|
HC JAK2 V617F MUTATION
|
Facility
|
OP
|
$388.07
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$349.26 |
| Rate for Payer: Aetna Commercial |
$329.86
|
| Rate for Payer: Aetna Medicare |
$100.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.27
|
| Rate for Payer: BCBS Complete |
$69.59
|
| Rate for Payer: BCBS MAPPO |
$97.02
|
| Rate for Payer: BCBS Trust/PPO |
$319.03
|
| Rate for Payer: BCN Commercial |
$301.72
|
| Rate for Payer: BCN Medicare Advantage |
$97.02
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cofinity Commercial |
$333.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.02
|
| Rate for Payer: Healthscope Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.05
|
| Rate for Payer: Mclaren Medicaid |
$66.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.87
|
| Rate for Payer: Meridian Medicaid |
$69.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.86
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE Senior Care Partners |
$92.17
|
| Rate for Payer: PACE SWMI |
$97.02
|
| Rate for Payer: PHP Commercial |
$329.86
|
| Rate for Payer: PHP Medicare Advantage |
$97.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO |
$337.62
|
| Rate for Payer: Priority Health Medicare |
$97.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.01
|
| Rate for Payer: Railroad Medicare Medicare |
$97.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.50
|
| Rate for Payer: UHC Core |
$324.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.02
|
| Rate for Payer: UHC Exchange |
$97.02
|
| Rate for Payer: UHC Medicare Advantage |
$97.02
|
| Rate for Payer: UHCCP Medicaid |
$66.27
|
| Rate for Payer: VA VA |
$97.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.05
|
|
|
HC JAK2 V617F MUTATION
|
Facility
|
IP
|
$388.07
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$349.26 |
| Rate for Payer: Aetna Commercial |
$329.86
|
| Rate for Payer: BCBS Trust/PPO |
$316.78
|
| Rate for Payer: BCN Commercial |
$299.90
|
| Rate for Payer: Cash Price |
$310.46
|
| Rate for Payer: Cofinity Commercial |
$333.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.46
|
| Rate for Payer: Healthscope Commercial |
$349.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.86
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PHP Commercial |
$329.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.25
|
| Rate for Payer: Priority Health HMO/PPO |
$337.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.50
|
| Rate for Payer: UHC Core |
$324.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.05
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
OP
|
$108.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.79
|
| Rate for Payer: BCBS Complete |
$26.64
|
| Rate for Payer: BCBS MAPPO |
$27.03
|
| Rate for Payer: BCBS Trust/PPO |
$88.89
|
| Rate for Payer: BCN Commercial |
$84.06
|
| Rate for Payer: BCN Medicare Advantage |
$27.03
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.03
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.09
|
| Rate for Payer: Mclaren Medicaid |
$25.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.38
|
| Rate for Payer: Meridian Medicaid |
$26.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| Rate for Payer: PACE Senior Care Partners |
$25.68
|
| Rate for Payer: PACE SWMI |
$27.03
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO |
$94.06
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.44
|
| Rate for Payer: Railroad Medicare Medicare |
$27.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.15
|
| Rate for Payer: UHC Core |
$90.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.03
|
| Rate for Payer: UHC Exchange |
$27.03
|
| Rate for Payer: UHC Medicare Advantage |
$27.03
|
| Rate for Payer: UHCCP Medicaid |
$25.37
|
| Rate for Payer: VA VA |
$27.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.09
|
|
|
HC JC VIRUS, PCR, CSF
|
Facility
|
IP
|
$108.12
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600335
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Aetna Commercial |
$91.90
|
| Rate for Payer: BCBS Trust/PPO |
$88.26
|
| Rate for Payer: BCN Commercial |
$83.56
|
| Rate for Payer: Cash Price |
$86.50
|
| Rate for Payer: Cofinity Commercial |
$92.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.50
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.90
|
| Rate for Payer: Nomi Health Commercial |
$88.66
|
| Rate for Payer: PHP Commercial |
$91.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.28
|
| Rate for Payer: Priority Health HMO/PPO |
$94.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.15
|
| Rate for Payer: UHC Core |
$90.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.09
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
OP
|
$2,576.21
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$477.98 |
| Max. Negotiated Rate |
$2,318.59 |
| Rate for Payer: Aetna Commercial |
$2,189.78
|
| Rate for Payer: Aetna Medicare |
$669.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$805.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$805.07
|
| Rate for Payer: BCBS Complete |
$501.91
|
| Rate for Payer: BCBS MAPPO |
$644.05
|
| Rate for Payer: BCBS Trust/PPO |
$2,117.90
|
| Rate for Payer: BCN Commercial |
$2,003.00
|
| Rate for Payer: BCN Medicare Advantage |
$644.05
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cofinity Commercial |
$2,215.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.05
|
| Rate for Payer: Healthscope Commercial |
$2,318.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,932.16
|
| Rate for Payer: Mclaren Medicaid |
$477.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.26
|
| Rate for Payer: Meridian Medicaid |
$501.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$740.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,189.78
|
| Rate for Payer: Nomi Health Commercial |
$2,112.49
|
| Rate for Payer: PACE Senior Care Partners |
$611.85
|
| Rate for Payer: PACE SWMI |
$644.05
|
| Rate for Payer: PHP Commercial |
$2,189.78
|
| Rate for Payer: PHP Medicare Advantage |
$644.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,674.54
|
| Rate for Payer: Priority Health HMO/PPO |
$2,241.30
|
| Rate for Payer: Priority Health Medicare |
$650.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,726.06
|
| Rate for Payer: Railroad Medicare Medicare |
$644.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,267.06
|
| Rate for Payer: UHC Core |
$2,151.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.05
|
| Rate for Payer: UHC Exchange |
$644.05
|
| Rate for Payer: UHC Medicare Advantage |
$644.05
|
| Rate for Payer: UHCCP Medicaid |
$477.98
|
| Rate for Payer: VA VA |
$644.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,932.16
|
|
|
HC JET VENT INITIAL DAY
|
Facility
|
IP
|
$2,576.21
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
41000057
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,674.54 |
| Max. Negotiated Rate |
$2,318.59 |
| Rate for Payer: Aetna Commercial |
$2,189.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.96
|
| Rate for Payer: BCN Commercial |
$1,990.90
|
| Rate for Payer: Cash Price |
$2,060.97
|
| Rate for Payer: Cofinity Commercial |
$2,215.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,060.97
|
| Rate for Payer: Healthscope Commercial |
$2,318.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,932.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,189.78
|
| Rate for Payer: Nomi Health Commercial |
$2,112.49
|
| Rate for Payer: PHP Commercial |
$2,189.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,674.54
|
| Rate for Payer: Priority Health HMO/PPO |
$2,241.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,726.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,267.06
|
| Rate for Payer: UHC Core |
$2,151.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,932.16
|
|
|
HC JET VENT SUB DAY
|
Facility
|
IP
|
$1,897.80
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,233.57 |
| Max. Negotiated Rate |
$1,708.02 |
| Rate for Payer: Aetna Commercial |
$1,613.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,549.17
|
| Rate for Payer: BCN Commercial |
$1,466.62
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cofinity Commercial |
$1,632.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.24
|
| Rate for Payer: Healthscope Commercial |
$1,708.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,423.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.13
|
| Rate for Payer: Nomi Health Commercial |
$1,556.20
|
| Rate for Payer: PHP Commercial |
$1,613.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.57
|
| Rate for Payer: Priority Health HMO/PPO |
$1,651.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,271.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,670.06
|
| Rate for Payer: UHC Core |
$1,584.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,423.35
|
|
|
HC JET VENT SUB DAY
|
Facility
|
OP
|
$1,897.80
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
41000058
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$450.73 |
| Max. Negotiated Rate |
$1,708.02 |
| Rate for Payer: Aetna Commercial |
$1,613.13
|
| Rate for Payer: Aetna Medicare |
$493.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$593.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$593.06
|
| Rate for Payer: BCBS Complete |
$501.91
|
| Rate for Payer: BCBS MAPPO |
$474.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,560.18
|
| Rate for Payer: BCN Commercial |
$1,475.54
|
| Rate for Payer: BCN Medicare Advantage |
$474.45
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cash Price |
$1,518.24
|
| Rate for Payer: Cofinity Commercial |
$1,632.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,518.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.45
|
| Rate for Payer: Healthscope Commercial |
$1,708.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,423.35
|
| Rate for Payer: Mclaren Medicaid |
$477.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.17
|
| Rate for Payer: Meridian Medicaid |
$501.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$545.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,613.13
|
| Rate for Payer: Nomi Health Commercial |
$1,556.20
|
| Rate for Payer: PACE Senior Care Partners |
$450.73
|
| Rate for Payer: PACE SWMI |
$474.45
|
| Rate for Payer: PHP Commercial |
$1,613.13
|
| Rate for Payer: PHP Medicare Advantage |
$474.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,233.57
|
| Rate for Payer: Priority Health HMO/PPO |
$1,651.09
|
| Rate for Payer: Priority Health Medicare |
$479.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,271.53
|
| Rate for Payer: Railroad Medicare Medicare |
$474.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,670.06
|
| Rate for Payer: UHC Core |
$1,584.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$474.45
|
| Rate for Payer: UHC Exchange |
$474.45
|
| Rate for Payer: UHC Medicare Advantage |
$474.45
|
| Rate for Payer: UHCCP Medicaid |
$477.98
|
| Rate for Payer: VA VA |
$474.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,423.35
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
OP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$9.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.99
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$8.79
|
| Rate for Payer: BCBS Trust/PPO |
$28.91
|
| Rate for Payer: BCN Commercial |
$27.34
|
| Rate for Payer: BCN Medicare Advantage |
$8.79
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.79
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.23
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PACE Senior Care Partners |
$8.35
|
| Rate for Payer: PACE SWMI |
$8.79
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: PHP Medicare Advantage |
$8.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO |
$30.60
|
| Rate for Payer: Priority Health Medicare |
$8.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.95
|
| Rate for Payer: UHC Core |
$29.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.79
|
| Rate for Payer: UHC Exchange |
$8.79
|
| Rate for Payer: UHC Medicare Advantage |
$8.79
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$8.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC JO 1 ANTIBODY
|
Facility
|
IP
|
$35.17
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200163
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$31.65 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: BCBS Trust/PPO |
$28.71
|
| Rate for Payer: BCN Commercial |
$27.18
|
| Rate for Payer: Cash Price |
$28.14
|
| Rate for Payer: Cofinity Commercial |
$30.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$31.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.89
|
| Rate for Payer: Nomi Health Commercial |
$28.84
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.86
|
| Rate for Payer: Priority Health HMO/PPO |
$30.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.95
|
| Rate for Payer: UHC Core |
$29.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.38
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
IP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$9.07
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$9.11
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: Priority Health HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.78
|
| Rate for Payer: UHC Core |
$9.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.33
|
|
|
HC JOBST FOAM PADDING
|
Facility
|
OP
|
$11.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
27000364
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.47
|
| Rate for Payer: BCBS Complete |
$4.44
|
| Rate for Payer: BCBS MAPPO |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.13
|
| Rate for Payer: BCN Commercial |
$8.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.78
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$10.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$9.11
|
| Rate for Payer: PACE Senior Care Partners |
$2.64
|
| Rate for Payer: PACE SWMI |
$2.78
|
| Rate for Payer: PHP Commercial |
$9.44
|
| Rate for Payer: PHP Medicare Advantage |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: Priority Health HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Medicare |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.78
|
| Rate for Payer: UHC Core |
$9.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.78
|
| Rate for Payer: UHC Exchange |
$2.78
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: VA VA |
$2.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.33
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
IP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.37 |
| Max. Negotiated Rate |
$191.58 |
| Rate for Payer: Aetna Commercial |
$180.94
|
| Rate for Payer: BCBS Trust/PPO |
$173.77
|
| Rate for Payer: BCN Commercial |
$164.51
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Healthscope Commercial |
$191.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: PHP Commercial |
$180.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health HMO/PPO |
$185.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.33
|
| Rate for Payer: UHC Core |
$177.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.65
|
|
|
HC JOINT W MANUAL STRESS
|
Facility
|
OP
|
$212.87
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
32000287
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$191.58 |
| Rate for Payer: Aetna Commercial |
$180.94
|
| Rate for Payer: Aetna Medicare |
$55.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.52
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$53.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.00
|
| Rate for Payer: BCN Commercial |
$165.51
|
| Rate for Payer: BCN Medicare Advantage |
$53.22
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cash Price |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$183.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.22
|
| Rate for Payer: Healthscope Commercial |
$191.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.65
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.88
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.94
|
| Rate for Payer: Nomi Health Commercial |
$174.55
|
| Rate for Payer: PACE Senior Care Partners |
$50.56
|
| Rate for Payer: PACE SWMI |
$53.22
|
| Rate for Payer: PHP Commercial |
$180.94
|
| Rate for Payer: PHP Medicare Advantage |
$53.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.37
|
| Rate for Payer: Priority Health HMO/PPO |
$185.20
|
| Rate for Payer: Priority Health Medicare |
$53.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.62
|
| Rate for Payer: Railroad Medicare Medicare |
$53.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.33
|
| Rate for Payer: UHC Core |
$177.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.22
|
| Rate for Payer: UHC Exchange |
$53.22
|
| Rate for Payer: UHC Medicare Advantage |
$53.22
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$53.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.65
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
IP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.32 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: BCBS Trust/PPO |
$63.20
|
| Rate for Payer: BCN Commercial |
$59.83
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC KAPPA FREE LIGHT CHAIN SERUM
|
Facility
|
OP
|
$77.42
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$69.68 |
| Rate for Payer: Aetna Commercial |
$65.81
|
| Rate for Payer: Aetna Medicare |
$20.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.19
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$19.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.65
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Medicare Advantage |
$19.36
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cash Price |
$61.94
|
| Rate for Payer: Cofinity Commercial |
$66.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.06
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.32
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.81
|
| Rate for Payer: Nomi Health Commercial |
$63.48
|
| Rate for Payer: PACE Senior Care Partners |
$18.39
|
| Rate for Payer: PACE SWMI |
$19.36
|
| Rate for Payer: PHP Commercial |
$65.81
|
| Rate for Payer: PHP Medicare Advantage |
$19.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.32
|
| Rate for Payer: Priority Health HMO/PPO |
$67.36
|
| Rate for Payer: Priority Health Medicare |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.87
|
| Rate for Payer: Railroad Medicare Medicare |
$19.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.13
|
| Rate for Payer: UHC Core |
$64.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.36
|
| Rate for Payer: UHC Exchange |
$19.36
|
| Rate for Payer: UHC Medicare Advantage |
$19.36
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$19.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.06
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC KENTUCKY BLUE IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200090
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC KETONES (ACETONE)
|
Facility
|
OP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.51
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: BCBS MAPPO |
$9.21
|
| Rate for Payer: BCBS Trust/PPO |
$30.27
|
| Rate for Payer: BCN Commercial |
$28.63
|
| Rate for Payer: BCN Medicare Advantage |
$9.21
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.21
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.61
|
| Rate for Payer: Mclaren Medicaid |
$3.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.67
|
| Rate for Payer: Meridian Medicaid |
$3.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: Nomi Health Commercial |
$30.19
|
| Rate for Payer: PACE Senior Care Partners |
$8.74
|
| Rate for Payer: PACE SWMI |
$9.21
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: PHP Medicare Advantage |
$9.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health HMO/PPO |
$32.03
|
| Rate for Payer: Priority Health Medicare |
$9.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.67
|
| Rate for Payer: Railroad Medicare Medicare |
$9.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.40
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.21
|
| Rate for Payer: UHC Exchange |
$9.21
|
| Rate for Payer: UHC Medicare Advantage |
$9.21
|
| Rate for Payer: UHCCP Medicaid |
$3.27
|
| Rate for Payer: VA VA |
$9.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.61
|
|
|
HC KETONES (ACETONE)
|
Facility
|
IP
|
$36.82
|
|
|
Service Code
|
CPT 82009
|
| Hospital Charge Code |
30100067
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.93 |
| Max. Negotiated Rate |
$33.14 |
| Rate for Payer: Aetna Commercial |
$31.30
|
| Rate for Payer: BCBS Trust/PPO |
$30.06
|
| Rate for Payer: BCN Commercial |
$28.45
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$31.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.46
|
| Rate for Payer: Healthscope Commercial |
$33.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.30
|
| Rate for Payer: Nomi Health Commercial |
$30.19
|
| Rate for Payer: PHP Commercial |
$31.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.93
|
| Rate for Payer: Priority Health HMO/PPO |
$32.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.40
|
| Rate for Payer: UHC Core |
$30.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.61
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
IP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,880.38 |
| Max. Negotiated Rate |
$5,372.84 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: BCBS Trust/PPO |
$4,873.16
|
| Rate for Payer: BCN Commercial |
$4,613.48
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,477.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: Nomi Health Commercial |
$4,895.25
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health HMO/PPO |
$5,193.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,999.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,253.44
|
| Rate for Payer: UHC Core |
$4,984.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,477.36
|
|
|
HC KIDNEY ENDOSCOPY
|
Facility
|
OP
|
$5,969.82
|
|
|
Service Code
|
CPT 50551
|
| Hospital Charge Code |
76100307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,417.83 |
| Max. Negotiated Rate |
$5,372.84 |
| Rate for Payer: Aetna Commercial |
$5,074.35
|
| Rate for Payer: Aetna Medicare |
$1,552.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,865.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,865.57
|
| Rate for Payer: BCBS Complete |
$3,859.48
|
| Rate for Payer: BCBS MAPPO |
$1,492.45
|
| Rate for Payer: BCBS Trust/PPO |
$4,907.79
|
| Rate for Payer: BCN Commercial |
$4,641.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,492.45
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cash Price |
$4,775.86
|
| Rate for Payer: Cofinity Commercial |
$5,134.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,775.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,492.45
|
| Rate for Payer: Healthscope Commercial |
$5,372.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,477.36
|
| Rate for Payer: Mclaren Medicaid |
$3,675.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,567.08
|
| Rate for Payer: Meridian Medicaid |
$3,859.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,716.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,074.35
|
| Rate for Payer: Nomi Health Commercial |
$4,895.25
|
| Rate for Payer: PACE Senior Care Partners |
$1,417.83
|
| Rate for Payer: PACE SWMI |
$1,492.45
|
| Rate for Payer: PHP Commercial |
$5,074.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,492.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,675.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,880.38
|
| Rate for Payer: Priority Health HMO/PPO |
$5,193.74
|
| Rate for Payer: Priority Health Medicare |
$1,507.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,999.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,492.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,253.44
|
| Rate for Payer: UHC Core |
$4,984.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,492.45
|
| Rate for Payer: UHC Exchange |
$1,492.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,492.45
|
| Rate for Payer: UHCCP Medicaid |
$3,675.46
|
| Rate for Payer: VA VA |
$1,492.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,477.36
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
IP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$124.59 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: BCBS Trust/PPO |
$113.00
|
| Rate for Payer: BCN Commercial |
$106.98
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: Nomi Health Commercial |
$113.51
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health HMO/PPO |
$120.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.82
|
| Rate for Payer: UHC Core |
$115.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.82
|
|
|
HC KINEVAC 5 MCG IV
|
Facility
|
OP
|
$138.43
|
|
|
Service Code
|
HCPCS J2805
|
| Hospital Charge Code |
63600014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$124.59 |
| Rate for Payer: Aetna Commercial |
$117.67
|
| Rate for Payer: Aetna Medicare |
$35.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.26
|
| Rate for Payer: BCBS Complete |
$55.37
|
| Rate for Payer: BCBS MAPPO |
$34.61
|
| Rate for Payer: BCBS Trust/PPO |
$113.80
|
| Rate for Payer: BCN Commercial |
$107.63
|
| Rate for Payer: BCN Medicare Advantage |
$34.61
|
| Rate for Payer: Cash Price |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.61
|
| Rate for Payer: Healthscope Commercial |
$124.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.67
|
| Rate for Payer: Nomi Health Commercial |
$113.51
|
| Rate for Payer: PACE Senior Care Partners |
$32.88
|
| Rate for Payer: PACE SWMI |
$34.61
|
| Rate for Payer: PHP Commercial |
$117.67
|
| Rate for Payer: PHP Medicare Advantage |
$34.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.98
|
| Rate for Payer: Priority Health HMO/PPO |
$120.43
|
| Rate for Payer: Priority Health Medicare |
$34.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.75
|
| Rate for Payer: Railroad Medicare Medicare |
$34.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.82
|
| Rate for Payer: UHC Core |
$115.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.61
|
| Rate for Payer: UHC Exchange |
$34.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.61
|
| Rate for Payer: VA VA |
$34.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.82
|
|
|
HC KIT ATS
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
27000666
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.34 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna Commercial |
$130.05
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.81
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$125.78
|
| Rate for Payer: BCN Commercial |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$131.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$137.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.05
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: PACE Senior Care Partners |
$36.34
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Commercial |
$130.05
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$133.11
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.51
|
| Rate for Payer: Railroad Medicare Medicare |
$38.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.64
|
| Rate for Payer: UHC Core |
$127.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Exchange |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$38.25
|
| Rate for Payer: VA VA |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.75
|
|
