|
HC MASTECTOMY SLEEVE EA $450
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000019
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$109.01 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna Commercial |
$390.15
|
| Rate for Payer: Aetna Medicare |
$119.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.44
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: BCBS MAPPO |
$114.75
|
| Rate for Payer: BCBS Trust/PPO |
$377.34
|
| Rate for Payer: BCN Commercial |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$114.75
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$394.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.75
|
| Rate for Payer: Healthscope Commercial |
$413.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.15
|
| Rate for Payer: Nomi Health Commercial |
$376.38
|
| Rate for Payer: PACE Senior Care Partners |
$109.01
|
| Rate for Payer: PACE SWMI |
$114.75
|
| Rate for Payer: PHP Commercial |
$390.15
|
| Rate for Payer: PHP Medicare Advantage |
$114.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
| Rate for Payer: Priority Health HMO/PPO |
$399.33
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.53
|
| Rate for Payer: Railroad Medicare Medicare |
$114.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.92
|
| Rate for Payer: UHC Core |
$383.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.75
|
| Rate for Payer: UHC Exchange |
$114.75
|
| Rate for Payer: UHC Medicare Advantage |
$114.75
|
| Rate for Payer: VA VA |
$114.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.25
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$41.63
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC MASTECTOMY SLEEVE EA $50
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000020
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Exchange |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$24.48
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$50.31
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Exchange |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.30
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC MASTECTOMY SLEEVE EA $60
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000021
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.78 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.02
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.78
|
| Rate for Payer: Priority Health HMO/PPO |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.96 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$18.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.31
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$58.70
|
| Rate for Payer: BCN Commercial |
$55.51
|
| Rate for Payer: BCN Medicare Advantage |
$17.85
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PACE Senior Care Partners |
$16.96
|
| Rate for Payer: PACE SWMI |
$17.85
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: PHP Medicare Advantage |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Medicare |
$18.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: Railroad Medicare Medicare |
$17.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.85
|
| Rate for Payer: UHC Exchange |
$17.85
|
| Rate for Payer: UHC Medicare Advantage |
$17.85
|
| Rate for Payer: VA VA |
$17.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC MASTECTOMY SLEEVE EA $70
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000022
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.28
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.83
|
| Rate for Payer: UHC Core |
$59.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.55
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
OP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.50
|
| Rate for Payer: BCBS Complete |
$32.64
|
| Rate for Payer: BCBS MAPPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$67.08
|
| Rate for Payer: BCN Commercial |
$63.44
|
| Rate for Payer: BCN Medicare Advantage |
$20.40
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PACE Senior Care Partners |
$19.38
|
| Rate for Payer: PACE SWMI |
$20.40
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Medicare |
$20.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.40
|
| Rate for Payer: UHC Exchange |
$20.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.40
|
| Rate for Payer: VA VA |
$20.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC MASTECTOMY SLEEVE EA $80
|
Facility
|
IP
|
$81.60
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$73.44 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: BCBS Trust/PPO |
$66.61
|
| Rate for Payer: BCN Commercial |
$63.06
|
| Rate for Payer: Cash Price |
$65.28
|
| Rate for Payer: Cofinity Commercial |
$70.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$73.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.36
|
| Rate for Payer: Nomi Health Commercial |
$66.91
|
| Rate for Payer: PHP Commercial |
$69.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.04
|
| Rate for Payer: Priority Health HMO/PPO |
$70.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.81
|
| Rate for Payer: UHC Core |
$68.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.20
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.67 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$74.94
|
| Rate for Payer: BCN Commercial |
$70.94
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC MASTECTOMY SLEEVE EA $90
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
HCPCS L8010
|
| Hospital Charge Code |
96000024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$71.37
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.51
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.95
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
IP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,392.35 |
| Max. Negotiated Rate |
$1,927.87 |
| Rate for Payer: Aetna Commercial |
$1,820.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,748.58
|
| Rate for Payer: BCN Commercial |
$1,655.40
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$1,842.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Healthscope Commercial |
$1,927.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: PHP Commercial |
$1,820.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,863.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,435.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,885.03
|
| Rate for Payer: UHC Core |
$1,788.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.56
|
|
|
HC MASTOTOMY W/EXPLORATION OR DRAINAGE OF ABSCESS, DEEP
|
Facility
|
OP
|
$2,142.08
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
76100281
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$508.74 |
| Max. Negotiated Rate |
$1,927.87 |
| Rate for Payer: Aetna Commercial |
$1,820.77
|
| Rate for Payer: Aetna Medicare |
$556.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$669.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$669.40
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$535.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,761.00
|
| Rate for Payer: BCN Commercial |
$1,665.47
|
| Rate for Payer: BCN Medicare Advantage |
$535.52
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cash Price |
$1,713.66
|
| Rate for Payer: Cofinity Commercial |
$1,842.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$535.52
|
| Rate for Payer: Healthscope Commercial |
$1,927.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.56
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$562.30
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$615.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,820.77
|
| Rate for Payer: Nomi Health Commercial |
$1,756.51
|
| Rate for Payer: PACE Senior Care Partners |
$508.74
|
| Rate for Payer: PACE SWMI |
$535.52
|
| Rate for Payer: PHP Commercial |
$1,820.77
|
| Rate for Payer: PHP Medicare Advantage |
$535.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,863.61
|
| Rate for Payer: Priority Health Medicare |
$540.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,435.19
|
| Rate for Payer: Railroad Medicare Medicare |
$535.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,885.03
|
| Rate for Payer: UHC Core |
$1,788.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$535.52
|
| Rate for Payer: UHC Exchange |
$535.52
|
| Rate for Payer: UHC Medicare Advantage |
$535.52
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$535.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.56
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.93 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$91.59
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 1
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100641
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.06
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$92.24
|
| Rate for Payer: BCN Commercial |
$87.24
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cash Price |
$89.76
|
| Rate for Payer: Cofinity Commercial |
$96.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$100.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.15
|
| Rate for Payer: Mclaren Medicaid |
$10.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: Meridian Medicaid |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.37
|
| Rate for Payer: Nomi Health Commercial |
$92.00
|
| Rate for Payer: PACE Senior Care Partners |
$26.65
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.93
|
| Rate for Payer: Priority Health HMO/PPO |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.17
|
| Rate for Payer: Railroad Medicare Medicare |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.74
|
| Rate for Payer: UHC Core |
$93.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Exchange |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: UHCCP Medicaid |
$10.88
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
IP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$218.12 |
| Rate for Payer: Aetna Commercial |
$206.00
|
| Rate for Payer: BCBS Trust/PPO |
$197.83
|
| Rate for Payer: BCN Commercial |
$187.29
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Healthscope Commercial |
$218.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: PHP Commercial |
$206.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: Priority Health HMO/PPO |
$210.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.27
|
| Rate for Payer: UHC Core |
$202.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.76
|
|
|
HC MATERNAL SCRN INTEGRATED SERUM 2
|
Facility
|
OP
|
$242.35
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100654
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$218.12 |
| Rate for Payer: Aetna Commercial |
$206.00
|
| Rate for Payer: Aetna Medicare |
$63.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.73
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: BCBS MAPPO |
$60.59
|
| Rate for Payer: BCBS Trust/PPO |
$199.24
|
| Rate for Payer: BCN Commercial |
$188.43
|
| Rate for Payer: BCN Medicare Advantage |
$60.59
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cash Price |
$193.88
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.59
|
| Rate for Payer: Healthscope Commercial |
$218.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.76
|
| Rate for Payer: Mclaren Medicaid |
$110.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.62
|
| Rate for Payer: Meridian Medicaid |
$116.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.00
|
| Rate for Payer: Nomi Health Commercial |
$198.73
|
| Rate for Payer: PACE Senior Care Partners |
$57.56
|
| Rate for Payer: PACE SWMI |
$60.59
|
| Rate for Payer: PHP Commercial |
$206.00
|
| Rate for Payer: PHP Medicare Advantage |
$60.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.53
|
| Rate for Payer: Priority Health HMO/PPO |
$210.84
|
| Rate for Payer: Priority Health Medicare |
$61.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.37
|
| Rate for Payer: Railroad Medicare Medicare |
$60.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.27
|
| Rate for Payer: UHC Core |
$202.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.59
|
| Rate for Payer: UHC Exchange |
$60.59
|
| Rate for Payer: UHC Medicare Advantage |
$60.59
|
| Rate for Payer: UHCCP Medicaid |
$110.98
|
| Rate for Payer: VA VA |
$60.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.76
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
IP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$110.37 |
| Rate for Payer: Aetna Commercial |
$104.24
|
| Rate for Payer: BCBS Trust/PPO |
$100.10
|
| Rate for Payer: BCN Commercial |
$94.77
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Healthscope Commercial |
$110.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: PHP Commercial |
$104.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: Priority Health HMO/PPO |
$106.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.91
|
| Rate for Payer: UHC Core |
$102.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.97
|
|
|
HC MAXIMUM VOLUNTARY VENTILATION
|
Facility
|
OP
|
$122.63
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
46000022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$110.37 |
| Rate for Payer: Aetna Commercial |
$104.24
|
| Rate for Payer: Aetna Medicare |
$31.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.32
|
| Rate for Payer: BCBS Complete |
$45.10
|
| Rate for Payer: BCBS MAPPO |
$30.66
|
| Rate for Payer: BCBS Trust/PPO |
$100.81
|
| Rate for Payer: BCN Commercial |
$95.34
|
| Rate for Payer: BCN Medicare Advantage |
$30.66
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cofinity Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.66
|
| Rate for Payer: Healthscope Commercial |
$110.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.97
|
| Rate for Payer: Mclaren Medicaid |
$42.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.19
|
| Rate for Payer: Meridian Medicaid |
$45.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.24
|
| Rate for Payer: Nomi Health Commercial |
$100.56
|
| Rate for Payer: PACE Senior Care Partners |
$29.12
|
| Rate for Payer: PACE SWMI |
$30.66
|
| Rate for Payer: PHP Commercial |
$104.24
|
| Rate for Payer: PHP Medicare Advantage |
$30.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.71
|
| Rate for Payer: Priority Health HMO/PPO |
$106.69
|
| Rate for Payer: Priority Health Medicare |
$30.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.16
|
| Rate for Payer: Railroad Medicare Medicare |
$30.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.91
|
| Rate for Payer: UHC Core |
$102.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.66
|
| Rate for Payer: UHC Exchange |
$30.66
|
| Rate for Payer: UHC Medicare Advantage |
$30.66
|
| Rate for Payer: UHCCP Medicaid |
$42.95
|
| Rate for Payer: VA VA |
$30.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.97
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
OP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: Aetna Medicare |
$87.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.70
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: BCBS MAPPO |
$84.56
|
| Rate for Payer: BCBS Trust/PPO |
$278.06
|
| Rate for Payer: BCN Commercial |
$262.97
|
| Rate for Payer: BCN Medicare Advantage |
$84.56
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$290.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.56
|
| Rate for Payer: Healthscope Commercial |
$304.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.67
|
| Rate for Payer: Mclaren Medicaid |
$8.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.79
|
| Rate for Payer: Meridian Medicaid |
$9.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: PACE Senior Care Partners |
$80.33
|
| Rate for Payer: PACE SWMI |
$84.56
|
| Rate for Payer: PHP Commercial |
$287.50
|
| Rate for Payer: PHP Medicare Advantage |
$84.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health HMO/PPO |
$294.26
|
| Rate for Payer: Priority Health Medicare |
$85.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.61
|
| Rate for Payer: Railroad Medicare Medicare |
$84.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.64
|
| Rate for Payer: UHC Core |
$282.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.56
|
| Rate for Payer: UHC Exchange |
$84.56
|
| Rate for Payer: UHC Medicare Advantage |
$84.56
|
| Rate for Payer: UHCCP Medicaid |
$8.60
|
| Rate for Payer: VA VA |
$84.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.67
|
|
|
HC MAYO CHROMOGENIC FACTOR 8
|
Facility
|
IP
|
$338.23
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500105
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$219.85 |
| Max. Negotiated Rate |
$304.41 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: BCBS Trust/PPO |
$276.10
|
| Rate for Payer: BCN Commercial |
$261.38
|
| Rate for Payer: Cash Price |
$270.58
|
| Rate for Payer: Cofinity Commercial |
$290.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.58
|
| Rate for Payer: Healthscope Commercial |
$304.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.50
|
| Rate for Payer: Nomi Health Commercial |
$277.35
|
| Rate for Payer: PHP Commercial |
$287.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.85
|
| Rate for Payer: Priority Health HMO/PPO |
$294.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.64
|
| Rate for Payer: UHC Core |
$282.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.67
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
IP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$233.06 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: BCBS Trust/PPO |
$292.69
|
| Rate for Payer: BCN Commercial |
$277.10
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$308.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Healthscope Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: PHP Commercial |
$304.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health HMO/PPO |
$311.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.53
|
| Rate for Payer: UHC Core |
$299.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.92
|
|
|
HC MAYO CHROMOGENIC FACTOR 9
|
Facility
|
OP
|
$358.56
|
|
|
Service Code
|
CPT 85130
|
| Hospital Charge Code |
30500104
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$322.70 |
| Rate for Payer: Aetna Commercial |
$304.78
|
| Rate for Payer: Aetna Medicare |
$93.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.05
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: BCBS MAPPO |
$89.64
|
| Rate for Payer: BCBS Trust/PPO |
$294.77
|
| Rate for Payer: BCN Commercial |
$278.78
|
| Rate for Payer: BCN Medicare Advantage |
$89.64
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cash Price |
$286.85
|
| Rate for Payer: Cofinity Commercial |
$308.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.64
|
| Rate for Payer: Healthscope Commercial |
$322.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.92
|
| Rate for Payer: Mclaren Medicaid |
$8.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.12
|
| Rate for Payer: Meridian Medicaid |
$9.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.78
|
| Rate for Payer: Nomi Health Commercial |
$294.02
|
| Rate for Payer: PACE Senior Care Partners |
$85.16
|
| Rate for Payer: PACE SWMI |
$89.64
|
| Rate for Payer: PHP Commercial |
$304.78
|
| Rate for Payer: PHP Medicare Advantage |
$89.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.06
|
| Rate for Payer: Priority Health HMO/PPO |
$311.95
|
| Rate for Payer: Priority Health Medicare |
$90.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.24
|
| Rate for Payer: Railroad Medicare Medicare |
$89.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.53
|
| Rate for Payer: UHC Core |
$299.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.64
|
| Rate for Payer: UHC Exchange |
$89.64
|
| Rate for Payer: UHC Medicare Advantage |
$89.64
|
| Rate for Payer: UHCCP Medicaid |
$8.60
|
| Rate for Payer: VA VA |
$89.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.92
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
IP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1,276.28 |
| Max. Negotiated Rate |
$1,767.15 |
| Rate for Payer: Aetna Commercial |
$1,668.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,602.81
|
| Rate for Payer: BCN Commercial |
$1,517.39
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,688.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Healthscope Commercial |
$1,767.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.97
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: PHP Commercial |
$1,668.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,708.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.88
|
| Rate for Payer: UHC Core |
$1,639.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.62
|
|
|
HC MAYOCOMPLETE MYELOID NEOPLASMS, NGS
|
Facility
|
OP
|
$1,963.50
|
|
|
Service Code
|
CPT 81450
|
| Hospital Charge Code |
31000084
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$466.33 |
| Max. Negotiated Rate |
$1,767.15 |
| Rate for Payer: Aetna Commercial |
$1,668.97
|
| Rate for Payer: Aetna Medicare |
$510.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.59
|
| Rate for Payer: BCBS Complete |
$576.64
|
| Rate for Payer: BCBS MAPPO |
$490.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.19
|
| Rate for Payer: BCN Commercial |
$1,526.62
|
| Rate for Payer: BCN Medicare Advantage |
$490.88
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cash Price |
$1,570.80
|
| Rate for Payer: Cofinity Commercial |
$1,688.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,570.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.88
|
| Rate for Payer: Healthscope Commercial |
$1,767.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,472.62
|
| Rate for Payer: Mclaren Medicaid |
$549.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.42
|
| Rate for Payer: Meridian Medicaid |
$576.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,668.97
|
| Rate for Payer: Nomi Health Commercial |
$1,610.07
|
| Rate for Payer: PACE Senior Care Partners |
$466.33
|
| Rate for Payer: PACE SWMI |
$490.88
|
| Rate for Payer: PHP Commercial |
$1,668.97
|
| Rate for Payer: PHP Medicare Advantage |
$490.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,276.28
|
| Rate for Payer: Priority Health HMO/PPO |
$1,708.24
|
| Rate for Payer: Priority Health Medicare |
$495.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.55
|
| Rate for Payer: Railroad Medicare Medicare |
$490.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.88
|
| Rate for Payer: UHC Core |
$1,639.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.88
|
| Rate for Payer: UHC Exchange |
$490.88
|
| Rate for Payer: UHC Medicare Advantage |
$490.88
|
| Rate for Payer: UHCCP Medicaid |
$549.14
|
| Rate for Payer: VA VA |
$490.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,472.62
|
|
