|
HC LOCM 100-199 MG/ML IODINE/ML1
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
HCPCS Q9965
|
| Hospital Charge Code |
25500002
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.00
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.19
|
| Rate for Payer: Nomi Health Commercial |
$3.08
|
| Rate for Payer: PHP Commercial |
$3.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.44
|
| Rate for Payer: Priority Health HMO/PPO |
$3.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.30
|
| Rate for Payer: UHC Core |
$3.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.81
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
IP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$194.44 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: BCBS Trust/PPO |
$176.35
|
| Rate for Payer: BCN Commercial |
$166.96
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Healthscope Commercial |
$194.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: Priority Health HMO/PPO |
$187.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.12
|
| Rate for Payer: UHC Core |
$180.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.03
|
|
|
HC LOOP AV 3/8 INCH OR 1/2 INCH
|
Facility
|
OP
|
$216.04
|
|
| Hospital Charge Code |
27000444
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$194.44 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$56.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.51
|
| Rate for Payer: BCBS Complete |
$86.42
|
| Rate for Payer: BCBS MAPPO |
$54.01
|
| Rate for Payer: BCBS Trust/PPO |
$177.61
|
| Rate for Payer: BCN Commercial |
$167.97
|
| Rate for Payer: BCN Medicare Advantage |
$54.01
|
| Rate for Payer: Cash Price |
$172.83
|
| Rate for Payer: Cofinity Commercial |
$185.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.01
|
| Rate for Payer: Healthscope Commercial |
$194.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.63
|
| Rate for Payer: Nomi Health Commercial |
$177.15
|
| Rate for Payer: PACE Senior Care Partners |
$51.31
|
| Rate for Payer: PACE SWMI |
$54.01
|
| Rate for Payer: PHP Commercial |
$183.63
|
| Rate for Payer: PHP Medicare Advantage |
$54.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.43
|
| Rate for Payer: Priority Health HMO/PPO |
$187.95
|
| Rate for Payer: Priority Health Medicare |
$54.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.75
|
| Rate for Payer: Railroad Medicare Medicare |
$54.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.12
|
| Rate for Payer: UHC Core |
$180.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.01
|
| Rate for Payer: UHC Exchange |
$54.01
|
| Rate for Payer: UHC Medicare Advantage |
$54.01
|
| Rate for Payer: VA VA |
$54.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.03
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC LOW-LEVEL LASER THERAPY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 0552T
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
IP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.53
|
| Rate for Payer: BCN Commercial |
$18.49
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO |
$20.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC LP (A) CHOLESTEROL LMPP
|
Facility
|
OP
|
$23.93
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
30100636
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.48
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.67
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cash Price |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Meridian Medicaid |
$8.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.34
|
| Rate for Payer: Nomi Health Commercial |
$19.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.68
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Commercial |
$20.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health HMO/PPO |
$20.82
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.03
|
| Rate for Payer: Railroad Medicare Medicare |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: VA VA |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
HC LTC ROOM AND BOARD
|
Facility
|
IP
|
$377.40
|
|
| Hospital Charge Code |
11000003
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$245.31 |
| Max. Negotiated Rate |
$2,337.50 |
| Rate for Payer: Aetna Commercial |
$320.79
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$308.07
|
| Rate for Payer: BCN Commercial |
$291.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cash Price |
$301.92
|
| Rate for Payer: Cofinity Commercial |
$324.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$339.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$320.79
|
| Rate for Payer: Nomi Health Commercial |
$309.47
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$320.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.31
|
| Rate for Payer: Priority Health HMO/PPO |
$328.34
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.11
|
| Rate for Payer: UHC Core |
$315.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.05
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
IP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,032.65 |
| Max. Negotiated Rate |
$11,122.13 |
| Rate for Payer: Aetna Commercial |
$10,504.23
|
| Rate for Payer: BCBS Trust/PPO |
$10,087.77
|
| Rate for Payer: BCN Commercial |
$9,550.20
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$10,627.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Healthscope Commercial |
$11,122.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,268.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: PHP Commercial |
$10,504.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health HMO/PPO |
$10,751.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,279.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,874.97
|
| Rate for Payer: UHC Core |
$10,318.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,268.44
|
|
|
HC LT/RT/C'S/CABG'S W INTERVENTION
|
Facility
|
OP
|
$12,357.92
|
|
|
Service Code
|
CPT 93461
|
| Hospital Charge Code |
48100051
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,278.44 |
| Max. Negotiated Rate |
$11,122.13 |
| Rate for Payer: Aetna Commercial |
$10,504.23
|
| Rate for Payer: Aetna Medicare |
$3,213.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,861.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,861.85
|
| Rate for Payer: BCBS Complete |
$2,392.52
|
| Rate for Payer: BCBS MAPPO |
$3,089.48
|
| Rate for Payer: BCBS Trust/PPO |
$10,159.45
|
| Rate for Payer: BCN Commercial |
$9,608.28
|
| Rate for Payer: BCN Medicare Advantage |
$3,089.48
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cash Price |
$9,886.34
|
| Rate for Payer: Cofinity Commercial |
$10,627.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,886.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,089.48
|
| Rate for Payer: Healthscope Commercial |
$11,122.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,268.44
|
| Rate for Payer: Mclaren Medicaid |
$2,278.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,243.95
|
| Rate for Payer: Meridian Medicaid |
$2,392.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,552.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,504.23
|
| Rate for Payer: Nomi Health Commercial |
$10,133.49
|
| Rate for Payer: PACE Senior Care Partners |
$2,935.01
|
| Rate for Payer: PACE SWMI |
$3,089.48
|
| Rate for Payer: PHP Commercial |
$10,504.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,089.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,278.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,032.65
|
| Rate for Payer: Priority Health HMO/PPO |
$10,751.39
|
| Rate for Payer: Priority Health Medicare |
$3,120.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,279.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,089.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,874.97
|
| Rate for Payer: UHC Core |
$10,318.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,089.48
|
| Rate for Payer: UHC Exchange |
$3,089.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,089.48
|
| Rate for Payer: UHCCP Medicaid |
$2,278.44
|
| Rate for Payer: VA VA |
$3,089.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,268.44
|
|
|
HC LUMASON PER ML
|
Facility
|
IP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.68 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Aetna Commercial |
$67.58
|
| Rate for Payer: BCBS Trust/PPO |
$64.90
|
| Rate for Payer: BCN Commercial |
$61.44
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Healthscope Commercial |
$71.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: PHP Commercial |
$67.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: Priority Health HMO/PPO |
$69.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.96
|
| Rate for Payer: UHC Core |
$66.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.62
|
|
|
HC LUMASON PER ML
|
Facility
|
OP
|
$79.50
|
|
|
Service Code
|
HCPCS Q9950
|
| Hospital Charge Code |
63600066
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.88 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Aetna Commercial |
$67.58
|
| Rate for Payer: Aetna Medicare |
$20.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.84
|
| Rate for Payer: BCBS Complete |
$31.80
|
| Rate for Payer: BCBS MAPPO |
$19.88
|
| Rate for Payer: BCBS Trust/PPO |
$65.36
|
| Rate for Payer: BCN Commercial |
$61.81
|
| Rate for Payer: BCN Medicare Advantage |
$19.88
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$68.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.88
|
| Rate for Payer: Healthscope Commercial |
$71.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.58
|
| Rate for Payer: Nomi Health Commercial |
$65.19
|
| Rate for Payer: PACE Senior Care Partners |
$18.88
|
| Rate for Payer: PACE SWMI |
$19.88
|
| Rate for Payer: PHP Commercial |
$67.58
|
| Rate for Payer: PHP Medicare Advantage |
$19.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.68
|
| Rate for Payer: Priority Health HMO/PPO |
$69.16
|
| Rate for Payer: Priority Health Medicare |
$20.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.26
|
| Rate for Payer: Railroad Medicare Medicare |
$19.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.96
|
| Rate for Payer: UHC Core |
$66.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.88
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicare Advantage |
$19.88
|
| Rate for Payer: VA VA |
$19.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.62
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
IP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: BCBS Trust/PPO |
$611.03
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC LUMBAR PUNCTURE
|
Facility
|
OP
|
$748.54
|
|
| Hospital Charge Code |
45000046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.78 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna Medicare |
$194.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.92
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS MAPPO |
$187.14
|
| Rate for Payer: BCBS Trust/PPO |
$615.37
|
| Rate for Payer: BCN Commercial |
$581.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.14
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.14
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PACE Senior Care Partners |
$177.78
|
| Rate for Payer: PACE SWMI |
$187.14
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: PHP Medicare Advantage |
$187.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Medicare |
$189.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: Railroad Medicare Medicare |
$187.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.14
|
| Rate for Payer: UHC Exchange |
$187.14
|
| Rate for Payer: UHC Medicare Advantage |
$187.14
|
| Rate for Payer: VA VA |
$187.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
OP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.64 |
| Max. Negotiated Rate |
$824.74 |
| Rate for Payer: Aetna Commercial |
$778.92
|
| Rate for Payer: Aetna Medicare |
$238.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$286.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$286.37
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$229.10
|
| Rate for Payer: BCBS Trust/PPO |
$753.36
|
| Rate for Payer: BCN Commercial |
$712.49
|
| Rate for Payer: BCN Medicare Advantage |
$229.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$788.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.10
|
| Rate for Payer: Healthscope Commercial |
$824.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.28
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.55
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: PACE Senior Care Partners |
$217.64
|
| Rate for Payer: PACE SWMI |
$229.10
|
| Rate for Payer: PHP Commercial |
$778.92
|
| Rate for Payer: PHP Medicare Advantage |
$229.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health HMO/PPO |
$797.25
|
| Rate for Payer: Priority Health Medicare |
$231.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.97
|
| Rate for Payer: Railroad Medicare Medicare |
$229.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.41
|
| Rate for Payer: UHC Core |
$765.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.10
|
| Rate for Payer: UHC Exchange |
$229.10
|
| Rate for Payer: UHC Medicare Advantage |
$229.10
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$229.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.28
|
|
|
HC LUMBAR PUNCTURE DIAGNOSTIC
|
Facility
|
IP
|
$916.38
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
36100278
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$595.65 |
| Max. Negotiated Rate |
$824.74 |
| Rate for Payer: Aetna Commercial |
$778.92
|
| Rate for Payer: BCBS Trust/PPO |
$748.04
|
| Rate for Payer: BCN Commercial |
$708.18
|
| Rate for Payer: Cash Price |
$733.10
|
| Rate for Payer: Cofinity Commercial |
$788.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$733.10
|
| Rate for Payer: Healthscope Commercial |
$824.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$778.92
|
| Rate for Payer: Nomi Health Commercial |
$751.43
|
| Rate for Payer: PHP Commercial |
$778.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.65
|
| Rate for Payer: Priority Health HMO/PPO |
$797.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$613.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.41
|
| Rate for Payer: UHC Core |
$765.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.28
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
OP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.11 |
| Max. Negotiated Rate |
$693.90 |
| Rate for Payer: Aetna Commercial |
$655.35
|
| Rate for Payer: Aetna Medicare |
$200.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$240.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$240.94
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$192.75
|
| Rate for Payer: BCBS Trust/PPO |
$633.84
|
| Rate for Payer: BCN Commercial |
$599.45
|
| Rate for Payer: BCN Medicare Advantage |
$192.75
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$663.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.75
|
| Rate for Payer: Healthscope Commercial |
$693.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.25
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.39
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: PACE Senior Care Partners |
$183.11
|
| Rate for Payer: PACE SWMI |
$192.75
|
| Rate for Payer: PHP Commercial |
$655.35
|
| Rate for Payer: PHP Medicare Advantage |
$192.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO |
$670.77
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.57
|
| Rate for Payer: Railroad Medicare Medicare |
$192.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.48
|
| Rate for Payer: UHC Core |
$643.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.75
|
| Rate for Payer: UHC Exchange |
$192.75
|
| Rate for Payer: UHC Medicare Advantage |
$192.75
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$192.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.25
|
|
|
HC LUMBAR PUNCTURE THERAPEUTIC
|
Facility
|
IP
|
$771.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
36100279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$501.15 |
| Max. Negotiated Rate |
$693.90 |
| Rate for Payer: Aetna Commercial |
$655.35
|
| Rate for Payer: BCBS Trust/PPO |
$629.37
|
| Rate for Payer: BCN Commercial |
$595.83
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$663.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.80
|
| Rate for Payer: Healthscope Commercial |
$693.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$578.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$655.35
|
| Rate for Payer: Nomi Health Commercial |
$632.22
|
| Rate for Payer: PHP Commercial |
$655.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health HMO/PPO |
$670.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$516.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.48
|
| Rate for Payer: UHC Core |
$643.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$578.25
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
OP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.63 |
| Max. Negotiated Rate |
$1,897.14 |
| Rate for Payer: Aetna Commercial |
$1,791.74
|
| Rate for Payer: Aetna Medicare |
$548.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$658.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$658.73
|
| Rate for Payer: BCBS Complete |
$1,205.21
|
| Rate for Payer: BCBS MAPPO |
$526.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.93
|
| Rate for Payer: BCN Commercial |
$1,638.92
|
| Rate for Payer: BCN Medicare Advantage |
$526.98
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,812.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.98
|
| Rate for Payer: Healthscope Commercial |
$1,897.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.95
|
| Rate for Payer: Mclaren Medicaid |
$1,147.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.33
|
| Rate for Payer: Meridian Medicaid |
$1,205.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$606.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$1,728.50
|
| Rate for Payer: PACE Senior Care Partners |
$500.63
|
| Rate for Payer: PACE SWMI |
$526.98
|
| Rate for Payer: PHP Commercial |
$1,791.74
|
| Rate for Payer: PHP Medicare Advantage |
$526.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,147.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,833.90
|
| Rate for Payer: Priority Health Medicare |
$532.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,412.31
|
| Rate for Payer: Railroad Medicare Medicare |
$526.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.98
|
| Rate for Payer: UHC Core |
$1,760.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$526.98
|
| Rate for Payer: UHC Exchange |
$526.98
|
| Rate for Payer: UHC Medicare Advantage |
$526.98
|
| Rate for Payer: UHCCP Medicaid |
$1,147.75
|
| Rate for Payer: VA VA |
$526.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.95
|
|
|
HC LUNG/MED BIOPSY
|
Facility
|
IP
|
$2,107.93
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
36100609
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,370.15 |
| Max. Negotiated Rate |
$1,897.14 |
| Rate for Payer: Aetna Commercial |
$1,791.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,720.70
|
| Rate for Payer: BCN Commercial |
$1,629.01
|
| Rate for Payer: Cash Price |
$1,686.34
|
| Rate for Payer: Cofinity Commercial |
$1,812.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.34
|
| Rate for Payer: Healthscope Commercial |
$1,897.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,580.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,791.74
|
| Rate for Payer: Nomi Health Commercial |
$1,728.50
|
| Rate for Payer: PHP Commercial |
$1,791.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,833.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,412.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.98
|
| Rate for Payer: UHC Core |
$1,760.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,580.95
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$13.65
|
| Rate for Payer: BCBS MAPPO |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$134.17
|
| Rate for Payer: BCN Commercial |
$126.89
|
| Rate for Payer: BCN Medicare Advantage |
$40.80
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Mclaren Medicaid |
$13.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.84
|
| Rate for Payer: Meridian Medicaid |
$13.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PACE Senior Care Partners |
$38.76
|
| Rate for Payer: PACE SWMI |
$40.80
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$40.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Medicare |
$41.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: Railroad Medicare Medicare |
$40.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.80
|
| Rate for Payer: UHC Exchange |
$40.80
|
| Rate for Payer: UHC Medicare Advantage |
$40.80
|
| Rate for Payer: UHCCP Medicaid |
$13.00
|
| Rate for Payer: VA VA |
$40.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC LUPUS ANTICOAGULANT HEX PHASE
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
30500057
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: BCBS Trust/PPO |
$133.22
|
| Rate for Payer: BCN Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.72
|
| Rate for Payer: Nomi Health Commercial |
$133.82
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.08
|
| Rate for Payer: Priority Health HMO/PPO |
$141.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
IP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$202.22 |
| Max. Negotiated Rate |
$279.99 |
| Rate for Payer: Aetna Commercial |
$264.44
|
| Rate for Payer: BCBS Trust/PPO |
$253.95
|
| Rate for Payer: BCN Commercial |
$240.42
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$267.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Healthscope Commercial |
$279.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$255.10
|
| Rate for Payer: PHP Commercial |
$264.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health HMO/PPO |
$270.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.77
|
| Rate for Payer: UHC Core |
$259.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.32
|
|
|
HC LV4RP GROSS_MICRO (BILL ONLY)
|
Facility
|
OP
|
$311.10
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
31000087
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$279.99 |
| Rate for Payer: Aetna Commercial |
$264.44
|
| Rate for Payer: Aetna Medicare |
$80.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.22
|
| Rate for Payer: BCBS Complete |
$39.74
|
| Rate for Payer: BCBS MAPPO |
$77.78
|
| Rate for Payer: BCBS Trust/PPO |
$255.76
|
| Rate for Payer: BCCCP Commercial |
$67.27
|
| Rate for Payer: BCN Commercial |
$241.88
|
| Rate for Payer: BCN Medicare Advantage |
$77.78
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cash Price |
$248.88
|
| Rate for Payer: Cofinity Commercial |
$267.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.78
|
| Rate for Payer: Healthscope Commercial |
$279.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.32
|
| Rate for Payer: Mclaren Medicaid |
$37.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.66
|
| Rate for Payer: Meridian Medicaid |
$39.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.44
|
| Rate for Payer: Nomi Health Commercial |
$255.10
|
| Rate for Payer: PACE Senior Care Partners |
$73.89
|
| Rate for Payer: PACE SWMI |
$77.78
|
| Rate for Payer: PHP Commercial |
$264.44
|
| Rate for Payer: PHP Medicare Advantage |
$77.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.22
|
| Rate for Payer: Priority Health HMO/PPO |
$270.66
|
| Rate for Payer: Priority Health Medicare |
$78.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.44
|
| Rate for Payer: Railroad Medicare Medicare |
$77.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.77
|
| Rate for Payer: UHC Core |
$259.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.78
|
| Rate for Payer: UHC Exchange |
$77.78
|
| Rate for Payer: UHC Medicare Advantage |
$77.78
|
| Rate for Payer: UHCCP Medicaid |
$37.85
|
| Rate for Payer: VA VA |
$77.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.32
|
|
|
HC LVAD INSERTION
|
Facility
|
OP
|
$3,223.64
|
|
|
Service Code
|
CPT 33990
|
| Hospital Charge Code |
36100084
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$765.61 |
| Max. Negotiated Rate |
$2,901.28 |
| Rate for Payer: Aetna Commercial |
$2,740.09
|
| Rate for Payer: Aetna Medicare |
$838.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.39
|
| Rate for Payer: BCBS Complete |
$1,289.46
|
| Rate for Payer: BCBS MAPPO |
$805.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,650.15
|
| Rate for Payer: BCN Commercial |
$2,506.38
|
| Rate for Payer: BCN Medicare Advantage |
$805.91
|
| Rate for Payer: Cash Price |
$2,578.91
|
| Rate for Payer: Cofinity Commercial |
$2,772.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,578.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.91
|
| Rate for Payer: Healthscope Commercial |
$2,901.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,417.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$846.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,740.09
|
| Rate for Payer: Nomi Health Commercial |
$2,643.38
|
| Rate for Payer: PACE Senior Care Partners |
$765.61
|
| Rate for Payer: PACE SWMI |
$805.91
|
| Rate for Payer: PHP Commercial |
$2,740.09
|
| Rate for Payer: PHP Medicare Advantage |
$805.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,095.37
|
| Rate for Payer: Priority Health HMO/PPO |
$2,804.57
|
| Rate for Payer: Priority Health Medicare |
$813.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,159.84
|
| Rate for Payer: Railroad Medicare Medicare |
$805.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,836.80
|
| Rate for Payer: UHC Core |
$2,691.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.91
|
| Rate for Payer: UHC Exchange |
$805.91
|
| Rate for Payer: UHC Medicare Advantage |
$805.91
|
| Rate for Payer: VA VA |
$805.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,417.73
|
|
