|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
IP
|
$72.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.23 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$59.61
|
| Rate for Payer: BCN Commercial |
$59.61
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Nomi Health Commercial |
$59.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.51
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.13
|
|
|
HC NEURON SPECIFIC ENOLASE
|
Facility
|
OP
|
$72.17
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100260
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.72 |
| Max. Negotiated Rate |
$64.95 |
| Rate for Payer: Aetna Commercial |
$61.34
|
| Rate for Payer: Aetna Medicare |
$18.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.55
|
| Rate for Payer: BCBS Complete |
$13.36
|
| Rate for Payer: BCBS MAPPO |
$18.04
|
| Rate for Payer: BCBS Trust/PPO |
$59.33
|
| Rate for Payer: BCN Commercial |
$59.33
|
| Rate for Payer: BCN Medicare Advantage |
$18.04
|
| Rate for Payer: Cash Price |
$57.74
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$64.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.13
|
| Rate for Payer: Mclaren Medicaid |
$12.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.94
|
| Rate for Payer: Meridian Medicaid |
$13.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.34
|
| Rate for Payer: Nomi Health Commercial |
$59.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.13
|
| Rate for Payer: PACE Senior Care Partners |
$17.14
|
| Rate for Payer: PACE SWMI |
$18.04
|
| Rate for Payer: PHP Commercial |
$61.34
|
| Rate for Payer: PHP Medicare Advantage |
$18.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.79
|
| Rate for Payer: Priority Health Medicare |
$18.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.23
|
| Rate for Payer: Railroad Medicare Medicare |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.51
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: UHC Exchange |
$18.04
|
| Rate for Payer: UHC Medicaid |
$12.72
|
| Rate for Payer: UHC Medicare Advantage |
$18.04
|
| Rate for Payer: UHCCP Medicaid |
$12.72
|
| Rate for Payer: VA VA |
$18.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.13
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
OP
|
$71.10
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.22
|
| Rate for Payer: BCBS Complete |
$13.16
|
| Rate for Payer: BCBS MAPPO |
$17.77
|
| Rate for Payer: BCBS Trust/PPO |
$58.45
|
| Rate for Payer: BCN Commercial |
$58.45
|
| Rate for Payer: BCN Medicare Advantage |
$17.77
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.77
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.33
|
| Rate for Payer: Mclaren Medicaid |
$12.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.66
|
| Rate for Payer: Meridian Medicaid |
$13.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.44
|
| Rate for Payer: Nomi Health Commercial |
$58.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.89
|
| Rate for Payer: PACE SWMI |
$17.77
|
| Rate for Payer: PHP Commercial |
$60.44
|
| Rate for Payer: PHP Medicare Advantage |
$17.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.86
|
| Rate for Payer: Priority Health Medicare |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: Railroad Medicare Medicare |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.57
|
| Rate for Payer: UHC Core |
$59.37
|
| Rate for Payer: UHC Exchange |
$17.77
|
| Rate for Payer: UHC Medicaid |
$12.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.77
|
| Rate for Payer: UHCCP Medicaid |
$12.53
|
| Rate for Payer: VA VA |
$17.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.33
|
|
|
HC NEUROPSYCH TEST EVAL BY PHYS FIRST HR
|
Facility
|
IP
|
$71.10
|
|
|
Service Code
|
CPT 96132
|
| Hospital Charge Code |
91800007
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$63.99 |
| Rate for Payer: Aetna Commercial |
$60.44
|
| Rate for Payer: BCBS Trust/PPO |
$58.72
|
| Rate for Payer: BCN Commercial |
$58.72
|
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.88
|
| Rate for Payer: Healthscope Commercial |
$63.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.44
|
| Rate for Payer: Nomi Health Commercial |
$58.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.33
|
| Rate for Payer: PHP Commercial |
$60.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.57
|
| Rate for Payer: UHC Core |
$59.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.33
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
IP
|
$37.14
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: BCBS Trust/PPO |
$30.67
|
| Rate for Payer: BCN Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC NEUROPSYCH TEST EVAL EA ADDL HR
|
Facility
|
OP
|
$37.14
|
|
|
Service Code
|
CPT 96133
|
| Hospital Charge Code |
91800008
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$33.43 |
| Rate for Payer: Aetna Commercial |
$31.57
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.61
|
| Rate for Payer: BCBS Complete |
$6.87
|
| Rate for Payer: BCBS MAPPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$30.53
|
| Rate for Payer: BCN Commercial |
$30.53
|
| Rate for Payer: BCN Medicare Advantage |
$9.29
|
| Rate for Payer: Cash Price |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$33.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.86
|
| Rate for Payer: Mclaren Medicaid |
$6.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.75
|
| Rate for Payer: Meridian Medicaid |
$6.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.57
|
| Rate for Payer: Nomi Health Commercial |
$30.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.82
|
| Rate for Payer: PACE SWMI |
$9.29
|
| Rate for Payer: PHP Commercial |
$31.57
|
| Rate for Payer: PHP Medicare Advantage |
$9.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.31
|
| Rate for Payer: Priority Health Medicare |
$9.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.85
|
| Rate for Payer: Railroad Medicare Medicare |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.68
|
| Rate for Payer: UHC Core |
$31.01
|
| Rate for Payer: UHC Exchange |
$9.29
|
| Rate for Payer: UHC Medicaid |
$6.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.29
|
| Rate for Payer: UHCCP Medicaid |
$6.55
|
| Rate for Payer: VA VA |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.86
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.88 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.63
|
| Rate for Payer: BCN Commercial |
$1,263.63
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$1,254.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.50
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,331.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,346.40
|
| Rate for Payer: UHC Core |
$1,277.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.50
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 15
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27800137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.74 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna Medicare |
$397.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$478.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$478.12
|
| Rate for Payer: BCBS Complete |
$283.20
|
| Rate for Payer: BCBS MAPPO |
$382.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,257.81
|
| Rate for Payer: BCN Commercial |
$1,257.81
|
| Rate for Payer: BCN Medicare Advantage |
$382.50
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.50
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.50
|
| Rate for Payer: Mclaren Medicaid |
$269.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.62
|
| Rate for Payer: Meridian Medicaid |
$283.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$420.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.50
|
| Rate for Payer: Nomi Health Commercial |
$1,254.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,147.50
|
| Rate for Payer: PACE Senior Care Partners |
$363.38
|
| Rate for Payer: PACE SWMI |
$382.50
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: PHP Medicare Advantage |
$382.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,331.10
|
| Rate for Payer: Priority Health Medicare |
$386.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.88
|
| Rate for Payer: Railroad Medicare Medicare |
$382.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,346.40
|
| Rate for Payer: UHC Core |
$1,277.55
|
| Rate for Payer: UHC Exchange |
$382.50
|
| Rate for Payer: UHC Medicaid |
$269.74
|
| Rate for Payer: UHC Medicare Advantage |
$382.50
|
| Rate for Payer: UHCCP Medicaid |
$269.74
|
| Rate for Payer: VA VA |
$382.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.50
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.56 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Aetna Commercial |
$2,167.50
|
| Rate for Payer: Aetna Medicare |
$663.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$796.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$796.88
|
| Rate for Payer: BCBS Complete |
$472.00
|
| Rate for Payer: BCBS MAPPO |
$637.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,096.36
|
| Rate for Payer: BCN Commercial |
$2,096.36
|
| Rate for Payer: BCN Medicare Advantage |
$637.50
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$2,193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.50
|
| Rate for Payer: Healthscope Commercial |
$2,295.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.50
|
| Rate for Payer: Mclaren Medicaid |
$449.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.38
|
| Rate for Payer: Meridian Medicaid |
$472.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$733.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Nomi Health Commercial |
$2,091.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.50
|
| Rate for Payer: PACE Senior Care Partners |
$605.62
|
| Rate for Payer: PACE SWMI |
$637.50
|
| Rate for Payer: PHP Commercial |
$2,167.50
|
| Rate for Payer: PHP Medicare Advantage |
$637.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,218.50
|
| Rate for Payer: Priority Health Medicare |
$643.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,774.80
|
| Rate for Payer: Railroad Medicare Medicare |
$637.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,244.00
|
| Rate for Payer: UHC Core |
$2,129.25
|
| Rate for Payer: UHC Exchange |
$637.50
|
| Rate for Payer: UHC Medicaid |
$449.56
|
| Rate for Payer: UHC Medicare Advantage |
$637.50
|
| Rate for Payer: UHCCP Medicaid |
$449.56
|
| Rate for Payer: VA VA |
$637.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.50
|
|
|
HC NEUROSTIMULATOR TEST KIT LVL 25
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT C1897
|
| Hospital Charge Code |
27800138
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,774.80 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Aetna Commercial |
$2,167.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.05
|
| Rate for Payer: BCN Commercial |
$2,106.05
|
| Rate for Payer: Cash Price |
$2,040.00
|
| Rate for Payer: Cofinity Commercial |
$2,193.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.00
|
| Rate for Payer: Healthscope Commercial |
$2,295.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,912.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,167.50
|
| Rate for Payer: Nomi Health Commercial |
$2,091.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,912.50
|
| Rate for Payer: PHP Commercial |
$2,167.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,218.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,774.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,244.00
|
| Rate for Payer: UHC Core |
$2,129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,912.50
|
|
|
HC NEUROSYPHILIS SCR, IGG, CSF
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200517
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$9.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.16
|
| Rate for Payer: BCBS Complete |
$6.61
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.35
|
| Rate for Payer: BCN Commercial |
$29.35
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Mclaren Medicaid |
$6.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.37
|
| Rate for Payer: Meridian Medicaid |
$6.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: PACE Senior Care Partners |
$8.48
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Medicare |
$9.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.85
|
| Rate for Payer: Railroad Medicare Medicare |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Exchange |
$8.93
|
| Rate for Payer: UHC Medicaid |
$6.29
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP Medicaid |
$6.29
|
| Rate for Payer: VA VA |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC NEUROSYPHILIS SCR, IGG, CSF
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
30200517
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$29.48
|
| Rate for Payer: BCN Commercial |
$29.48
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
OP
|
$161.53
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna Commercial |
$137.30
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.48
|
| Rate for Payer: BCBS Complete |
$29.90
|
| Rate for Payer: BCBS MAPPO |
$40.38
|
| Rate for Payer: BCBS Trust/PPO |
$132.79
|
| Rate for Payer: BCN Commercial |
$132.79
|
| Rate for Payer: BCN Medicare Advantage |
$40.38
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$145.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.15
|
| Rate for Payer: Mclaren Medicaid |
$28.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.40
|
| Rate for Payer: Meridian Medicaid |
$29.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.30
|
| Rate for Payer: Nomi Health Commercial |
$132.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.15
|
| Rate for Payer: PACE Senior Care Partners |
$38.36
|
| Rate for Payer: PACE SWMI |
$40.38
|
| Rate for Payer: PHP Commercial |
$137.30
|
| Rate for Payer: PHP Medicare Advantage |
$40.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.53
|
| Rate for Payer: Priority Health Medicare |
$40.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.42
|
| Rate for Payer: Railroad Medicare Medicare |
$40.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.15
|
| Rate for Payer: UHC Core |
$134.88
|
| Rate for Payer: UHC Exchange |
$40.38
|
| Rate for Payer: UHC Medicaid |
$28.48
|
| Rate for Payer: UHC Medicare Advantage |
$40.38
|
| Rate for Payer: UHCCP Medicaid |
$28.48
|
| Rate for Payer: VA VA |
$40.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.15
|
|
|
HC NEUTROPHIL OXIDATIVE BURST
|
Facility
|
IP
|
$161.53
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000003
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$112.42 |
| Max. Negotiated Rate |
$145.38 |
| Rate for Payer: Aetna Commercial |
$137.30
|
| Rate for Payer: BCBS Trust/PPO |
$133.41
|
| Rate for Payer: BCN Commercial |
$133.41
|
| Rate for Payer: Cash Price |
$129.22
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.22
|
| Rate for Payer: Healthscope Commercial |
$145.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.30
|
| Rate for Payer: Nomi Health Commercial |
$132.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.15
|
| Rate for Payer: PHP Commercial |
$137.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.15
|
| Rate for Payer: UHC Core |
$134.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.15
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
IP
|
$57.30
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$39.88 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: BCBS Trust/PPO |
$47.32
|
| Rate for Payer: BCN Commercial |
$47.32
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.42
|
| Rate for Payer: UHC Core |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$57.30
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$51.57 |
| Rate for Payer: Aetna Commercial |
$48.70
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.91
|
| Rate for Payer: BCBS Complete |
$10.61
|
| Rate for Payer: BCBS MAPPO |
$14.32
|
| Rate for Payer: BCBS Trust/PPO |
$47.11
|
| Rate for Payer: BCN Commercial |
$47.11
|
| Rate for Payer: BCN Medicare Advantage |
$14.32
|
| Rate for Payer: Cash Price |
$45.84
|
| Rate for Payer: Cofinity Commercial |
$49.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$51.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.98
|
| Rate for Payer: Mclaren Medicaid |
$10.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.04
|
| Rate for Payer: Meridian Medicaid |
$10.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.70
|
| Rate for Payer: Nomi Health Commercial |
$46.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.98
|
| Rate for Payer: PACE Senior Care Partners |
$13.61
|
| Rate for Payer: PACE SWMI |
$14.32
|
| Rate for Payer: PHP Commercial |
$48.70
|
| Rate for Payer: PHP Medicare Advantage |
$14.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.85
|
| Rate for Payer: Priority Health Medicare |
$14.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.42
|
| Rate for Payer: UHC Core |
$47.85
|
| Rate for Payer: UHC Exchange |
$14.32
|
| Rate for Payer: UHC Medicaid |
$10.10
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
| Rate for Payer: UHCCP Medicaid |
$10.10
|
| Rate for Payer: VA VA |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.98
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: BCBS Trust/PPO |
$139.59
|
| Rate for Payer: BCN Commercial |
$139.59
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.77
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.82
|
| Rate for Payer: BCBS Complete |
$31.29
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$138.95
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$138.95
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.77
|
| Rate for Payer: Mclaren Medicaid |
$29.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Meridian Medicaid |
$31.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.77
|
| Rate for Payer: PACE Senior Care Partners |
$40.14
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.05
|
| Rate for Payer: Priority Health Medicare |
$42.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.64
|
| Rate for Payer: Railroad Medicare Medicare |
$42.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: UHC Exchange |
$42.26
|
| Rate for Payer: UHC Medicaid |
$29.80
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UHCCP Medicaid |
$29.80
|
| Rate for Payer: VA VA |
$42.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.77
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.75 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: BCBS Trust/PPO |
$169.39
|
| Rate for Payer: BCN Commercial |
$169.39
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$178.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$36.16 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.09
|
| Rate for Payer: BCBS Complete |
$37.96
|
| Rate for Payer: BCBS MAPPO |
$51.27
|
| Rate for Payer: BCBS Trust/PPO |
$168.61
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$168.61
|
| Rate for Payer: BCN Medicare Advantage |
$51.27
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.27
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Mclaren Medicaid |
$36.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: Meridian Medicaid |
$37.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.82
|
| Rate for Payer: PACE Senior Care Partners |
$48.71
|
| Rate for Payer: PACE SWMI |
$51.27
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$51.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$178.44
|
| Rate for Payer: Priority Health Medicare |
$51.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.75
|
| Rate for Payer: Railroad Medicare Medicare |
$51.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: UHC Exchange |
$51.27
|
| Rate for Payer: UHC Medicaid |
$36.16
|
| Rate for Payer: UHC Medicare Advantage |
$51.27
|
| Rate for Payer: UHCCP Medicaid |
$36.16
|
| Rate for Payer: VA VA |
$51.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$204.99 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: BCBS Trust/PPO |
$243.25
|
| Rate for Payer: BCN Commercial |
$243.25
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$256.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.93 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$76.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.04
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: BCBS MAPPO |
$73.63
|
| Rate for Payer: BCBS Trust/PPO |
$242.13
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$242.13
|
| Rate for Payer: BCN Medicare Advantage |
$73.63
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.63
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Mclaren Medicaid |
$51.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.31
|
| Rate for Payer: Meridian Medicaid |
$54.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.90
|
| Rate for Payer: PACE Senior Care Partners |
$69.95
|
| Rate for Payer: PACE SWMI |
$73.63
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: PHP Medicare Advantage |
$73.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$256.24
|
| Rate for Payer: Priority Health Medicare |
$74.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.99
|
| Rate for Payer: Railroad Medicare Medicare |
$73.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: UHC Exchange |
$73.63
|
| Rate for Payer: UHC Medicaid |
$51.93
|
| Rate for Payer: UHC Medicare Advantage |
$73.63
|
| Rate for Payer: UHCCP Medicaid |
$51.93
|
| Rate for Payer: VA VA |
$73.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$341.34 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: BCBS Trust/PPO |
$405.05
|
| Rate for Payer: BCN Commercial |
$405.05
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$426.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.26
|
| Rate for Payer: BCBS Complete |
$90.78
|
| Rate for Payer: BCBS MAPPO |
$122.61
|
| Rate for Payer: BCBS Trust/PPO |
$403.18
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$403.18
|
| Rate for Payer: BCN Medicare Advantage |
$122.61
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Mclaren Medicaid |
$86.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.74
|
| Rate for Payer: Meridian Medicaid |
$90.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.82
|
| Rate for Payer: PACE Senior Care Partners |
$116.48
|
| Rate for Payer: PACE SWMI |
$122.61
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: PHP Medicare Advantage |
$122.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$426.67
|
| Rate for Payer: Priority Health Medicare |
$123.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$341.34
|
| Rate for Payer: Railroad Medicare Medicare |
$122.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: UHC Exchange |
$122.61
|
| Rate for Payer: UHC Medicaid |
$86.46
|
| Rate for Payer: UHC Medicare Advantage |
$122.61
|
| Rate for Payer: UHCCP Medicaid |
$86.46
|
| Rate for Payer: VA VA |
$122.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NG/CT DETECT BY NUCLEIC ACID CEPHEID
|
Facility
|
OP
|
$135.26
|
|
|
Service Code
|
CPT 87494
|
| Hospital Charge Code |
30600357
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$121.73 |
| Rate for Payer: Aetna Commercial |
$114.97
|
| Rate for Payer: Aetna Medicare |
$35.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.27
|
| Rate for Payer: BCBS Complete |
$25.04
|
| Rate for Payer: BCBS MAPPO |
$33.81
|
| Rate for Payer: BCBS Trust/PPO |
$111.20
|
| Rate for Payer: BCN Commercial |
$111.20
|
| Rate for Payer: BCN Medicare Advantage |
$33.81
|
| Rate for Payer: Cash Price |
$108.21
|
| Rate for Payer: Cofinity Commercial |
$116.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.81
|
| Rate for Payer: Healthscope Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.44
|
| Rate for Payer: Mclaren Medicaid |
$23.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.51
|
| Rate for Payer: Meridian Medicaid |
$25.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.97
|
| Rate for Payer: Nomi Health Commercial |
$110.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.44
|
| Rate for Payer: PACE Senior Care Partners |
$32.12
|
| Rate for Payer: PACE SWMI |
$33.81
|
| Rate for Payer: PHP Commercial |
$114.97
|
| Rate for Payer: PHP Medicare Advantage |
$33.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$117.68
|
| Rate for Payer: Priority Health Medicare |
$34.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.14
|
| Rate for Payer: Railroad Medicare Medicare |
$33.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.03
|
| Rate for Payer: UHC Core |
$112.94
|
| Rate for Payer: UHC Exchange |
$33.81
|
| Rate for Payer: UHC Medicaid |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$33.81
|
| Rate for Payer: UHCCP Medicaid |
$23.85
|
| Rate for Payer: VA VA |
$33.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.44
|
|
