|
HC TC 99M PYROPHOSPHATE PER STUDY UP TO 25 MILLICURIES
|
Facility
|
IP
|
$231.54
|
|
|
Service Code
|
CPT A9538
|
| Hospital Charge Code |
34300037
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna Commercial |
$196.81
|
| Rate for Payer: BCBS Trust/PPO |
$178.93
|
| Rate for Payer: BCN Commercial |
$178.93
|
| 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: Healthscope Commercial |
$208.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.81
|
| Rate for Payer: PHP Commercial |
$196.81
|
| 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 Narrow/Tiered Network |
$141.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.76
|
| Rate for Payer: UHC Core |
$193.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.66
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
OP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: Aetna Medicare |
$63.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.68
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS MAPPO |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$190.78
|
| Rate for Payer: BCN Commercial |
$190.78
|
| Rate for Payer: BCN Medicare Advantage |
$61.34
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PACE Senior Care Partners |
$58.28
|
| Rate for Payer: PACE SWMI |
$61.34
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: PHP Medicare Advantage |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.48
|
| Rate for Payer: Priority Health Medicare |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.66
|
| Rate for Payer: Railroad Medicare Medicare |
$61.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$204.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.34
|
| Rate for Payer: UHC Medicare Advantage |
$63.19
|
| Rate for Payer: VA VA |
$61.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC TC 99M SULFUR COLLOID PER STUDY
|
Facility
|
IP
|
$245.38
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
34300020
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$149.66 |
| Max. Negotiated Rate |
$220.84 |
| Rate for Payer: Aetna Commercial |
$208.57
|
| Rate for Payer: BCBS Trust/PPO |
$189.63
|
| Rate for Payer: BCN Commercial |
$189.63
|
| Rate for Payer: Cash Price |
$196.30
|
| Rate for Payer: Cofinity Commercial |
$211.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.30
|
| Rate for Payer: Healthscope Commercial |
$220.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.57
|
| Rate for Payer: PHP Commercial |
$208.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.93
|
| Rate for Payer: UHC Core |
$204.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.04
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.94
|
| Rate for Payer: BCBS Complete |
$16.60
|
| Rate for Payer: BCBS MAPPO |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.21
|
| Rate for Payer: BCN Commercial |
$27.21
|
| Rate for Payer: BCN Medicare Advantage |
$8.75
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.75
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Mclaren Medicaid |
$15.81
|
| Rate for Payer: Meridian Medicaid |
$16.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: PHP Medicare Advantage |
$8.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.45
|
| Rate for Payer: Priority Health Medicare |
$8.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.75
|
| Rate for Payer: UHC Medicare Advantage |
$9.01
|
| Rate for Payer: VA VA |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC T CELL ACUTE LYMPH LEUK
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$21.35 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$29.75
|
| Rate for Payer: BCBS Trust/PPO |
$27.05
|
| Rate for Payer: BCN Commercial |
$27.05
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.75
|
| Rate for Payer: PHP Commercial |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.80
|
| Rate for Payer: UHC Core |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.25
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
IP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: BCBS Trust/PPO |
$89.86
|
| Rate for Payer: BCN Commercial |
$89.86
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.33
|
| Rate for Payer: UHC Core |
$97.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT1
|
Facility
|
OP
|
$116.28
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000040
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.62 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$98.84
|
| Rate for Payer: Aetna Medicare |
$30.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.34
|
| Rate for Payer: BCBS Complete |
$39.67
|
| Rate for Payer: BCBS MAPPO |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCN Commercial |
$90.41
|
| Rate for Payer: BCN Medicare Advantage |
$29.07
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cash Price |
$93.02
|
| Rate for Payer: Cofinity Commercial |
$100.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.07
|
| Rate for Payer: Healthscope Commercial |
$104.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.21
|
| Rate for Payer: Mclaren Medicaid |
$37.78
|
| Rate for Payer: Meridian Medicaid |
$39.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.84
|
| Rate for Payer: PACE Senior Care Partners |
$27.62
|
| Rate for Payer: PACE SWMI |
$29.07
|
| Rate for Payer: PHP Commercial |
$98.84
|
| Rate for Payer: PHP Medicare Advantage |
$29.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.16
|
| Rate for Payer: Priority Health Medicare |
$29.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.92
|
| Rate for Payer: Railroad Medicare Medicare |
$29.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.33
|
| Rate for Payer: UHC Core |
$97.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.07
|
| Rate for Payer: UHC Medicare Advantage |
$29.94
|
| Rate for Payer: VA VA |
$29.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.21
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
OP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.19
|
| Rate for Payer: BCBS Complete |
$16.60
|
| Rate for Payer: BCBS MAPPO |
$25.76
|
| Rate for Payer: BCBS Trust/PPO |
$80.10
|
| Rate for Payer: BCN Commercial |
$80.10
|
| Rate for Payer: BCN Medicare Advantage |
$25.76
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.76
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Mclaren Medicaid |
$15.81
|
| Rate for Payer: Meridian Medicaid |
$16.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PACE Senior Care Partners |
$24.47
|
| Rate for Payer: PACE SWMI |
$25.76
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: PHP Medicare Advantage |
$25.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.63
|
| Rate for Payer: Priority Health Medicare |
$25.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.83
|
| Rate for Payer: Railroad Medicare Medicare |
$25.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.66
|
| Rate for Payer: UHC Core |
$86.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.76
|
| Rate for Payer: UHC Medicare Advantage |
$26.53
|
| Rate for Payer: VA VA |
$25.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
HC T CELL ACUTE LYMPH LEUK CMPT2
|
Facility
|
IP
|
$103.02
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
31000029
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.83 |
| Max. Negotiated Rate |
$92.72 |
| Rate for Payer: Aetna Commercial |
$87.57
|
| Rate for Payer: BCBS Trust/PPO |
$79.61
|
| Rate for Payer: BCN Commercial |
$79.61
|
| Rate for Payer: Cash Price |
$82.42
|
| Rate for Payer: Cofinity Commercial |
$88.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.42
|
| Rate for Payer: Healthscope Commercial |
$92.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.57
|
| Rate for Payer: PHP Commercial |
$87.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.66
|
| Rate for Payer: UHC Core |
$86.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.26
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.94
|
| Rate for Payer: BCBS Complete |
$39.67
|
| Rate for Payer: BCBS MAPPO |
$20.75
|
| Rate for Payer: BCBS Trust/PPO |
$64.53
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: BCN Medicare Advantage |
$20.75
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Mclaren Medicaid |
$37.78
|
| Rate for Payer: Meridian Medicaid |
$39.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PACE Senior Care Partners |
$19.71
|
| Rate for Payer: PACE SWMI |
$20.75
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: PHP Medicare Advantage |
$20.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.21
|
| Rate for Payer: Priority Health Medicare |
$20.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.62
|
| Rate for Payer: Railroad Medicare Medicare |
$20.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.04
|
| Rate for Payer: UHC Core |
$69.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.75
|
| Rate for Payer: UHC Medicare Advantage |
$21.37
|
| Rate for Payer: VA VA |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC T CELL ACUTE LYMPH LEUK FISH
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000039
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$70.55
|
| Rate for Payer: BCBS Trust/PPO |
$64.14
|
| Rate for Payer: BCN Commercial |
$64.14
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$71.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.40
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.55
|
| Rate for Payer: PHP Commercial |
$70.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.04
|
| Rate for Payer: UHC Core |
$69.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.25
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
OP
|
$74.23
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$66.81 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.20
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$57.71
|
| Rate for Payer: BCN Commercial |
$57.71
|
| Rate for Payer: BCN Medicare Advantage |
$18.56
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$66.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.67
|
| Rate for Payer: Mclaren Medicaid |
$34.67
|
| Rate for Payer: Meridian Medicaid |
$36.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.10
|
| Rate for Payer: PACE Senior Care Partners |
$17.63
|
| Rate for Payer: PACE SWMI |
$18.56
|
| Rate for Payer: PHP Commercial |
$63.10
|
| Rate for Payer: PHP Medicare Advantage |
$18.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.58
|
| Rate for Payer: Priority Health Medicare |
$18.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.27
|
| Rate for Payer: Railroad Medicare Medicare |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.32
|
| Rate for Payer: UHC Core |
$61.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.56
|
| Rate for Payer: UHC Medicare Advantage |
$19.11
|
| Rate for Payer: VA VA |
$18.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.67
|
|
|
HC T CELLS CD4 CD8 COUNT
|
Facility
|
IP
|
$74.23
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
30200207
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$66.81 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: BCBS Trust/PPO |
$57.36
|
| Rate for Payer: BCN Commercial |
$57.36
|
| Rate for Payer: Cash Price |
$59.38
|
| Rate for Payer: Cofinity Commercial |
$63.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.38
|
| Rate for Payer: Healthscope Commercial |
$66.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.10
|
| Rate for Payer: PHP Commercial |
$63.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.32
|
| Rate for Payer: UHC Core |
$61.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.67
|
|
|
HC T CELL TOTAL
|
Facility
|
IP
|
$59.60
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$53.64 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: BCBS Trust/PPO |
$46.06
|
| Rate for Payer: BCN Commercial |
$46.06
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$53.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.66
|
| Rate for Payer: PHP Commercial |
$50.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.45
|
| Rate for Payer: UHC Core |
$49.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.70
|
|
|
HC T CELL TOTAL
|
Facility
|
OP
|
$59.60
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
30200205
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$53.64 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$29.24
|
| Rate for Payer: BCBS MAPPO |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$46.34
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: BCN Medicare Advantage |
$14.90
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$53.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.70
|
| Rate for Payer: Mclaren Medicaid |
$27.84
|
| Rate for Payer: Meridian Medicaid |
$29.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.66
|
| Rate for Payer: PACE Senior Care Partners |
$14.16
|
| Rate for Payer: PACE SWMI |
$14.90
|
| Rate for Payer: PHP Commercial |
$50.66
|
| Rate for Payer: PHP Medicare Advantage |
$14.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.85
|
| Rate for Payer: Priority Health Medicare |
$14.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.35
|
| Rate for Payer: Railroad Medicare Medicare |
$14.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.45
|
| Rate for Payer: UHC Core |
$49.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.90
|
| Rate for Payer: UHC Medicare Advantage |
$15.35
|
| Rate for Payer: VA VA |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.70
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
OP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$685.87 |
| Max. Negotiated Rate |
$3,150.48 |
| Rate for Payer: Aetna Commercial |
$2,975.45
|
| Rate for Payer: Aetna Medicare |
$910.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,093.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,093.92
|
| Rate for Payer: BCBS Complete |
$720.16
|
| Rate for Payer: BCBS MAPPO |
$875.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,721.66
|
| Rate for Payer: BCN Commercial |
$2,721.66
|
| Rate for Payer: BCN Medicare Advantage |
$875.13
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$3,010.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.13
|
| Rate for Payer: Healthscope Commercial |
$3,150.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.40
|
| Rate for Payer: Mclaren Medicaid |
$685.87
|
| Rate for Payer: Meridian Medicaid |
$720.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$918.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,006.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: PACE Senior Care Partners |
$831.38
|
| Rate for Payer: PACE SWMI |
$875.13
|
| Rate for Payer: PHP Commercial |
$2,975.45
|
| Rate for Payer: PHP Medicare Advantage |
$875.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,045.46
|
| Rate for Payer: Priority Health Medicare |
$875.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,134.97
|
| Rate for Payer: Railroad Medicare Medicare |
$875.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,080.47
|
| Rate for Payer: UHC Core |
$2,922.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.13
|
| Rate for Payer: UHC Medicare Advantage |
$901.39
|
| Rate for Payer: VA VA |
$875.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.40
|
|
|
HC TCMEPS UPPER/LOWER EXT. STIM
|
Facility
|
IP
|
$3,500.53
|
|
|
Service Code
|
CPT 95939
|
| Hospital Charge Code |
92200026
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2,134.97 |
| Max. Negotiated Rate |
$3,150.48 |
| Rate for Payer: Aetna Commercial |
$2,975.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,705.21
|
| Rate for Payer: BCN Commercial |
$2,705.21
|
| Rate for Payer: Cash Price |
$2,800.42
|
| Rate for Payer: Cofinity Commercial |
$3,010.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,800.42
|
| Rate for Payer: Healthscope Commercial |
$3,150.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,625.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,975.45
|
| Rate for Payer: PHP Commercial |
$2,975.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,045.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,134.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,080.47
|
| Rate for Payer: UHC Core |
$2,922.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,625.40
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
IP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$246.16 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: BCBS Trust/PPO |
$311.91
|
| Rate for Payer: BCN Commercial |
$311.91
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.89
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.18
|
| Rate for Payer: UHC Core |
$337.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.71
|
|
|
HC TCOM INITIAL DAY
|
Facility
|
OP
|
$403.61
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000011
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$95.86 |
| Max. Negotiated Rate |
$363.25 |
| Rate for Payer: Aetna Commercial |
$343.07
|
| Rate for Payer: Aetna Medicare |
$104.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.13
|
| Rate for Payer: BCBS Complete |
$161.44
|
| Rate for Payer: BCBS MAPPO |
$100.90
|
| Rate for Payer: BCBS Trust/PPO |
$313.81
|
| Rate for Payer: BCN Commercial |
$313.81
|
| Rate for Payer: BCN Medicare Advantage |
$100.90
|
| Rate for Payer: Cash Price |
$322.89
|
| Rate for Payer: Cofinity Commercial |
$347.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.90
|
| Rate for Payer: Healthscope Commercial |
$363.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$343.07
|
| Rate for Payer: PACE Senior Care Partners |
$95.86
|
| Rate for Payer: PACE SWMI |
$100.90
|
| Rate for Payer: PHP Commercial |
$343.07
|
| Rate for Payer: PHP Medicare Advantage |
$100.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.14
|
| Rate for Payer: Priority Health Medicare |
$100.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.16
|
| Rate for Payer: Railroad Medicare Medicare |
$100.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.18
|
| Rate for Payer: UHC Core |
$337.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.90
|
| Rate for Payer: UHC Medicare Advantage |
$103.93
|
| Rate for Payer: VA VA |
$100.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.71
|
|
|
HC TCOM SUBS DAY
|
Facility
|
OP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$73.61 |
| Max. Negotiated Rate |
$278.95 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: Aetna Medicare |
$80.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.86
|
| Rate for Payer: BCBS Complete |
$123.98
|
| Rate for Payer: BCBS MAPPO |
$77.48
|
| Rate for Payer: BCBS Trust/PPO |
$240.98
|
| Rate for Payer: BCN Commercial |
$240.98
|
| Rate for Payer: BCN Medicare Advantage |
$77.48
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$266.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.48
|
| Rate for Payer: Healthscope Commercial |
$278.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: PACE Senior Care Partners |
$73.61
|
| Rate for Payer: PACE SWMI |
$77.48
|
| Rate for Payer: PHP Commercial |
$263.45
|
| Rate for Payer: PHP Medicare Advantage |
$77.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.65
|
| Rate for Payer: Priority Health Medicare |
$77.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.03
|
| Rate for Payer: Railroad Medicare Medicare |
$77.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.75
|
| Rate for Payer: UHC Core |
$258.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.48
|
| Rate for Payer: UHC Medicare Advantage |
$79.81
|
| Rate for Payer: VA VA |
$77.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.46
|
|
|
HC TCOM SUBS DAY
|
Facility
|
IP
|
$309.94
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
46000010
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$189.03 |
| Max. Negotiated Rate |
$278.95 |
| Rate for Payer: Aetna Commercial |
$263.45
|
| Rate for Payer: BCBS Trust/PPO |
$239.52
|
| Rate for Payer: BCN Commercial |
$239.52
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Cofinity Commercial |
$266.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.95
|
| Rate for Payer: Healthscope Commercial |
$278.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.45
|
| Rate for Payer: PHP Commercial |
$263.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.75
|
| Rate for Payer: UHC Core |
$258.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.46
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$31.90 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: Aetna Medicare |
$34.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.98
|
| Rate for Payer: BCBS Complete |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$33.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.44
|
| Rate for Payer: BCN Commercial |
$104.44
|
| Rate for Payer: BCN Medicare Advantage |
$33.58
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.58
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PACE Senior Care Partners |
$31.90
|
| Rate for Payer: PACE SWMI |
$33.58
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: PHP Medicare Advantage |
$33.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: Railroad Medicare Medicare |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.58
|
| Rate for Payer: UHC Medicare Advantage |
$34.59
|
| Rate for Payer: VA VA |
$33.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC TCU OBSERVATION PER HOUR
|
Facility
|
IP
|
$134.33
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Commercial |
$114.18
|
| Rate for Payer: BCBS Trust/PPO |
$103.81
|
| Rate for Payer: BCN Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$107.46
|
| Rate for Payer: Cofinity Commercial |
$115.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.46
|
| Rate for Payer: Healthscope Commercial |
$120.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.18
|
| Rate for Payer: PHP Commercial |
$114.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.21
|
| Rate for Payer: UHC Core |
$112.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.75
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$4,970.09
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$1,577.95 |
| Max. Negotiated Rate |
$166,100.00 |
| Rate for Payer: Aetna Commercial |
$4,224.58
|
| Rate for Payer: Aetna Medicare |
$1,727.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,076.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,076.25
|
| Rate for Payer: BCBS MAPPO |
$1,661.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,840.89
|
| Rate for Payer: BCN Commercial |
$3,840.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.00
|
| Rate for Payer: Cash Price |
$3,976.07
|
| Rate for Payer: Cash Price |
$3,976.07
|
| Rate for Payer: Cash Price |
$3,976.07
|
| Rate for Payer: Cofinity Commercial |
$4,274.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,976.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.00
|
| Rate for Payer: Healthscope Commercial |
$4,473.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,727.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,744.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,910.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,224.58
|
| Rate for Payer: PACE Senior Care Partners |
$1,577.95
|
| Rate for Payer: PACE SWMI |
$1,661.00
|
| Rate for Payer: PHP Commercial |
$4,224.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,479.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,323.98
|
| Rate for Payer: Priority Health Medicare |
$1,661.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,031.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,661.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,373.68
|
| Rate for Payer: UHC Core |
$4,150.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$166,100.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,710.83
|
| Rate for Payer: VA VA |
$1,661.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,727.57
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,129.46 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,431.13
|
| Rate for Payer: BCN Commercial |
$1,431.13
|
| Rate for Payer: Cash Price |
$1,481.50
|
| Rate for Payer: Cofinity Commercial |
$1,592.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,481.50
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,611.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,629.65
|
| Rate for Payer: UHC Core |
$1,546.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.90
|
|
