSIST
|
Facility
|
IP
|
$119.72
|
|
| Hospital Charge Code |
27000120
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.82 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.78
|
| Rate for Payer: Healthscope Commercial |
$107.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.76
|
| Rate for Payer: Nomi Health Commercial |
$98.17
|
| Rate for Payer: PHP Commercial |
$101.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.82
|
| Rate for Payer: Priority Health HMO/PPO |
$104.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.35
|
| Rate for Payer: UHC Core |
$99.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.79
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
OP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: Aetna Medicare |
$22.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.69
|
| Rate for Payer: BCBS Complete |
$34.16
|
| Rate for Payer: BCBS MAPPO |
$21.35
|
| Rate for Payer: BCBS Trust/PPO |
$70.22
|
| Rate for Payer: BCN Commercial |
$66.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.35
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: PACE Senior Care Partners |
$20.28
|
| Rate for Payer: PACE SWMI |
$21.35
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: PHP Medicare Advantage |
$21.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Medicare |
$21.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.35
|
| Rate for Payer: UHC Exchange |
$21.35
|
| Rate for Payer: UHC Medicare Advantage |
$21.35
|
| Rate for Payer: VA VA |
$21.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV 0.45% NS 1000
|
Facility
|
IP
|
$85.41
|
|
| Hospital Charge Code |
25000010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$76.87 |
| Rate for Payer: Aetna Commercial |
$72.60
|
| Rate for Payer: BCBS Trust/PPO |
$69.72
|
| Rate for Payer: BCN Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$68.33
|
| Rate for Payer: Cofinity Commercial |
$73.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.33
|
| Rate for Payer: Healthscope Commercial |
$76.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.60
|
| Rate for Payer: Nomi Health Commercial |
$70.04
|
| Rate for Payer: PHP Commercial |
$72.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.52
|
| Rate for Payer: Priority Health HMO/PPO |
$74.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.16
|
| Rate for Payer: UHC Core |
$71.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.06
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
IP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$183.21 |
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: BCBS Trust/PPO |
$166.17
|
| Rate for Payer: BCN Commercial |
$157.32
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO |
$177.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Core |
$169.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
|
HC IV HYDRATION ONLY, EACH ADDL HR
|
Facility
|
OP
|
$203.57
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
26000002
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$183.21 |
| Rate for Payer: Aetna Commercial |
$173.03
|
| Rate for Payer: Aetna Medicare |
$52.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.62
|
| Rate for Payer: BCBS Complete |
$35.03
|
| Rate for Payer: BCBS MAPPO |
$50.89
|
| Rate for Payer: BCBS Trust/PPO |
$167.35
|
| Rate for Payer: BCN Commercial |
$158.28
|
| Rate for Payer: BCN Medicare Advantage |
$50.89
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cash Price |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$175.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$183.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.68
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.44
|
| Rate for Payer: Meridian Medicaid |
$35.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.03
|
| Rate for Payer: Nomi Health Commercial |
$166.93
|
| Rate for Payer: PACE Senior Care Partners |
$48.35
|
| Rate for Payer: PACE SWMI |
$50.89
|
| Rate for Payer: PHP Commercial |
$173.03
|
| Rate for Payer: PHP Medicare Advantage |
$50.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.32
|
| Rate for Payer: Priority Health HMO/PPO |
$177.11
|
| Rate for Payer: Priority Health Medicare |
$51.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.39
|
| Rate for Payer: Railroad Medicare Medicare |
$50.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Core |
$169.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.89
|
| Rate for Payer: UHC Exchange |
$50.89
|
| Rate for Payer: UHC Medicare Advantage |
$50.89
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: VA VA |
$50.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.68
|
|
