|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
IP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$228.71 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: BCBS Trust/PPO |
$289.80
|
| Rate for Payer: BCN Commercial |
$289.80
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC SENSOR CDI 550 ART SHUNT
|
Facility
|
OP
|
$375.00
|
|
| Hospital Charge Code |
27000655
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$337.50 |
| Rate for Payer: Aetna Commercial |
$318.75
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.19
|
| Rate for Payer: BCBS Complete |
$150.00
|
| Rate for Payer: BCBS MAPPO |
$93.75
|
| Rate for Payer: BCBS Trust/PPO |
$291.56
|
| Rate for Payer: BCN Commercial |
$291.56
|
| Rate for Payer: BCN Medicare Advantage |
$93.75
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$322.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.75
|
| Rate for Payer: Healthscope Commercial |
$337.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$318.75
|
| Rate for Payer: PACE Senior Care Partners |
$89.06
|
| Rate for Payer: PACE SWMI |
$93.75
|
| Rate for Payer: PHP Commercial |
$318.75
|
| Rate for Payer: PHP Medicare Advantage |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$326.25
|
| Rate for Payer: Priority Health Medicare |
$93.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.71
|
| Rate for Payer: Railroad Medicare Medicare |
$93.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.00
|
| Rate for Payer: UHC Core |
$313.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.75
|
| Rate for Payer: UHC Medicare Advantage |
$96.56
|
| Rate for Payer: VA VA |
$93.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.25
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
OP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.39
|
| Rate for Payer: BCBS Complete |
$6.90
|
| Rate for Payer: BCBS MAPPO |
$4.31
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: BCN Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.31
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: PACE Senior Care Partners |
$4.10
|
| Rate for Payer: PACE SWMI |
$4.31
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: PHP Medicare Advantage |
$4.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.01
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.18
|
| Rate for Payer: UHC Core |
$14.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.31
|
| Rate for Payer: UHC Medicare Advantage |
$4.44
|
| Rate for Payer: VA VA |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.94
|
|
|
HC SENSOR PAD LEVEL DETECTOR
|
Facility
|
IP
|
$17.25
|
|
| Hospital Charge Code |
27000656
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$14.66
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Commercial |
$13.33
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.80
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.66
|
| Rate for Payer: PHP Commercial |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.18
|
| Rate for Payer: UHC Core |
$14.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.94
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
IP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$146.38 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: BCBS Trust/PPO |
$185.47
|
| Rate for Payer: BCN Commercial |
$185.47
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$206.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: PHP Commercial |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.20
|
| Rate for Payer: UHC Core |
$200.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.00
|
|
|
HC SENSORS CEREBRAL OXIMETER
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$204.00
|
| Rate for Payer: Aetna Medicare |
$62.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$186.60
|
| Rate for Payer: BCN Commercial |
$186.60
|
| Rate for Payer: BCN Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$206.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.00
|
| Rate for Payer: Healthscope Commercial |
$216.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.00
|
| Rate for Payer: PACE Senior Care Partners |
$57.00
|
| Rate for Payer: PACE SWMI |
$60.00
|
| Rate for Payer: PHP Commercial |
$204.00
|
| Rate for Payer: PHP Medicare Advantage |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.80
|
| Rate for Payer: Priority Health Medicare |
$60.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.38
|
| Rate for Payer: Railroad Medicare Medicare |
$60.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.20
|
| Rate for Payer: UHC Core |
$200.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.00
|
| Rate for Payer: UHC Medicare Advantage |
$61.80
|
| Rate for Payer: VA VA |
$60.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.00
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: BCBS Trust/PPO |
$68.78
|
| Rate for Payer: BCN Commercial |
$68.78
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.32
|
| Rate for Payer: UHC Core |
$74.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.75
|
|
|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.14 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Aetna Commercial |
$75.65
|
| Rate for Payer: Aetna Medicare |
$23.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.81
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$69.20
|
| Rate for Payer: BCN Commercial |
$69.20
|
| Rate for Payer: BCN Medicare Advantage |
$22.25
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$76.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$80.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.65
|
| Rate for Payer: PACE Senior Care Partners |
$21.14
|
| Rate for Payer: PACE SWMI |
$22.25
|
| Rate for Payer: PHP Commercial |
$75.65
|
| Rate for Payer: PHP Medicare Advantage |
$22.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.43
|
| Rate for Payer: Priority Health Medicare |
$22.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.28
|
| Rate for Payer: Railroad Medicare Medicare |
$22.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.32
|
| Rate for Payer: UHC Core |
$74.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.25
|
| Rate for Payer: UHC Medicare Advantage |
$22.92
|
| Rate for Payer: VA VA |
$22.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.75
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$230.83 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: Aetna Medicare |
$252.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$303.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$303.72
|
| Rate for Payer: BCBS Complete |
$388.77
|
| Rate for Payer: BCBS MAPPO |
$242.98
|
| Rate for Payer: BCBS Trust/PPO |
$755.67
|
| Rate for Payer: BCN Commercial |
$755.67
|
| Rate for Payer: BCN Medicare Advantage |
$242.98
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.98
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$255.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$279.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PACE Senior Care Partners |
$230.83
|
| Rate for Payer: PACE SWMI |
$242.98
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: PHP Medicare Advantage |
$242.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.57
|
| Rate for Payer: Priority Health Medicare |
$242.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.77
|
| Rate for Payer: Railroad Medicare Medicare |
$242.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$811.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.98
|
| Rate for Payer: UHC Medicare Advantage |
$250.27
|
| Rate for Payer: VA VA |
$242.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.94
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$971.92
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$592.77 |
| Max. Negotiated Rate |
$874.73 |
| Rate for Payer: Aetna Commercial |
$826.13
|
| Rate for Payer: BCBS Trust/PPO |
$751.10
|
| Rate for Payer: BCN Commercial |
$751.10
|
| Rate for Payer: Cash Price |
$777.54
|
| Rate for Payer: Cofinity Commercial |
$835.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$777.54
|
| Rate for Payer: Healthscope Commercial |
$874.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$728.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$826.13
|
| Rate for Payer: PHP Commercial |
$826.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$680.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.29
|
| Rate for Payer: UHC Core |
$811.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$728.94
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Medicare |
$23.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.12
|
| Rate for Payer: BCBS Complete |
$11.66
|
| Rate for Payer: BCBS MAPPO |
$22.50
|
| Rate for Payer: BCBS Trust/PPO |
$69.98
|
| Rate for Payer: BCN Commercial |
$69.98
|
| Rate for Payer: BCN Medicare Advantage |
$22.50
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$77.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.50
|
| Rate for Payer: Healthscope Commercial |
$81.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.50
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Meridian Medicaid |
$11.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.50
|
| Rate for Payer: PACE Senior Care Partners |
$21.38
|
| Rate for Payer: PACE SWMI |
$22.50
|
| Rate for Payer: PHP Commercial |
$76.50
|
| Rate for Payer: PHP Medicare Advantage |
$22.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.30
|
| Rate for Payer: Priority Health Medicare |
$22.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.20
|
| Rate for Payer: UHC Core |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.50
|
| Rate for Payer: UHC Medicare Advantage |
$23.18
|
| Rate for Payer: VA VA |
$22.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.50
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$144.91 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: BCBS Trust/PPO |
$183.62
|
| Rate for Payer: BCN Commercial |
$183.62
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.09
|
| Rate for Payer: UHC Core |
$198.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$237.60
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.43 |
| Max. Negotiated Rate |
$213.84 |
| Rate for Payer: Aetna Commercial |
$201.96
|
| Rate for Payer: Aetna Medicare |
$61.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.25
|
| Rate for Payer: BCBS Complete |
$118.95
|
| Rate for Payer: BCBS MAPPO |
$59.40
|
| Rate for Payer: BCBS Trust/PPO |
$184.73
|
| Rate for Payer: BCN Commercial |
$184.73
|
| Rate for Payer: BCN Medicare Advantage |
$59.40
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cash Price |
$190.08
|
| Rate for Payer: Cofinity Commercial |
$204.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.40
|
| Rate for Payer: Healthscope Commercial |
$213.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.20
|
| Rate for Payer: Mclaren Medicaid |
$113.28
|
| Rate for Payer: Meridian Medicaid |
$118.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.96
|
| Rate for Payer: PACE Senior Care Partners |
$56.43
|
| Rate for Payer: PACE SWMI |
$59.40
|
| Rate for Payer: PHP Commercial |
$201.96
|
| Rate for Payer: PHP Medicare Advantage |
$59.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.71
|
| Rate for Payer: Priority Health Medicare |
$59.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.91
|
| Rate for Payer: Railroad Medicare Medicare |
$59.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.09
|
| Rate for Payer: UHC Core |
$198.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.40
|
| Rate for Payer: UHC Medicare Advantage |
$61.18
|
| Rate for Payer: VA VA |
$59.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.20
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$461.54 |
| Max. Negotiated Rate |
$1,924.88 |
| Rate for Payer: Aetna Commercial |
$1,817.94
|
| Rate for Payer: Aetna Medicare |
$556.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$668.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$668.36
|
| Rate for Payer: BCBS Complete |
$484.61
|
| Rate for Payer: BCBS MAPPO |
$534.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,662.88
|
| Rate for Payer: BCN Commercial |
$1,662.88
|
| Rate for Payer: BCN Medicare Advantage |
$534.69
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$1,839.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$534.69
|
| Rate for Payer: Healthscope Commercial |
$1,924.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,604.06
|
| Rate for Payer: Mclaren Medicaid |
$461.54
|
| Rate for Payer: Meridian Medicaid |
$484.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$561.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$614.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: PACE Senior Care Partners |
$507.95
|
| Rate for Payer: PACE SWMI |
$534.69
|
| Rate for Payer: PHP Commercial |
$1,817.94
|
| Rate for Payer: PHP Medicare Advantage |
$534.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,860.71
|
| Rate for Payer: Priority Health Medicare |
$534.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.42
|
| Rate for Payer: Railroad Medicare Medicare |
$534.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,882.10
|
| Rate for Payer: UHC Core |
$1,785.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$534.69
|
| Rate for Payer: UHC Medicare Advantage |
$550.73
|
| Rate for Payer: VA VA |
$534.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,604.06
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,138.75
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,304.42 |
| Max. Negotiated Rate |
$1,924.88 |
| Rate for Payer: Aetna Commercial |
$1,817.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,652.83
|
| Rate for Payer: BCN Commercial |
$1,652.83
|
| Rate for Payer: Cash Price |
$1,711.00
|
| Rate for Payer: Cofinity Commercial |
$1,839.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,711.00
|
| Rate for Payer: Healthscope Commercial |
$1,924.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,604.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,817.94
|
| Rate for Payer: PHP Commercial |
$1,817.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,860.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,304.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,882.10
|
| Rate for Payer: UHC Core |
$1,785.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,604.06
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$968.44 |
| Max. Negotiated Rate |
$5,851.75 |
| Rate for Payer: Aetna Commercial |
$3,465.99
|
| Rate for Payer: Aetna Medicare |
$1,060.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,274.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,274.26
|
| Rate for Payer: BCBS Complete |
$5,851.75
|
| Rate for Payer: BCBS MAPPO |
$1,019.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,170.36
|
| Rate for Payer: BCN Commercial |
$3,170.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,019.41
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$3,506.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,019.41
|
| Rate for Payer: Healthscope Commercial |
$3,669.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,058.22
|
| Rate for Payer: Mclaren Medicaid |
$5,573.10
|
| Rate for Payer: Meridian Medicaid |
$5,851.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,070.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,172.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: PACE Senior Care Partners |
$968.44
|
| Rate for Payer: PACE SWMI |
$1,019.41
|
| Rate for Payer: PHP Commercial |
$3,465.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,019.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,573.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,547.54
|
| Rate for Payer: Priority Health Medicare |
$1,019.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,486.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,019.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,588.31
|
| Rate for Payer: UHC Core |
$3,404.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,019.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,049.99
|
| Rate for Payer: VA VA |
$1,019.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,058.22
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,077.63
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,486.95 |
| Max. Negotiated Rate |
$3,669.87 |
| Rate for Payer: Aetna Commercial |
$3,465.99
|
| Rate for Payer: BCBS Trust/PPO |
$3,151.19
|
| Rate for Payer: BCN Commercial |
$3,151.19
|
| Rate for Payer: Cash Price |
$3,262.10
|
| Rate for Payer: Cofinity Commercial |
$3,506.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,262.10
|
| Rate for Payer: Healthscope Commercial |
$3,669.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,058.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,465.99
|
| Rate for Payer: PHP Commercial |
$3,465.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,547.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,486.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,588.31
|
| Rate for Payer: UHC Core |
$3,404.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,058.22
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.40 |
| Max. Negotiated Rate |
$9,221.31 |
| Rate for Payer: Aetna Commercial |
$8,709.02
|
| Rate for Payer: Aetna Medicare |
$2,663.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,201.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,201.84
|
| Rate for Payer: BCBS Complete |
$4,098.36
|
| Rate for Payer: BCBS MAPPO |
$2,561.48
|
| Rate for Payer: BCBS Trust/PPO |
$7,966.19
|
| Rate for Payer: BCN Commercial |
$7,966.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,561.48
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$8,811.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,561.48
|
| Rate for Payer: Healthscope Commercial |
$9,221.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,684.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,689.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,945.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: PACE Senior Care Partners |
$2,433.40
|
| Rate for Payer: PACE SWMI |
$2,561.48
|
| Rate for Payer: PHP Commercial |
$8,709.02
|
| Rate for Payer: PHP Medicare Advantage |
$2,561.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.93
|
| Rate for Payer: Priority Health Medicare |
$2,561.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,248.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2,561.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,016.39
|
| Rate for Payer: UHC Core |
$8,555.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,561.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,638.32
|
| Rate for Payer: VA VA |
$2,561.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,684.42
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,245.90
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,248.97 |
| Max. Negotiated Rate |
$9,221.31 |
| Rate for Payer: Aetna Commercial |
$8,709.02
|
| Rate for Payer: BCBS Trust/PPO |
$7,918.03
|
| Rate for Payer: BCN Commercial |
$7,918.03
|
| Rate for Payer: Cash Price |
$8,196.72
|
| Rate for Payer: Cofinity Commercial |
$8,811.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,196.72
|
| Rate for Payer: Healthscope Commercial |
$9,221.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,684.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,709.02
|
| Rate for Payer: PHP Commercial |
$8,709.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,172.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,248.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,016.39
|
| Rate for Payer: UHC Core |
$8,555.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,684.42
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$50.45
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$24.01
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$50.76
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$22.86
|
| Rate for Payer: Meridian Medicaid |
$24.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.49
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.81
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.81
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$206.54 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: BCBS Trust/PPO |
$261.70
|
| Rate for Payer: BCN Commercial |
$261.70
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.00
|
| Rate for Payer: UHC Core |
$282.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$338.64
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$304.78 |
| Rate for Payer: Aetna Commercial |
$287.84
|
| Rate for Payer: Aetna Medicare |
$88.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.82
|
| Rate for Payer: BCBS Complete |
$14.23
|
| Rate for Payer: BCBS MAPPO |
$84.66
|
| Rate for Payer: BCBS Trust/PPO |
$263.29
|
| Rate for Payer: BCN Commercial |
$263.29
|
| Rate for Payer: BCN Medicare Advantage |
$84.66
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cash Price |
$270.91
|
| Rate for Payer: Cofinity Commercial |
$291.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.66
|
| Rate for Payer: Healthscope Commercial |
$304.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.98
|
| Rate for Payer: Mclaren Medicaid |
$13.56
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.84
|
| Rate for Payer: PACE Senior Care Partners |
$80.43
|
| Rate for Payer: PACE SWMI |
$84.66
|
| Rate for Payer: PHP Commercial |
$287.84
|
| Rate for Payer: PHP Medicare Advantage |
$84.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.62
|
| Rate for Payer: Priority Health Medicare |
$84.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.54
|
| Rate for Payer: Railroad Medicare Medicare |
$84.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.00
|
| Rate for Payer: UHC Core |
$282.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.66
|
| Rate for Payer: UHC Medicare Advantage |
$87.20
|
| Rate for Payer: VA VA |
$84.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.98
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.19
|
| Rate for Payer: BCBS Complete |
$14.23
|
| Rate for Payer: BCBS MAPPO |
$25.76
|
| Rate for Payer: BCBS Trust/PPO |
$80.10
|
| Rate for Payer: BCN Commercial |
$80.10
|
| Rate for Payer: BCN Medicare Advantage |
$25.76
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.76
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Mclaren Medicaid |
$13.56
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PACE Senior Care Partners |
$24.47
|
| Rate for Payer: PACE SWMI |
$25.76
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$25.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.63
|
| Rate for Payer: Priority Health Medicare |
$25.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.83
|
| Rate for Payer: Railroad Medicare Medicare |
$25.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.66
|
| Rate for Payer: UHC Core |
$86.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.76
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: VA VA |
$25.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
