|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
IP
|
$81.91
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$49.96 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: BCBS Trust/PPO |
$63.30
|
| Rate for Payer: BCN Commercial |
$63.30
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.08
|
| Rate for Payer: UHC Core |
$68.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.43
|
|
|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$81.91
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$73.72 |
| Rate for Payer: Aetna Commercial |
$69.62
|
| Rate for Payer: Aetna Medicare |
$21.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.60
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: BCBS MAPPO |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$63.69
|
| Rate for Payer: BCN Commercial |
$63.69
|
| Rate for Payer: BCN Medicare Advantage |
$20.48
|
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Cofinity Commercial |
$70.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.48
|
| Rate for Payer: Healthscope Commercial |
$73.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.62
|
| Rate for Payer: PACE Senior Care Partners |
$19.45
|
| Rate for Payer: PACE SWMI |
$20.48
|
| Rate for Payer: PHP Commercial |
$69.62
|
| Rate for Payer: PHP Medicare Advantage |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.26
|
| Rate for Payer: Priority Health Medicare |
$20.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.96
|
| Rate for Payer: Railroad Medicare Medicare |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.08
|
| Rate for Payer: UHC Core |
$68.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.48
|
| Rate for Payer: UHC Medicare Advantage |
$21.09
|
| Rate for Payer: VA VA |
$20.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.43
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$243.27 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: BCBS Trust/PPO |
$208.89
|
| Rate for Payer: BCN Commercial |
$208.89
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.86
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.72
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$270.30
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.20 |
| Max. Negotiated Rate |
$243.27 |
| Rate for Payer: Aetna Commercial |
$229.76
|
| Rate for Payer: Aetna Medicare |
$70.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.47
|
| Rate for Payer: BCBS Complete |
$137.89
|
| Rate for Payer: BCBS MAPPO |
$67.58
|
| Rate for Payer: BCBS Trust/PPO |
$210.16
|
| Rate for Payer: BCN Commercial |
$210.16
|
| Rate for Payer: BCN Medicare Advantage |
$67.58
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cash Price |
$216.24
|
| Rate for Payer: Cofinity Commercial |
$232.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.58
|
| Rate for Payer: Healthscope Commercial |
$243.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.72
|
| Rate for Payer: Mclaren Medicaid |
$131.33
|
| Rate for Payer: Meridian Medicaid |
$137.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.76
|
| Rate for Payer: PACE Senior Care Partners |
$64.20
|
| Rate for Payer: PACE SWMI |
$67.58
|
| Rate for Payer: PHP Commercial |
$229.76
|
| Rate for Payer: PHP Medicare Advantage |
$67.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.16
|
| Rate for Payer: Priority Health Medicare |
$67.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.86
|
| Rate for Payer: Railroad Medicare Medicare |
$67.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.86
|
| Rate for Payer: UHC Core |
$225.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.58
|
| Rate for Payer: UHC Medicare Advantage |
$69.60
|
| Rate for Payer: VA VA |
$67.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.72
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,871.25 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: BCBS Trust/PPO |
$28,980.00
|
| Rate for Payer: BCN Commercial |
$28,980.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22,871.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,000.00
|
| Rate for Payer: UHC Core |
$31,312.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,906.25 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna Medicare |
$9,750.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,718.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,718.75
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: BCBS MAPPO |
$9,375.00
|
| Rate for Payer: BCBS Trust/PPO |
$29,156.25
|
| Rate for Payer: BCN Commercial |
$29,156.25
|
| Rate for Payer: BCN Medicare Advantage |
$9,375.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,375.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,843.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,781.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31,875.00
|
| Rate for Payer: PACE Senior Care Partners |
$8,906.25
|
| Rate for Payer: PACE SWMI |
$9,375.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: PHP Medicare Advantage |
$9,375.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,250.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,625.00
|
| Rate for Payer: Priority Health Medicare |
$9,375.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22,871.25
|
| Rate for Payer: Railroad Medicare Medicare |
$9,375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,000.00
|
| Rate for Payer: UHC Core |
$31,312.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,375.00
|
| Rate for Payer: UHC Medicare Advantage |
$9,656.25
|
| Rate for Payer: VA VA |
$9,375.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,777.19 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: BCBS Trust/PPO |
$31,395.00
|
| Rate for Payer: BCN Commercial |
$31,395.00
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,343.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24,777.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,750.00
|
| Rate for Payer: UHC Core |
$33,921.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,648.44 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna Medicare |
$10,562.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,695.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,695.31
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: BCBS MAPPO |
$10,156.25
|
| Rate for Payer: BCBS Trust/PPO |
$31,585.94
|
| Rate for Payer: BCN Commercial |
$31,585.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,156.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,156.25
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,664.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,679.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34,531.25
|
| Rate for Payer: PACE Senior Care Partners |
$9,648.44
|
| Rate for Payer: PACE SWMI |
$10,156.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: PHP Medicare Advantage |
$10,156.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28,437.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,343.75
|
| Rate for Payer: Priority Health Medicare |
$10,156.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24,777.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,156.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,750.00
|
| Rate for Payer: UHC Core |
$33,921.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,156.25
|
| Rate for Payer: UHC Medicare Advantage |
$10,460.94
|
| Rate for Payer: VA VA |
$10,156.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.43 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: BCBS Trust/PPO |
$189.34
|
| Rate for Payer: BCN Commercial |
$189.34
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.19 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$63.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.56
|
| Rate for Payer: BCBS Complete |
$62.59
|
| Rate for Payer: BCBS MAPPO |
$61.25
|
| Rate for Payer: BCBS Trust/PPO |
$190.49
|
| Rate for Payer: BCN Commercial |
$190.49
|
| Rate for Payer: BCN Medicare Advantage |
$61.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.25
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Mclaren Medicaid |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$62.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PACE Senior Care Partners |
$58.19
|
| Rate for Payer: PACE SWMI |
$61.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: PHP Medicare Advantage |
$61.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.15
|
| Rate for Payer: Priority Health Medicare |
$61.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.43
|
| Rate for Payer: Railroad Medicare Medicare |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.60
|
| Rate for Payer: UHC Core |
$204.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.25
|
| Rate for Payer: UHC Medicare Advantage |
$63.09
|
| Rate for Payer: VA VA |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.55
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$20.51
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$18.66
|
| Rate for Payer: BCN Commercial |
$18.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Mclaren Medicaid |
$19.53
|
| Rate for Payer: Meridian Medicaid |
$20.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.40
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.88
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.18
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$94.19 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$119.34
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.90
|
| Rate for Payer: UHC Core |
$128.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.82
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$154.43
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$138.99 |
| Rate for Payer: Aetna Commercial |
$131.27
|
| Rate for Payer: Aetna Medicare |
$40.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.26
|
| Rate for Payer: BCBS Complete |
$61.77
|
| Rate for Payer: BCBS MAPPO |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$120.07
|
| Rate for Payer: BCN Commercial |
$120.07
|
| Rate for Payer: BCN Medicare Advantage |
$38.61
|
| Rate for Payer: Cash Price |
$123.54
|
| Rate for Payer: Cofinity Commercial |
$132.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.61
|
| Rate for Payer: Healthscope Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.27
|
| Rate for Payer: PACE Senior Care Partners |
$36.68
|
| Rate for Payer: PACE SWMI |
$38.61
|
| Rate for Payer: PHP Commercial |
$131.27
|
| Rate for Payer: PHP Medicare Advantage |
$38.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.35
|
| Rate for Payer: Priority Health Medicare |
$38.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.19
|
| Rate for Payer: Railroad Medicare Medicare |
$38.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.90
|
| Rate for Payer: UHC Core |
$128.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.61
|
| Rate for Payer: UHC Medicare Advantage |
$39.77
|
| Rate for Payer: VA VA |
$38.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.82
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,064.28 |
| Max. Negotiated Rate |
$1,570.51 |
| Rate for Payer: Aetna Commercial |
$1,483.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,348.54
|
| Rate for Payer: BCN Commercial |
$1,348.54
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,500.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Healthscope Commercial |
$1,570.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,308.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: PHP Commercial |
$1,483.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,535.61
|
| Rate for Payer: UHC Core |
$1,457.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,308.76
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,745.01
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$414.44 |
| Max. Negotiated Rate |
$1,570.51 |
| Rate for Payer: Aetna Commercial |
$1,483.26
|
| Rate for Payer: Aetna Medicare |
$453.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$545.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$545.32
|
| Rate for Payer: BCBS Complete |
$698.00
|
| Rate for Payer: BCBS MAPPO |
$436.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,356.75
|
| Rate for Payer: BCN Commercial |
$1,356.75
|
| Rate for Payer: BCN Medicare Advantage |
$436.25
|
| Rate for Payer: Cash Price |
$1,396.01
|
| Rate for Payer: Cofinity Commercial |
$1,500.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,396.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.25
|
| Rate for Payer: Healthscope Commercial |
$1,570.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,308.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$458.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,483.26
|
| Rate for Payer: PACE Senior Care Partners |
$414.44
|
| Rate for Payer: PACE SWMI |
$436.25
|
| Rate for Payer: PHP Commercial |
$1,483.26
|
| Rate for Payer: PHP Medicare Advantage |
$436.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,221.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.16
|
| Rate for Payer: Priority Health Medicare |
$436.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.28
|
| Rate for Payer: Railroad Medicare Medicare |
$436.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,535.61
|
| Rate for Payer: UHC Core |
$1,457.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.25
|
| Rate for Payer: UHC Medicare Advantage |
$449.34
|
| Rate for Payer: VA VA |
$436.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,308.76
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$80.13 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: BCBS Trust/PPO |
$101.54
|
| Rate for Payer: BCN Commercial |
$101.54
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$113.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: PHP Commercial |
$111.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.62
|
| Rate for Payer: UHC Core |
$109.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.54
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$131.39
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.21 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna Commercial |
$111.68
|
| Rate for Payer: Aetna Medicare |
$34.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.06
|
| Rate for Payer: BCBS Complete |
$52.56
|
| Rate for Payer: BCBS MAPPO |
$32.85
|
| Rate for Payer: BCBS Trust/PPO |
$102.16
|
| Rate for Payer: BCN Commercial |
$102.16
|
| Rate for Payer: BCN Medicare Advantage |
$32.85
|
| Rate for Payer: Cash Price |
$105.11
|
| Rate for Payer: Cofinity Commercial |
$113.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.68
|
| Rate for Payer: PACE Senior Care Partners |
$31.21
|
| Rate for Payer: PACE SWMI |
$32.85
|
| Rate for Payer: PHP Commercial |
$111.68
|
| Rate for Payer: PHP Medicare Advantage |
$32.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.31
|
| Rate for Payer: Priority Health Medicare |
$32.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.13
|
| Rate for Payer: Railroad Medicare Medicare |
$32.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.62
|
| Rate for Payer: UHC Core |
$109.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.85
|
| Rate for Payer: UHC Medicare Advantage |
$33.83
|
| Rate for Payer: VA VA |
$32.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.54
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$106.08
|
| Rate for Payer: Aetna Medicare |
$32.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.00
|
| Rate for Payer: BCBS Complete |
$49.92
|
| Rate for Payer: BCBS MAPPO |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$97.03
|
| Rate for Payer: BCN Commercial |
$97.03
|
| Rate for Payer: BCN Medicare Advantage |
$31.20
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$107.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.20
|
| Rate for Payer: Healthscope Commercial |
$112.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: PACE Senior Care Partners |
$29.64
|
| Rate for Payer: PACE SWMI |
$31.20
|
| Rate for Payer: PHP Commercial |
$106.08
|
| Rate for Payer: PHP Medicare Advantage |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.58
|
| Rate for Payer: Priority Health Medicare |
$31.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.12
|
| Rate for Payer: Railroad Medicare Medicare |
$31.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.20
|
| Rate for Payer: UHC Medicare Advantage |
$32.14
|
| Rate for Payer: VA VA |
$31.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.60
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$124.80
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$106.08
|
| Rate for Payer: BCBS Trust/PPO |
$96.45
|
| Rate for Payer: BCN Commercial |
$96.45
|
| Rate for Payer: Cash Price |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$107.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.84
|
| Rate for Payer: Healthscope Commercial |
$112.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.08
|
| Rate for Payer: PHP Commercial |
$106.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.82
|
| Rate for Payer: UHC Core |
$104.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.60
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna Commercial |
$119.03
|
| Rate for Payer: BCBS Trust/PPO |
$108.22
|
| Rate for Payer: BCN Commercial |
$108.22
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$120.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Healthscope Commercial |
$126.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: PHP Commercial |
$119.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.23
|
| Rate for Payer: UHC Core |
$116.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.02
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$140.03
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$33.26 |
| Max. Negotiated Rate |
$126.03 |
| Rate for Payer: Aetna Commercial |
$119.03
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.76
|
| Rate for Payer: BCBS Complete |
$56.01
|
| Rate for Payer: BCBS MAPPO |
$35.01
|
| Rate for Payer: BCBS Trust/PPO |
$108.87
|
| Rate for Payer: BCN Commercial |
$108.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.01
|
| Rate for Payer: Cash Price |
$112.02
|
| Rate for Payer: Cofinity Commercial |
$120.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.01
|
| Rate for Payer: Healthscope Commercial |
$126.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.03
|
| Rate for Payer: PACE Senior Care Partners |
$33.26
|
| Rate for Payer: PACE SWMI |
$35.01
|
| Rate for Payer: PHP Commercial |
$119.03
|
| Rate for Payer: PHP Medicare Advantage |
$35.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.83
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.40
|
| Rate for Payer: Railroad Medicare Medicare |
$35.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.23
|
| Rate for Payer: UHC Core |
$116.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.01
|
| Rate for Payer: UHC Medicare Advantage |
$36.06
|
| Rate for Payer: VA VA |
$35.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.02
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
IP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$28.47 |
| Max. Negotiated Rate |
$42.01 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: BCBS Trust/PPO |
$36.07
|
| Rate for Payer: BCN Commercial |
$36.07
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$40.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$42.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: PHP Commercial |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.08
|
| Rate for Payer: UHC Core |
$38.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.01
|
|
|
HC TC 99M PERTECHNETATE PER MCI
|
Facility
|
OP
|
$46.68
|
|
|
Service Code
|
HCPCS A9512
|
| Hospital Charge Code |
34300029
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$42.01 |
| Rate for Payer: Aetna Commercial |
$39.68
|
| Rate for Payer: Aetna Medicare |
$12.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.59
|
| Rate for Payer: BCBS Complete |
$18.67
|
| Rate for Payer: BCBS MAPPO |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.29
|
| Rate for Payer: BCN Commercial |
$36.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.67
|
| Rate for Payer: Cash Price |
$37.34
|
| Rate for Payer: Cofinity Commercial |
$40.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.67
|
| Rate for Payer: Healthscope Commercial |
$42.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: PACE Senior Care Partners |
$11.09
|
| Rate for Payer: PACE SWMI |
$11.67
|
| Rate for Payer: PHP Commercial |
$39.68
|
| Rate for Payer: PHP Medicare Advantage |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.61
|
| Rate for Payer: Priority Health Medicare |
$11.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.47
|
| Rate for Payer: Railroad Medicare Medicare |
$11.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.08
|
| Rate for Payer: UHC Core |
$38.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.67
|
| Rate for Payer: UHC Medicare Advantage |
$12.02
|
| Rate for Payer: VA VA |
$11.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.01
|
|
|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
OP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: Aetna Medicare |
$60.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.36
|
| Rate for Payer: BCBS Complete |
$92.62
|
| Rate for Payer: BCBS MAPPO |
$57.88
|
| Rate for Payer: BCBS Trust/PPO |
$180.02
|
| Rate for Payer: BCN Commercial |
$180.02
|
| Rate for Payer: BCN Medicare Advantage |
$57.88
|
| Rate for Payer: Cash Price |
$185.23
|
| Rate for Payer: Cofinity Commercial |
$199.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.88
|
| Rate for Payer: Healthscope Commercial |
$208.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: PACE Senior Care Partners |
$54.99
|
| Rate for Payer: PACE SWMI |
$57.88
|
| Rate for Payer: PHP Commercial |
$196.81
|
| Rate for Payer: PHP Medicare Advantage |
$57.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.44
|
| Rate for Payer: Priority Health Medicare |
$57.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.22
|
| Rate for Payer: Railroad Medicare Medicare |
$57.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.76
|
| Rate for Payer: UHC Core |
$193.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.88
|
| Rate for Payer: UHC Medicare Advantage |
$59.62
|
| Rate for Payer: VA VA |
$57.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.66
|
|
