|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,851.87
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$361.89 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna Medicare |
$481.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$578.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$578.71
|
| Rate for Payer: BCBS Complete |
$379.99
|
| Rate for Payer: BCBS MAPPO |
$462.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.83
|
| Rate for Payer: BCN Commercial |
$1,439.83
|
| Rate for Payer: BCN Medicare Advantage |
$462.97
|
| Rate for Payer: Cash Price |
$1,481.50
|
| 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: Health Alliance Plan Medicare Advantage |
$462.97
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.90
|
| Rate for Payer: Mclaren Medicaid |
$361.89
|
| Rate for Payer: Meridian Medicaid |
$379.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$486.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$532.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PACE Senior Care Partners |
$439.82
|
| Rate for Payer: PACE SWMI |
$462.97
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: PHP Medicare Advantage |
$462.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.89
|
| 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 Medicare |
$462.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.46
|
| Rate for Payer: Railroad Medicare Medicare |
$462.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,629.65
|
| Rate for Payer: UHC Core |
$1,546.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.97
|
| Rate for Payer: UHC Medicare Advantage |
$476.86
|
| Rate for Payer: VA VA |
$462.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.90
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,851.87
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$439.82 |
| Max. Negotiated Rate |
$1,666.68 |
| Rate for Payer: Aetna Commercial |
$1,574.09
|
| Rate for Payer: Aetna Medicare |
$481.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$578.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$578.71
|
| Rate for Payer: BCBS Complete |
$551.50
|
| Rate for Payer: BCBS MAPPO |
$462.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,439.83
|
| Rate for Payer: BCN Commercial |
$1,439.83
|
| Rate for Payer: BCN Medicare Advantage |
$462.97
|
| Rate for Payer: Cash Price |
$1,481.50
|
| 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: Health Alliance Plan Medicare Advantage |
$462.97
|
| Rate for Payer: Healthscope Commercial |
$1,666.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,388.90
|
| Rate for Payer: Mclaren Medicaid |
$525.24
|
| Rate for Payer: Meridian Medicaid |
$551.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$486.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$532.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,574.09
|
| Rate for Payer: PACE Senior Care Partners |
$439.82
|
| Rate for Payer: PACE SWMI |
$462.97
|
| Rate for Payer: PHP Commercial |
$1,574.09
|
| Rate for Payer: PHP Medicare Advantage |
$462.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.24
|
| 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 Medicare |
$462.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.46
|
| Rate for Payer: Railroad Medicare Medicare |
$462.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,629.65
|
| Rate for Payer: UHC Core |
$1,546.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.97
|
| Rate for Payer: UHC Medicare Advantage |
$476.86
|
| Rate for Payer: VA VA |
$462.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,388.90
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,851.87
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| 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
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.92
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCN Commercial |
$22.21
|
| Rate for Payer: BCN Medicare Advantage |
$7.14
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.14
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Mclaren Medicaid |
$3.16
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PACE Senior Care Partners |
$6.78
|
| Rate for Payer: PACE SWMI |
$7.14
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$7.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.85
|
| Rate for Payer: Priority Health Medicare |
$7.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.42
|
| Rate for Payer: Railroad Medicare Medicare |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.14
|
| Rate for Payer: UHC Medicare Advantage |
$7.35
|
| Rate for Payer: VA VA |
$7.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$49.46
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.20
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.32
|
| Rate for Payer: UHC Core |
$53.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.00
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$54.40
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.00
|
| Rate for Payer: BCBS Complete |
$7.53
|
| Rate for Payer: BCBS MAPPO |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$49.76
|
| Rate for Payer: BCN Commercial |
$49.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.00
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$55.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$57.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.00
|
| Rate for Payer: Mclaren Medicaid |
$7.17
|
| Rate for Payer: Meridian Medicaid |
$7.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.40
|
| Rate for Payer: PACE Senior Care Partners |
$15.20
|
| Rate for Payer: PACE SWMI |
$16.00
|
| Rate for Payer: PHP Commercial |
$54.40
|
| Rate for Payer: PHP Medicare Advantage |
$16.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.68
|
| Rate for Payer: Priority Health Medicare |
$16.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.03
|
| Rate for Payer: Railroad Medicare Medicare |
$16.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.32
|
| Rate for Payer: UHC Core |
$53.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.00
|
| Rate for Payer: UHC Medicare Advantage |
$16.48
|
| Rate for Payer: VA VA |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.00
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$122.40
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.38 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.25
|
| Rate for Payer: BCBS Complete |
$19.30
|
| Rate for Payer: BCBS MAPPO |
$30.60
|
| Rate for Payer: BCBS Trust/PPO |
$95.17
|
| Rate for Payer: BCN Commercial |
$95.17
|
| Rate for Payer: BCN Medicare Advantage |
$30.60
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.60
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.80
|
| Rate for Payer: Mclaren Medicaid |
$18.38
|
| Rate for Payer: Meridian Medicaid |
$19.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PACE Senior Care Partners |
$29.07
|
| Rate for Payer: PACE SWMI |
$30.60
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: PHP Medicare Advantage |
$30.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.49
|
| Rate for Payer: Priority Health Medicare |
$30.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.65
|
| Rate for Payer: Railroad Medicare Medicare |
$30.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.71
|
| Rate for Payer: UHC Core |
$102.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.60
|
| Rate for Payer: UHC Medicare Advantage |
$31.52
|
| Rate for Payer: VA VA |
$30.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.80
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$122.40
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.65 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Aetna Commercial |
$104.04
|
| Rate for Payer: BCBS Trust/PPO |
$94.59
|
| Rate for Payer: BCN Commercial |
$94.59
|
| Rate for Payer: Cash Price |
$97.92
|
| Rate for Payer: Cofinity Commercial |
$105.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.92
|
| Rate for Payer: Healthscope Commercial |
$110.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.04
|
| Rate for Payer: PHP Commercial |
$104.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.71
|
| Rate for Payer: UHC Core |
$102.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.80
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: BCBS Trust/PPO |
$81.45
|
| Rate for Payer: BCN Commercial |
$81.45
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$27.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.94
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$81.95
|
| Rate for Payer: BCN Commercial |
$81.95
|
| Rate for Payer: BCN Medicare Advantage |
$26.35
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cash Price |
$84.32
|
| Rate for Payer: Cofinity Commercial |
$90.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.35
|
| Rate for Payer: Healthscope Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.05
|
| Rate for Payer: Mclaren Medicaid |
$10.75
|
| Rate for Payer: Meridian Medicaid |
$11.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.59
|
| Rate for Payer: PACE Senior Care Partners |
$25.03
|
| Rate for Payer: PACE SWMI |
$26.35
|
| Rate for Payer: PHP Commercial |
$89.59
|
| Rate for Payer: PHP Medicare Advantage |
$26.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.70
|
| Rate for Payer: Priority Health Medicare |
$26.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.28
|
| Rate for Payer: Railroad Medicare Medicare |
$26.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.75
|
| Rate for Payer: UHC Core |
$88.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.35
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: VA VA |
$26.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.05
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$10.75
|
| Rate for Payer: Meridian Medicaid |
$11.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$35.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.53
|
| Rate for Payer: BCN Commercial |
$31.53
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$36.72 |
| Rate for Payer: Aetna Commercial |
$34.68
|
| Rate for Payer: Aetna Medicare |
$10.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.75
|
| Rate for Payer: BCBS Complete |
$10.27
|
| Rate for Payer: BCBS MAPPO |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$31.72
|
| Rate for Payer: BCN Medicare Advantage |
$10.20
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cash Price |
$32.64
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.20
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.60
|
| Rate for Payer: Mclaren Medicaid |
$9.78
|
| Rate for Payer: Meridian Medicaid |
$10.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.68
|
| Rate for Payer: PACE Senior Care Partners |
$9.69
|
| Rate for Payer: PACE SWMI |
$10.20
|
| Rate for Payer: PHP Commercial |
$34.68
|
| Rate for Payer: PHP Medicare Advantage |
$10.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.90
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.20
|
| Rate for Payer: UHC Medicare Advantage |
$10.51
|
| Rate for Payer: VA VA |
$10.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.60
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$88.02
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$74.82
|
| Rate for Payer: Aetna Medicare |
$22.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.51
|
| Rate for Payer: BCBS Complete |
$35.21
|
| Rate for Payer: BCBS MAPPO |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$68.44
|
| Rate for Payer: BCN Commercial |
$68.44
|
| Rate for Payer: BCN Medicare Advantage |
$22.00
|
| Rate for Payer: Cash Price |
$70.42
|
| Rate for Payer: Cofinity Commercial |
$75.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$79.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.82
|
| Rate for Payer: PACE Senior Care Partners |
$20.90
|
| Rate for Payer: PACE SWMI |
$22.00
|
| Rate for Payer: PHP Commercial |
$74.82
|
| Rate for Payer: PHP Medicare Advantage |
$22.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.58
|
| Rate for Payer: Priority Health Medicare |
$22.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.68
|
| Rate for Payer: Railroad Medicare Medicare |
$22.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.46
|
| Rate for Payer: UHC Core |
$73.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.00
|
| Rate for Payer: UHC Medicare Advantage |
$22.67
|
| Rate for Payer: VA VA |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.02
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$88.02
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$79.22 |
| Rate for Payer: Aetna Commercial |
$74.82
|
| Rate for Payer: BCBS Trust/PPO |
$68.02
|
| Rate for Payer: BCN Commercial |
$68.02
|
| Rate for Payer: Cash Price |
$70.42
|
| Rate for Payer: Cofinity Commercial |
$75.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.42
|
| Rate for Payer: Healthscope Commercial |
$79.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.82
|
| Rate for Payer: PHP Commercial |
$74.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.46
|
| Rate for Payer: UHC Core |
$73.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.02
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$112.20
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.65 |
| 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 |
$44.88
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.24
|
| 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: 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: Meridian Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.37
|
| 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 Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.61
|
| Rate for Payer: Priority Health Medicare |
$28.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.43
|
| 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 Medicare Advantage |
$28.89
|
| Rate for Payer: VA VA |
$28.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.15
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$112.20
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$100.98 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: BCBS Trust/PPO |
$86.71
|
| 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 Multiplan/Beech St/PHCS |
$95.37
|
| Rate for Payer: PHP Commercial |
$95.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.43
|
| 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 TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,748.90
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,676.55 |
| Max. Negotiated Rate |
$2,474.01 |
| Rate for Payer: Aetna Commercial |
$2,336.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,124.35
|
| Rate for Payer: BCN Commercial |
$2,124.35
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,364.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,199.12
|
| Rate for Payer: Healthscope Commercial |
$2,474.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,061.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,336.56
|
| Rate for Payer: PHP Commercial |
$2,336.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,924.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,391.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,676.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,419.03
|
| Rate for Payer: UHC Core |
$2,295.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,061.68
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,748.90
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$652.86 |
| Max. Negotiated Rate |
$5,851.75 |
| Rate for Payer: Aetna Commercial |
$2,336.56
|
| Rate for Payer: Aetna Medicare |
$714.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$859.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$859.03
|
| Rate for Payer: BCBS Complete |
$5,851.75
|
| Rate for Payer: BCBS MAPPO |
$687.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,137.27
|
| Rate for Payer: BCN Commercial |
$2,137.27
|
| Rate for Payer: BCN Medicare Advantage |
$687.22
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cash Price |
$2,199.12
|
| Rate for Payer: Cofinity Commercial |
$2,364.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,199.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.22
|
| Rate for Payer: Healthscope Commercial |
$2,474.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,061.68
|
| Rate for Payer: Mclaren Medicaid |
$5,573.10
|
| Rate for Payer: Meridian Medicaid |
$5,851.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$790.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,336.56
|
| Rate for Payer: PACE Senior Care Partners |
$652.86
|
| Rate for Payer: PACE SWMI |
$687.22
|
| Rate for Payer: PHP Commercial |
$2,336.56
|
| Rate for Payer: PHP Medicare Advantage |
$687.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,573.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,924.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,391.54
|
| Rate for Payer: Priority Health Medicare |
$687.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,676.55
|
| Rate for Payer: Railroad Medicare Medicare |
$687.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,419.03
|
| Rate for Payer: UHC Core |
$2,295.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.22
|
| Rate for Payer: UHC Medicare Advantage |
$707.84
|
| Rate for Payer: VA VA |
$687.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,061.68
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$674.79
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.26 |
| Max. Negotiated Rate |
$607.31 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: Aetna Medicare |
$175.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$210.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$210.87
|
| Rate for Payer: BCBS Complete |
$269.92
|
| Rate for Payer: BCBS MAPPO |
$168.70
|
| Rate for Payer: BCBS Trust/PPO |
$524.65
|
| Rate for Payer: BCN Commercial |
$524.65
|
| Rate for Payer: BCN Medicare Advantage |
$168.70
|
| Rate for Payer: Cash Price |
$539.83
|
| Rate for Payer: Cofinity Commercial |
$580.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.70
|
| Rate for Payer: Healthscope Commercial |
$607.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.57
|
| Rate for Payer: PACE Senior Care Partners |
$160.26
|
| Rate for Payer: PACE SWMI |
$168.70
|
| Rate for Payer: PHP Commercial |
$573.57
|
| Rate for Payer: PHP Medicare Advantage |
$168.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.07
|
| Rate for Payer: Priority Health Medicare |
$168.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.55
|
| Rate for Payer: Railroad Medicare Medicare |
$168.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.82
|
| Rate for Payer: UHC Core |
$563.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.70
|
| Rate for Payer: UHC Medicare Advantage |
$173.76
|
| Rate for Payer: VA VA |
$168.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.09
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
IP
|
$674.79
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.55 |
| Max. Negotiated Rate |
$607.31 |
| Rate for Payer: Aetna Commercial |
$573.57
|
| Rate for Payer: BCBS Trust/PPO |
$521.48
|
| Rate for Payer: BCN Commercial |
$521.48
|
| Rate for Payer: Cash Price |
$539.83
|
| Rate for Payer: Cofinity Commercial |
$580.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$539.83
|
| Rate for Payer: Healthscope Commercial |
$607.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$506.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$573.57
|
| Rate for Payer: PHP Commercial |
$573.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$587.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$411.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.82
|
| Rate for Payer: UHC Core |
$563.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$506.09
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
IP
|
$104.04
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: BCBS Trust/PPO |
$80.40
|
| Rate for Payer: BCN Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
|
HC TE NEURO EA 15 MIN
|
Facility
|
OP
|
$104.04
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
42000021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$93.64 |
| Rate for Payer: Aetna Commercial |
$88.43
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.51
|
| Rate for Payer: BCBS Complete |
$41.62
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$80.89
|
| Rate for Payer: BCN Commercial |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cofinity Commercial |
$89.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Healthscope Commercial |
$93.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.43
|
| Rate for Payer: PACE Senior Care Partners |
$24.71
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$88.43
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.51
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.45
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.56
|
| Rate for Payer: UHC Core |
$86.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.01
|
| Rate for Payer: UHC Medicare Advantage |
$26.79
|
| Rate for Payer: VA VA |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.03
|
|
