|
HC SINOGRAM INJECTION
|
Facility
|
IP
|
$443.15
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
36100021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.28 |
| Max. Negotiated Rate |
$398.84 |
| Rate for Payer: Aetna Commercial |
$376.68
|
| Rate for Payer: BCBS Trust/PPO |
$342.47
|
| Rate for Payer: BCN Commercial |
$342.47
|
| Rate for Payer: Cash Price |
$354.52
|
| Rate for Payer: Cofinity Commercial |
$381.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.52
|
| Rate for Payer: Healthscope Commercial |
$398.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$332.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$376.68
|
| Rate for Payer: PHP Commercial |
$376.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.97
|
| Rate for Payer: UHC Core |
$370.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$332.36
|
|
|
HC SIROLIMUS
|
Facility
|
OP
|
$74.46
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.27
|
| Rate for Payer: BCBS Complete |
$10.64
|
| Rate for Payer: BCBS MAPPO |
$18.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.89
|
| Rate for Payer: BCN Commercial |
$57.89
|
| Rate for Payer: BCN Medicare Advantage |
$18.62
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.84
|
| Rate for Payer: Mclaren Medicaid |
$10.13
|
| Rate for Payer: Meridian Medicaid |
$10.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PACE Senior Care Partners |
$17.68
|
| Rate for Payer: PACE SWMI |
$18.62
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: PHP Medicare Advantage |
$18.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.78
|
| Rate for Payer: Priority Health Medicare |
$18.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.41
|
| Rate for Payer: Railroad Medicare Medicare |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$62.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.62
|
| Rate for Payer: UHC Medicare Advantage |
$19.17
|
| Rate for Payer: VA VA |
$18.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
|
HC SIROLIMUS
|
Facility
|
IP
|
$74.46
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
30100045
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$67.01 |
| Rate for Payer: Aetna Commercial |
$63.29
|
| Rate for Payer: BCBS Trust/PPO |
$57.54
|
| Rate for Payer: BCN Commercial |
$57.54
|
| Rate for Payer: Cash Price |
$59.57
|
| Rate for Payer: Cofinity Commercial |
$64.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.57
|
| Rate for Payer: Healthscope Commercial |
$67.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.29
|
| Rate for Payer: PHP Commercial |
$63.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$62.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,049.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,864.00
|
| Rate for Payer: BCN Commercial |
$3,864.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.00
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,750.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,350.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,049.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,400.00
|
| Rate for Payer: UHC Core |
$4,175.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,750.00
|
|
|
HC SKIN FULL GRFT FACE/GENIT/HF 20 SQ CM OR <
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,187.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$4,250.00
|
| Rate for Payer: Aetna Medicare |
$1,300.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,562.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,562.50
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$1,250.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,887.50
|
| Rate for Payer: BCN Commercial |
$3,887.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$4,300.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,250.00
|
| Rate for Payer: Healthscope Commercial |
$4,500.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,750.00
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,312.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,437.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,250.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,187.50
|
| Rate for Payer: PACE SWMI |
$1,250.00
|
| Rate for Payer: PHP Commercial |
$4,250.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,250.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,350.00
|
| Rate for Payer: Priority Health Medicare |
$1,250.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,049.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,250.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,400.00
|
| Rate for Payer: UHC Core |
$4,175.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,250.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,287.50
|
| Rate for Payer: VA VA |
$1,250.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,750.00
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
IP
|
$267.34
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.05 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: BCBS Trust/PPO |
$206.60
|
| Rate for Payer: BCN Commercial |
$206.60
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.26
|
| Rate for Payer: UHC Core |
$223.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.50
|
|
|
HC SKIN TAG REMOVAL UP TO 15
|
Facility
|
OP
|
$267.34
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
45000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.49 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Aetna Medicare |
$69.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.54
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$66.84
|
| Rate for Payer: BCBS Trust/PPO |
$207.86
|
| Rate for Payer: BCN Commercial |
$207.86
|
| Rate for Payer: BCN Medicare Advantage |
$66.84
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cash Price |
$213.87
|
| Rate for Payer: Cofinity Commercial |
$229.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$240.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.50
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.24
|
| Rate for Payer: PACE Senior Care Partners |
$63.49
|
| Rate for Payer: PACE SWMI |
$66.84
|
| Rate for Payer: PHP Commercial |
$227.24
|
| Rate for Payer: PHP Medicare Advantage |
$66.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.59
|
| Rate for Payer: Priority Health Medicare |
$66.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.05
|
| Rate for Payer: Railroad Medicare Medicare |
$66.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.26
|
| Rate for Payer: UHC Core |
$223.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.84
|
| Rate for Payer: UHC Medicare Advantage |
$68.84
|
| Rate for Payer: VA VA |
$66.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.50
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$14.19
|
| Rate for Payer: BCN Commercial |
$14.19
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
HC SKIN TAGS REMOVAL EA ADDL 10 LESIONS
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
76100079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$4.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.74
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: BCBS MAPPO |
$4.59
|
| Rate for Payer: BCBS Trust/PPO |
$14.27
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.59
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.36
|
| Rate for Payer: PACE SWMI |
$4.59
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: PHP Medicare Advantage |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.97
|
| Rate for Payer: Priority Health Medicare |
$4.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.16
|
| Rate for Payer: UHC Core |
$15.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.59
|
| Rate for Payer: UHC Medicare Advantage |
$4.73
|
| Rate for Payer: VA VA |
$4.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
OP
|
$2,710.48
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$643.74 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: Aetna Medicare |
$704.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$847.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$847.02
|
| Rate for Payer: BCBS Complete |
$1,402.94
|
| Rate for Payer: BCBS MAPPO |
$677.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,107.40
|
| Rate for Payer: BCN Commercial |
$2,107.40
|
| Rate for Payer: BCN Medicare Advantage |
$677.62
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,168.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.62
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,032.86
|
| Rate for Payer: Mclaren Medicaid |
$1,336.13
|
| Rate for Payer: Meridian Medicaid |
$1,402.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$711.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$779.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PACE Senior Care Partners |
$643.74
|
| Rate for Payer: PACE SWMI |
$677.62
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: PHP Medicare Advantage |
$677.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,336.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,358.12
|
| Rate for Payer: Priority Health Medicare |
$677.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,653.12
|
| Rate for Payer: Railroad Medicare Medicare |
$677.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,385.22
|
| Rate for Payer: UHC Core |
$2,263.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.62
|
| Rate for Payer: UHC Medicare Advantage |
$697.95
|
| Rate for Payer: VA VA |
$677.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,032.86
|
|
|
HC SLITTING OF PREPUCE, DORSAL/LAT, EXCEPT NEWBORN
|
Facility
|
IP
|
$2,710.48
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
76100250
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,653.12 |
| Max. Negotiated Rate |
$2,439.43 |
| Rate for Payer: Aetna Commercial |
$2,303.91
|
| Rate for Payer: BCBS Trust/PPO |
$2,094.66
|
| Rate for Payer: BCN Commercial |
$2,094.66
|
| Rate for Payer: Cash Price |
$2,168.38
|
| Rate for Payer: Cofinity Commercial |
$2,331.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,168.38
|
| Rate for Payer: Healthscope Commercial |
$2,439.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,032.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,303.91
|
| Rate for Payer: PHP Commercial |
$2,303.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,358.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,653.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,385.22
|
| Rate for Payer: UHC Core |
$2,263.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,032.86
|
|
|
HC SMART NEEDLE
|
Facility
|
IP
|
$490.51
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$299.16 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: BCBS Trust/PPO |
$379.07
|
| Rate for Payer: BCN Commercial |
$379.07
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.41
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.65
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.88
|
|
|
HC SMART NEEDLE
|
Facility
|
OP
|
$490.51
|
|
| Hospital Charge Code |
62200011
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$116.50 |
| Max. Negotiated Rate |
$441.46 |
| Rate for Payer: Aetna Commercial |
$416.93
|
| Rate for Payer: Aetna Medicare |
$127.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.28
|
| Rate for Payer: BCBS Complete |
$196.20
|
| Rate for Payer: BCBS MAPPO |
$122.63
|
| Rate for Payer: BCBS Trust/PPO |
$381.37
|
| Rate for Payer: BCN Commercial |
$381.37
|
| Rate for Payer: BCN Medicare Advantage |
$122.63
|
| Rate for Payer: Cash Price |
$392.41
|
| Rate for Payer: Cofinity Commercial |
$421.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.63
|
| Rate for Payer: Healthscope Commercial |
$441.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$416.93
|
| Rate for Payer: PACE Senior Care Partners |
$116.50
|
| Rate for Payer: PACE SWMI |
$122.63
|
| Rate for Payer: PHP Commercial |
$416.93
|
| Rate for Payer: PHP Medicare Advantage |
$122.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$426.74
|
| Rate for Payer: Priority Health Medicare |
$122.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.16
|
| Rate for Payer: Railroad Medicare Medicare |
$122.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.65
|
| Rate for Payer: UHC Core |
$409.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.63
|
| Rate for Payer: UHC Medicare Advantage |
$126.31
|
| Rate for Payer: VA VA |
$122.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.88
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC SMITH SM ANTIBODY
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200165
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$26.81
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$8.19
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
IP
|
$120.35
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: BCBS Trust/PPO |
$93.01
|
| Rate for Payer: BCN Commercial |
$93.01
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.28
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.91
|
| Rate for Payer: UHC Core |
$100.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.26
|
|
|
HC SMOKE CESSATION > 10 MIN
|
Facility
|
OP
|
$120.35
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
94200033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$31.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.61
|
| Rate for Payer: BCBS Complete |
$19.77
|
| Rate for Payer: BCBS MAPPO |
$30.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.57
|
| Rate for Payer: BCN Commercial |
$93.57
|
| Rate for Payer: BCN Medicare Advantage |
$30.09
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.09
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.26
|
| Rate for Payer: Mclaren Medicaid |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$19.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PACE Senior Care Partners |
$28.58
|
| Rate for Payer: PACE SWMI |
$30.09
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: PHP Medicare Advantage |
$30.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.70
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.40
|
| Rate for Payer: Railroad Medicare Medicare |
$30.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.91
|
| Rate for Payer: UHC Core |
$100.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.09
|
| Rate for Payer: UHC Medicare Advantage |
$30.99
|
| Rate for Payer: VA VA |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.26
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
IP
|
$120.35
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: BCBS Trust/PPO |
$93.01
|
| Rate for Payer: BCN Commercial |
$93.01
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.28
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.91
|
| Rate for Payer: UHC Core |
$100.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.26
|
|
|
HC SMOKING CESSATION 3-10 MIN
|
Facility
|
OP
|
$120.35
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
94200034
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$102.30
|
| Rate for Payer: Aetna Medicare |
$31.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.61
|
| Rate for Payer: BCBS Complete |
$19.77
|
| Rate for Payer: BCBS MAPPO |
$30.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.57
|
| Rate for Payer: BCN Commercial |
$93.57
|
| Rate for Payer: BCN Medicare Advantage |
$30.09
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cash Price |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.09
|
| Rate for Payer: Healthscope Commercial |
$108.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.26
|
| Rate for Payer: Mclaren Medicaid |
$18.83
|
| Rate for Payer: Meridian Medicaid |
$19.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.30
|
| Rate for Payer: PACE Senior Care Partners |
$28.58
|
| Rate for Payer: PACE SWMI |
$30.09
|
| Rate for Payer: PHP Commercial |
$102.30
|
| Rate for Payer: PHP Medicare Advantage |
$30.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.70
|
| Rate for Payer: Priority Health Medicare |
$30.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.40
|
| Rate for Payer: Railroad Medicare Medicare |
$30.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.91
|
| Rate for Payer: UHC Core |
$100.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.09
|
| Rate for Payer: UHC Medicare Advantage |
$30.99
|
| Rate for Payer: VA VA |
$30.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.26
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC SMOOTH MUSCLE AB TITER
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86015
|
| Hospital Charge Code |
30200487
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC SMRNP
|
Facility
|
OP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.78
|
| Rate for Payer: BCBS Complete |
$13.89
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.81
|
| Rate for Payer: BCN Commercial |
$26.81
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Mclaren Medicaid |
$13.23
|
| Rate for Payer: Meridian Medicaid |
$13.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PACE Senior Care Partners |
$8.19
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.88
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC SMRNP
|
Facility
|
IP
|
$34.48
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.03 |
| Max. Negotiated Rate |
$31.03 |
| Rate for Payer: Aetna Commercial |
$29.31
|
| Rate for Payer: BCBS Trust/PPO |
$26.65
|
| Rate for Payer: BCN Commercial |
$26.65
|
| Rate for Payer: Cash Price |
$27.58
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.58
|
| Rate for Payer: Healthscope Commercial |
$31.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.31
|
| Rate for Payer: PHP Commercial |
$29.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.34
|
| Rate for Payer: UHC Core |
$28.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.86
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,263.96
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.19 |
| Max. Negotiated Rate |
$1,137.56 |
| Rate for Payer: Aetna Commercial |
$1,074.37
|
| Rate for Payer: Aetna Medicare |
$328.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.99
|
| Rate for Payer: BCBS Complete |
$505.58
|
| Rate for Payer: BCBS MAPPO |
$315.99
|
| Rate for Payer: BCBS Trust/PPO |
$982.73
|
| Rate for Payer: BCN Commercial |
$982.73
|
| Rate for Payer: BCN Medicare Advantage |
$315.99
|
| Rate for Payer: Cash Price |
$1,011.17
|
| Rate for Payer: Cofinity Commercial |
$1,087.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.99
|
| Rate for Payer: Healthscope Commercial |
$1,137.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$331.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,074.37
|
| Rate for Payer: PACE Senior Care Partners |
$300.19
|
| Rate for Payer: PACE SWMI |
$315.99
|
| Rate for Payer: PHP Commercial |
$1,074.37
|
| Rate for Payer: PHP Medicare Advantage |
$315.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.65
|
| Rate for Payer: Priority Health Medicare |
$315.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.89
|
| Rate for Payer: Railroad Medicare Medicare |
$315.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.28
|
| Rate for Payer: UHC Core |
$1,055.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.99
|
| Rate for Payer: UHC Medicare Advantage |
$325.47
|
| Rate for Payer: VA VA |
$315.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.97
|
|
|
HC SNARE
|
Facility
|
IP
|
$1,263.96
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$770.89 |
| Max. Negotiated Rate |
$1,137.56 |
| Rate for Payer: Aetna Commercial |
$1,074.37
|
| Rate for Payer: BCBS Trust/PPO |
$976.79
|
| Rate for Payer: BCN Commercial |
$976.79
|
| Rate for Payer: Cash Price |
$1,011.17
|
| Rate for Payer: Cofinity Commercial |
$1,087.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.17
|
| Rate for Payer: Healthscope Commercial |
$1,137.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$947.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,074.37
|
| Rate for Payer: PHP Commercial |
$1,074.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$884.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$770.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.28
|
| Rate for Payer: UHC Core |
$1,055.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$947.97
|
|
