|
HC LYMPH SUPPLY CUSTOM GARMEN
|
Facility
|
OP
|
$673.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000003
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$159.88 |
| Max. Negotiated Rate |
$605.88 |
| Rate for Payer: Aetna Commercial |
$572.22
|
| Rate for Payer: Aetna Medicare |
$175.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.38
|
| Rate for Payer: BCBS Complete |
$269.28
|
| Rate for Payer: BCBS MAPPO |
$168.30
|
| Rate for Payer: BCBS Trust/PPO |
$553.44
|
| Rate for Payer: BCN Commercial |
$523.41
|
| Rate for Payer: BCN Medicare Advantage |
$168.30
|
| Rate for Payer: Cash Price |
$538.56
|
| Rate for Payer: Cofinity Commercial |
$578.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.30
|
| Rate for Payer: Healthscope Commercial |
$605.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$504.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.22
|
| Rate for Payer: Nomi Health Commercial |
$552.02
|
| Rate for Payer: PACE Senior Care Partners |
$159.88
|
| Rate for Payer: PACE SWMI |
$168.30
|
| Rate for Payer: PHP Commercial |
$572.22
|
| Rate for Payer: PHP Medicare Advantage |
$168.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.58
|
| Rate for Payer: Priority Health HMO/PPO |
$585.68
|
| Rate for Payer: Priority Health Medicare |
$169.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$451.04
|
| Rate for Payer: Railroad Medicare Medicare |
$168.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.42
|
| Rate for Payer: UHC Core |
$562.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.30
|
| Rate for Payer: UHC Exchange |
$168.30
|
| Rate for Payer: UHC Medicare Advantage |
$168.30
|
| Rate for Payer: VA VA |
$168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$504.90
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$3,730.85
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.08 |
| Max. Negotiated Rate |
$3,357.76 |
| Rate for Payer: Aetna Commercial |
$3,171.22
|
| Rate for Payer: Aetna Medicare |
$970.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,165.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,165.89
|
| Rate for Payer: BCBS Complete |
$1,555.23
|
| Rate for Payer: BCBS MAPPO |
$932.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,067.13
|
| Rate for Payer: BCN Commercial |
$2,900.74
|
| Rate for Payer: BCN Medicare Advantage |
$932.71
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cofinity Commercial |
$3,208.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,984.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$932.71
|
| Rate for Payer: Healthscope Commercial |
$3,357.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,798.14
|
| Rate for Payer: Mclaren Medicaid |
$1,481.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$979.35
|
| Rate for Payer: Meridian Medicaid |
$1,555.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,072.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,171.22
|
| Rate for Payer: Nomi Health Commercial |
$3,059.30
|
| Rate for Payer: PACE Senior Care Partners |
$886.08
|
| Rate for Payer: PACE SWMI |
$932.71
|
| Rate for Payer: PHP Commercial |
$3,171.22
|
| Rate for Payer: PHP Medicare Advantage |
$932.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,481.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.05
|
| Rate for Payer: Priority Health HMO/PPO |
$3,245.84
|
| Rate for Payer: Priority Health Medicare |
$942.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,499.67
|
| Rate for Payer: Railroad Medicare Medicare |
$932.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,283.15
|
| Rate for Payer: UHC Core |
$3,115.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$932.71
|
| Rate for Payer: UHC Exchange |
$932.71
|
| Rate for Payer: UHC Medicare Advantage |
$932.71
|
| Rate for Payer: UHCCP Medicaid |
$1,481.07
|
| Rate for Payer: VA VA |
$932.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,798.14
|
|
|
HC LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Facility
|
IP
|
$3,730.85
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
36100617
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,425.05 |
| Max. Negotiated Rate |
$3,357.76 |
| Rate for Payer: Aetna Commercial |
$3,171.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,045.49
|
| Rate for Payer: BCN Commercial |
$2,883.20
|
| Rate for Payer: Cash Price |
$2,984.68
|
| Rate for Payer: Cofinity Commercial |
$3,208.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,984.68
|
| Rate for Payer: Healthscope Commercial |
$3,357.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,798.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,171.22
|
| Rate for Payer: Nomi Health Commercial |
$3,059.30
|
| Rate for Payer: PHP Commercial |
$3,171.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.05
|
| Rate for Payer: Priority Health HMO/PPO |
$3,245.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,499.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,283.15
|
| Rate for Payer: UHC Core |
$3,115.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,798.14
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$1,377.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$327.04 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: Aetna Medicare |
$358.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$430.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$430.31
|
| Rate for Payer: BCBS Complete |
$386.62
|
| Rate for Payer: BCBS MAPPO |
$344.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.03
|
| Rate for Payer: BCN Commercial |
$1,070.62
|
| Rate for Payer: BCN Medicare Advantage |
$344.25
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.25
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.75
|
| Rate for Payer: Mclaren Medicaid |
$368.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.46
|
| Rate for Payer: Meridian Medicaid |
$386.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$395.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: PACE Senior Care Partners |
$327.04
|
| Rate for Payer: PACE SWMI |
$344.25
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: PHP Medicare Advantage |
$344.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.99
|
| Rate for Payer: Priority Health Medicare |
$347.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.59
|
| Rate for Payer: Railroad Medicare Medicare |
$344.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.76
|
| Rate for Payer: UHC Core |
$1,149.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.25
|
| Rate for Payer: UHC Exchange |
$344.25
|
| Rate for Payer: UHC Medicare Advantage |
$344.25
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$344.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.75
|
|
|
HC LYSIS INTRANASAL SYNECHIA
|
Facility
|
IP
|
$1,377.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.05 |
| Max. Negotiated Rate |
$1,239.30 |
| Rate for Payer: Aetna Commercial |
$1,170.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.05
|
| Rate for Payer: BCN Commercial |
$1,064.15
|
| Rate for Payer: Cash Price |
$1,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,184.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,101.60
|
| Rate for Payer: Healthscope Commercial |
$1,239.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,032.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,129.14
|
| Rate for Payer: PHP Commercial |
$1,170.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$895.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,197.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$922.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,211.76
|
| Rate for Payer: UHC Core |
$1,149.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,032.75
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
IP
|
$7,784.64
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,060.02 |
| Max. Negotiated Rate |
$7,006.18 |
| Rate for Payer: Aetna Commercial |
$6,616.94
|
| Rate for Payer: BCBS Trust/PPO |
$6,354.60
|
| Rate for Payer: BCN Commercial |
$6,015.97
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cofinity Commercial |
$6,694.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,227.71
|
| Rate for Payer: Healthscope Commercial |
$7,006.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,838.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,616.94
|
| Rate for Payer: Nomi Health Commercial |
$6,383.40
|
| Rate for Payer: PHP Commercial |
$6,616.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.02
|
| Rate for Payer: Priority Health HMO/PPO |
$6,772.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,215.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,850.48
|
| Rate for Payer: UHC Core |
$6,500.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,838.48
|
|
|
HC LYSIS OF LABIAL LESION(S)
|
Facility
|
OP
|
$7,784.64
|
|
|
Service Code
|
CPT 56441
|
| Hospital Charge Code |
76100516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,848.85 |
| Max. Negotiated Rate |
$7,006.18 |
| Rate for Payer: Aetna Commercial |
$6,616.94
|
| Rate for Payer: Aetna Medicare |
$2,024.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,432.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,432.70
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,946.16
|
| Rate for Payer: BCBS Trust/PPO |
$6,399.75
|
| Rate for Payer: BCN Commercial |
$6,052.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,946.16
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cash Price |
$6,227.71
|
| Rate for Payer: Cofinity Commercial |
$6,694.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,227.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,946.16
|
| Rate for Payer: Healthscope Commercial |
$7,006.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,838.48
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,043.47
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,238.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,616.94
|
| Rate for Payer: Nomi Health Commercial |
$6,383.40
|
| Rate for Payer: PACE Senior Care Partners |
$1,848.85
|
| Rate for Payer: PACE SWMI |
$1,946.16
|
| Rate for Payer: PHP Commercial |
$6,616.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,946.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,060.02
|
| Rate for Payer: Priority Health HMO/PPO |
$6,772.64
|
| Rate for Payer: Priority Health Medicare |
$1,965.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,215.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,946.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,850.48
|
| Rate for Payer: UHC Core |
$6,500.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,946.16
|
| Rate for Payer: UHC Exchange |
$1,946.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,946.16
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,946.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,838.48
|
|
|
HC LYSOZYME (MURAMIDASE)
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
30500108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$53.29
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC LYSOZYME (MURAMIDASE)
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85549
|
| Hospital Charge Code |
30500108
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$14.23
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$13.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: Meridian Medicaid |
$14.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Exchange |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.32
|
| Rate for Payer: UHCCP Medicaid |
$13.56
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC MAC/REGIONAL PER MINUTE
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
37000025
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$3.50
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCN Commercial |
$10.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.50
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: PACE Senior Care Partners |
$3.33
|
| Rate for Payer: PACE SWMI |
$3.50
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Medicare Advantage |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO |
$12.18
|
| Rate for Payer: Priority Health Medicare |
$3.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.50
|
| Rate for Payer: UHC Exchange |
$3.50
|
| Rate for Payer: UHC Medicare Advantage |
$3.50
|
| Rate for Payer: VA VA |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC MAC/REGIONAL PER MINUTE
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
37000025
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$11.43
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO |
$12.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
|
|
HC MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
OP
|
$44.94
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
30600092
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$40.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$11.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.04
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$11.23
|
| Rate for Payer: BCBS Trust/PPO |
$36.95
|
| Rate for Payer: BCN Commercial |
$34.94
|
| Rate for Payer: BCN Medicare Advantage |
$11.23
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cofinity Commercial |
$38.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.23
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.70
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.80
|
| Rate for Payer: Meridian Medicaid |
$3.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$36.85
|
| Rate for Payer: PACE Senior Care Partners |
$10.67
|
| Rate for Payer: PACE SWMI |
$11.23
|
| Rate for Payer: PHP Commercial |
$38.20
|
| Rate for Payer: PHP Medicare Advantage |
$11.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.21
|
| Rate for Payer: Priority Health HMO/PPO |
$39.10
|
| Rate for Payer: Priority Health Medicare |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.11
|
| Rate for Payer: Railroad Medicare Medicare |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.55
|
| Rate for Payer: UHC Core |
$37.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.23
|
| Rate for Payer: UHC Exchange |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$11.23
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$11.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.70
|
|
|
HC MACROSCOPIC EXAM ARTHROPOD
|
Facility
|
IP
|
$44.94
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
30600092
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.21 |
| Max. Negotiated Rate |
$40.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.68
|
| Rate for Payer: BCN Commercial |
$34.73
|
| Rate for Payer: Cash Price |
$35.95
|
| Rate for Payer: Cofinity Commercial |
$38.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.95
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$36.85
|
| Rate for Payer: PHP Commercial |
$38.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.21
|
| Rate for Payer: Priority Health HMO/PPO |
$39.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.55
|
| Rate for Payer: UHC Core |
$37.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.70
|
|
|
HC MACROSCOPIC EXAM PARASITE
|
Facility
|
OP
|
$44.06
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
30600093
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$37.45
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.77
|
| Rate for Payer: BCBS Complete |
$3.27
|
| Rate for Payer: BCBS MAPPO |
$11.02
|
| Rate for Payer: BCBS Trust/PPO |
$36.22
|
| Rate for Payer: BCN Commercial |
$34.26
|
| Rate for Payer: BCN Medicare Advantage |
$11.02
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$37.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.02
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.05
|
| Rate for Payer: Mclaren Medicaid |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.57
|
| Rate for Payer: Meridian Medicaid |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.45
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.46
|
| Rate for Payer: PACE SWMI |
$11.02
|
| Rate for Payer: PHP Commercial |
$37.45
|
| Rate for Payer: PHP Medicare Advantage |
$11.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: Priority Health HMO/PPO |
$38.33
|
| Rate for Payer: Priority Health Medicare |
$11.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.52
|
| Rate for Payer: Railroad Medicare Medicare |
$11.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.77
|
| Rate for Payer: UHC Core |
$36.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.02
|
| Rate for Payer: UHC Exchange |
$11.02
|
| Rate for Payer: UHC Medicare Advantage |
$11.02
|
| Rate for Payer: UHCCP Medicaid |
$3.12
|
| Rate for Payer: VA VA |
$11.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.05
|
|
|
HC MACROSCOPIC EXAM PARASITE
|
Facility
|
IP
|
$44.06
|
|
|
Service Code
|
CPT 87169
|
| Hospital Charge Code |
30600093
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.64 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$37.45
|
| Rate for Payer: BCBS Trust/PPO |
$35.97
|
| Rate for Payer: BCN Commercial |
$34.05
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Cofinity Commercial |
$37.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.45
|
| Rate for Payer: Nomi Health Commercial |
$36.13
|
| Rate for Payer: PHP Commercial |
$37.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.64
|
| Rate for Payer: Priority Health HMO/PPO |
$38.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.77
|
| Rate for Payer: UHC Core |
$36.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.05
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
OP
|
$975.34
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$231.64 |
| Max. Negotiated Rate |
$877.81 |
| Rate for Payer: Aetna Commercial |
$829.04
|
| Rate for Payer: Aetna Medicare |
$253.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.79
|
| Rate for Payer: BCBS Complete |
$390.14
|
| Rate for Payer: BCBS MAPPO |
$243.84
|
| Rate for Payer: BCBS Trust/PPO |
$801.83
|
| Rate for Payer: BCN Commercial |
$758.33
|
| Rate for Payer: BCN Medicare Advantage |
$243.84
|
| Rate for Payer: Cash Price |
$780.27
|
| Rate for Payer: Cofinity Commercial |
$838.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.84
|
| Rate for Payer: Healthscope Commercial |
$877.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.04
|
| Rate for Payer: Nomi Health Commercial |
$799.78
|
| Rate for Payer: PACE Senior Care Partners |
$231.64
|
| Rate for Payer: PACE SWMI |
$243.84
|
| Rate for Payer: PHP Commercial |
$829.04
|
| Rate for Payer: PHP Medicare Advantage |
$243.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.97
|
| Rate for Payer: Priority Health HMO/PPO |
$848.55
|
| Rate for Payer: Priority Health Medicare |
$246.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.48
|
| Rate for Payer: Railroad Medicare Medicare |
$243.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.30
|
| Rate for Payer: UHC Core |
$814.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$243.84
|
| Rate for Payer: UHC Exchange |
$243.84
|
| Rate for Payer: UHC Medicare Advantage |
$243.84
|
| Rate for Payer: VA VA |
$243.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.50
|
|
|
HC MAG 3 TC 99M PER STUDY
|
Facility
|
IP
|
$975.34
|
|
|
Service Code
|
HCPCS A9562
|
| Hospital Charge Code |
34300016
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$633.97 |
| Max. Negotiated Rate |
$877.81 |
| Rate for Payer: Aetna Commercial |
$829.04
|
| Rate for Payer: BCBS Trust/PPO |
$796.17
|
| Rate for Payer: BCN Commercial |
$753.74
|
| Rate for Payer: Cash Price |
$780.27
|
| Rate for Payer: Cofinity Commercial |
$838.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.27
|
| Rate for Payer: Healthscope Commercial |
$877.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$829.04
|
| Rate for Payer: Nomi Health Commercial |
$799.78
|
| Rate for Payer: PHP Commercial |
$829.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.97
|
| Rate for Payer: Priority Health HMO/PPO |
$848.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.30
|
| Rate for Payer: UHC Core |
$814.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.50
|
|
|
HC MAGGOT THERAPY
|
Facility
|
OP
|
$1,092.42
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.45 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: Aetna Medicare |
$284.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$341.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$341.38
|
| Rate for Payer: BCBS Complete |
$436.97
|
| Rate for Payer: BCBS MAPPO |
$273.11
|
| Rate for Payer: BCBS Trust/PPO |
$898.08
|
| Rate for Payer: BCN Commercial |
$849.36
|
| Rate for Payer: BCN Medicare Advantage |
$273.11
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.11
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PACE Senior Care Partners |
$259.45
|
| Rate for Payer: PACE SWMI |
$273.11
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: PHP Medicare Advantage |
$273.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Medicare |
$275.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: Railroad Medicare Medicare |
$273.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.11
|
| Rate for Payer: UHC Exchange |
$273.11
|
| Rate for Payer: UHC Medicare Advantage |
$273.11
|
| Rate for Payer: VA VA |
$273.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC MAGGOT THERAPY
|
Facility
|
IP
|
$1,092.42
|
|
| Hospital Charge Code |
27000634
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$710.07 |
| Max. Negotiated Rate |
$983.18 |
| Rate for Payer: Aetna Commercial |
$928.56
|
| Rate for Payer: BCBS Trust/PPO |
$891.74
|
| Rate for Payer: BCN Commercial |
$844.22
|
| Rate for Payer: Cash Price |
$873.94
|
| Rate for Payer: Cofinity Commercial |
$939.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$873.94
|
| Rate for Payer: Healthscope Commercial |
$983.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$819.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.56
|
| Rate for Payer: Nomi Health Commercial |
$895.78
|
| Rate for Payer: PHP Commercial |
$928.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$710.07
|
| Rate for Payer: Priority Health HMO/PPO |
$950.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$961.33
|
| Rate for Payer: UHC Core |
$912.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$819.32
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
OP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.13
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$21.38
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Mclaren Medicaid |
$4.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Meridian Medicaid |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PACE Senior Care Partners |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Medicare |
$6.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Exchange |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
| Rate for Payer: UHCCP Medicaid |
$4.84
|
| Rate for Payer: VA VA |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MAGNESIUM LEVEL
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
30100284
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$23.41 |
| Rate for Payer: Aetna Commercial |
$22.11
|
| Rate for Payer: BCBS Trust/PPO |
$21.23
|
| Rate for Payer: BCN Commercial |
$20.10
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$22.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$23.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.11
|
| Rate for Payer: Nomi Health Commercial |
$21.33
|
| Rate for Payer: PHP Commercial |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.91
|
| Rate for Payer: Priority Health HMO/PPO |
$22.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.89
|
| Rate for Payer: UHC Core |
$21.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.51
|
|
|
HC MAKENA 10 MG
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO |
$2.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
HC MAKENA 10 MG
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
63600141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.81
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS MAPPO |
$0.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.14
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.65
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.65
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.21
|
| Rate for Payer: Nomi Health Commercial |
$2.13
|
| Rate for Payer: PACE Senior Care Partners |
$0.62
|
| Rate for Payer: PACE SWMI |
$0.65
|
| Rate for Payer: PHP Commercial |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.69
|
| Rate for Payer: Priority Health HMO/PPO |
$2.26
|
| Rate for Payer: Priority Health Medicare |
$0.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: Railroad Medicare Medicare |
$0.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.65
|
| Rate for Payer: UHC Exchange |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.65
|
| Rate for Payer: VA VA |
$0.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.95
|
|
|
HC MALARIA SMEAR
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.99 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: BCBS Trust/PPO |
$62.78
|
| Rate for Payer: BCN Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
|
HC MALARIA SMEAR
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
30600106
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$69.22 |
| Rate for Payer: Aetna Commercial |
$65.37
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.03
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$63.23
|
| Rate for Payer: BCN Commercial |
$59.80
|
| Rate for Payer: BCN Medicare Advantage |
$19.23
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$66.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$69.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.68
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.19
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: PACE Senior Care Partners |
$18.27
|
| Rate for Payer: PACE SWMI |
$19.23
|
| Rate for Payer: PHP Commercial |
$65.37
|
| Rate for Payer: PHP Medicare Advantage |
$19.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO |
$66.91
|
| Rate for Payer: Priority Health Medicare |
$19.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.53
|
| Rate for Payer: Railroad Medicare Medicare |
$19.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.68
|
| Rate for Payer: UHC Core |
$64.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.23
|
| Rate for Payer: UHC Exchange |
$19.23
|
| Rate for Payer: UHC Medicare Advantage |
$19.23
|
| Rate for Payer: UHCCP Medicaid |
$4.33
|
| Rate for Payer: VA VA |
$19.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.68
|
|
