|
HC MUCORE RACEMOSUS IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200093
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MUGWORT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MUGWORT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200094
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MULBERRY IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MULBERRY IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200095
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: BCBS Trust/PPO |
$5.45
|
| Rate for Payer: BCN Commercial |
$5.16
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: Priority Health HMO/PPO |
$5.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
HCPCS A9577
|
| Hospital Charge Code |
63600016
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Aetna Commercial |
$5.68
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.09
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS MAPPO |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: BCN Commercial |
$5.19
|
| Rate for Payer: BCN Medicare Advantage |
$1.67
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.59
|
| Rate for Payer: PACE SWMI |
$1.67
|
| Rate for Payer: PHP Commercial |
$5.68
|
| Rate for Payer: PHP Medicare Advantage |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: Priority Health HMO/PPO |
$5.81
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.88
|
| Rate for Payer: UHC Core |
$5.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.67
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UHC Medicare Advantage |
$1.67
|
| Rate for Payer: VA VA |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.01
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
OP
|
$641.58
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$577.42 |
| Rate for Payer: Aetna Commercial |
$545.34
|
| Rate for Payer: Aetna Medicare |
$166.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.49
|
| Rate for Payer: BCBS Complete |
$117.37
|
| Rate for Payer: BCBS MAPPO |
$160.40
|
| Rate for Payer: BCBS Trust/PPO |
$527.44
|
| Rate for Payer: BCN Commercial |
$498.83
|
| Rate for Payer: BCN Medicare Advantage |
$160.40
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cofinity Commercial |
$551.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.40
|
| Rate for Payer: Healthscope Commercial |
$577.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.18
|
| Rate for Payer: Mclaren Medicaid |
$111.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.41
|
| Rate for Payer: Meridian Medicaid |
$117.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.34
|
| Rate for Payer: Nomi Health Commercial |
$526.10
|
| Rate for Payer: PACE Senior Care Partners |
$152.38
|
| Rate for Payer: PACE SWMI |
$160.40
|
| Rate for Payer: PHP Commercial |
$545.34
|
| Rate for Payer: PHP Medicare Advantage |
$160.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.03
|
| Rate for Payer: Priority Health HMO/PPO |
$558.17
|
| Rate for Payer: Priority Health Medicare |
$162.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.86
|
| Rate for Payer: Railroad Medicare Medicare |
$160.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.59
|
| Rate for Payer: UHC Core |
$535.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.40
|
| Rate for Payer: UHC Exchange |
$160.40
|
| Rate for Payer: UHC Medicare Advantage |
$160.40
|
| Rate for Payer: UHCCP Medicaid |
$111.78
|
| Rate for Payer: VA VA |
$160.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.18
|
|
|
HC MULTILAYER COMP DSG BK
|
Facility
|
IP
|
$641.58
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100020
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$417.03 |
| Max. Negotiated Rate |
$577.42 |
| Rate for Payer: Aetna Commercial |
$545.34
|
| Rate for Payer: BCBS Trust/PPO |
$523.72
|
| Rate for Payer: BCN Commercial |
$495.81
|
| Rate for Payer: Cash Price |
$513.26
|
| Rate for Payer: Cofinity Commercial |
$551.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$513.26
|
| Rate for Payer: Healthscope Commercial |
$577.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$481.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$545.34
|
| Rate for Payer: Nomi Health Commercial |
$526.10
|
| Rate for Payer: PHP Commercial |
$545.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.03
|
| Rate for Payer: Priority Health HMO/PPO |
$558.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.59
|
| Rate for Payer: UHC Core |
$535.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$481.18
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
OP
|
$853.13
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$202.62 |
| Max. Negotiated Rate |
$767.82 |
| Rate for Payer: Aetna Commercial |
$725.16
|
| Rate for Payer: Aetna Medicare |
$221.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$266.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$266.60
|
| Rate for Payer: BCBS Complete |
$272.30
|
| Rate for Payer: BCBS MAPPO |
$213.28
|
| Rate for Payer: BCBS Trust/PPO |
$701.36
|
| Rate for Payer: BCN Commercial |
$663.31
|
| Rate for Payer: BCN Medicare Advantage |
$213.28
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$733.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.28
|
| Rate for Payer: Healthscope Commercial |
$767.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.85
|
| Rate for Payer: Mclaren Medicaid |
$259.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.95
|
| Rate for Payer: Meridian Medicaid |
$272.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.16
|
| Rate for Payer: Nomi Health Commercial |
$699.57
|
| Rate for Payer: PACE Senior Care Partners |
$202.62
|
| Rate for Payer: PACE SWMI |
$213.28
|
| Rate for Payer: PHP Commercial |
$725.16
|
| Rate for Payer: PHP Medicare Advantage |
$213.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.53
|
| Rate for Payer: Priority Health HMO/PPO |
$742.22
|
| Rate for Payer: Priority Health Medicare |
$215.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$571.60
|
| Rate for Payer: Railroad Medicare Medicare |
$213.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.75
|
| Rate for Payer: UHC Core |
$712.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.28
|
| Rate for Payer: UHC Exchange |
$213.28
|
| Rate for Payer: UHC Medicare Advantage |
$213.28
|
| Rate for Payer: UHCCP Medicaid |
$259.32
|
| Rate for Payer: VA VA |
$213.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.85
|
|
|
HC MULTILEAF COLLIMATOR
|
Facility
|
IP
|
$853.13
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
33300016
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$554.53 |
| Max. Negotiated Rate |
$767.82 |
| Rate for Payer: Aetna Commercial |
$725.16
|
| Rate for Payer: BCBS Trust/PPO |
$696.41
|
| Rate for Payer: BCN Commercial |
$659.30
|
| Rate for Payer: Cash Price |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$733.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.50
|
| Rate for Payer: Healthscope Commercial |
$767.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$639.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$725.16
|
| Rate for Payer: Nomi Health Commercial |
$699.57
|
| Rate for Payer: PHP Commercial |
$725.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$554.53
|
| Rate for Payer: Priority Health HMO/PPO |
$742.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$571.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.75
|
| Rate for Payer: UHC Core |
$712.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$639.85
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
IP
|
$122.48
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.61 |
| Max. Negotiated Rate |
$110.23 |
| Rate for Payer: Aetna Commercial |
$104.11
|
| Rate for Payer: BCBS Trust/PPO |
$99.98
|
| Rate for Payer: BCN Commercial |
$94.65
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cofinity Commercial |
$105.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.98
|
| Rate for Payer: Healthscope Commercial |
$110.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.11
|
| Rate for Payer: Nomi Health Commercial |
$100.43
|
| Rate for Payer: PHP Commercial |
$104.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.61
|
| Rate for Payer: Priority Health HMO/PPO |
$106.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.78
|
| Rate for Payer: UHC Core |
$102.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.86
|
|
|
HC MULTIPLE SCLEROSIS PROFILE
|
Facility
|
OP
|
$122.48
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100744
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$110.23 |
| Rate for Payer: Aetna Commercial |
$104.11
|
| Rate for Payer: Aetna Medicare |
$31.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.28
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS MAPPO |
$30.62
|
| Rate for Payer: BCBS Trust/PPO |
$100.69
|
| Rate for Payer: BCN Commercial |
$95.23
|
| Rate for Payer: BCN Medicare Advantage |
$30.62
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cofinity Commercial |
$105.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.62
|
| Rate for Payer: Healthscope Commercial |
$110.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.86
|
| Rate for Payer: Mclaren Medicaid |
$12.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.15
|
| Rate for Payer: Meridian Medicaid |
$13.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.11
|
| Rate for Payer: Nomi Health Commercial |
$100.43
|
| Rate for Payer: PACE Senior Care Partners |
$29.09
|
| Rate for Payer: PACE SWMI |
$30.62
|
| Rate for Payer: PHP Commercial |
$104.11
|
| Rate for Payer: PHP Medicare Advantage |
$30.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.61
|
| Rate for Payer: Priority Health HMO/PPO |
$106.56
|
| Rate for Payer: Priority Health Medicare |
$30.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.06
|
| Rate for Payer: Railroad Medicare Medicare |
$30.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.78
|
| Rate for Payer: UHC Core |
$102.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.62
|
| Rate for Payer: UHC Exchange |
$30.62
|
| Rate for Payer: UHC Medicare Advantage |
$30.62
|
| Rate for Payer: UHCCP Medicaid |
$12.49
|
| Rate for Payer: VA VA |
$30.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.86
|
|
|
HC MUMPS AB IGG
|
Facility
|
IP
|
$80.58
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$52.38 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: BCBS Trust/PPO |
$65.78
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO |
$70.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.91
|
| Rate for Payer: UHC Core |
$67.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC MUMPS AB IGG
|
Facility
|
OP
|
$80.58
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200305
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$72.52 |
| Rate for Payer: Aetna Commercial |
$68.49
|
| Rate for Payer: Aetna Medicare |
$20.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.18
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$20.14
|
| Rate for Payer: BCBS Trust/PPO |
$66.24
|
| Rate for Payer: BCN Commercial |
$62.65
|
| Rate for Payer: BCN Medicare Advantage |
$20.14
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cash Price |
$64.46
|
| Rate for Payer: Cofinity Commercial |
$69.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.44
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.15
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.49
|
| Rate for Payer: Nomi Health Commercial |
$66.08
|
| Rate for Payer: PACE Senior Care Partners |
$19.14
|
| Rate for Payer: PACE SWMI |
$20.14
|
| Rate for Payer: PHP Commercial |
$68.49
|
| Rate for Payer: PHP Medicare Advantage |
$20.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.38
|
| Rate for Payer: Priority Health HMO/PPO |
$70.10
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.99
|
| Rate for Payer: Railroad Medicare Medicare |
$20.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.91
|
| Rate for Payer: UHC Core |
$67.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.14
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$20.14
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$20.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.44
|
|
|
HC MUMPS IGM ANTIBODY
|
Facility
|
OP
|
$77.52
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: Aetna Medicare |
$20.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.22
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS MAPPO |
$19.38
|
| Rate for Payer: BCBS Trust/PPO |
$63.73
|
| Rate for Payer: BCN Commercial |
$60.27
|
| Rate for Payer: BCN Medicare Advantage |
$19.38
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.38
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.35
|
| Rate for Payer: Meridian Medicaid |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.89
|
| Rate for Payer: Nomi Health Commercial |
$63.57
|
| Rate for Payer: PACE Senior Care Partners |
$18.41
|
| Rate for Payer: PACE SWMI |
$19.38
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: PHP Medicare Advantage |
$19.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO |
$67.44
|
| Rate for Payer: Priority Health Medicare |
$19.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.94
|
| Rate for Payer: Railroad Medicare Medicare |
$19.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.22
|
| Rate for Payer: UHC Core |
$64.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.38
|
| Rate for Payer: UHC Exchange |
$19.38
|
| Rate for Payer: UHC Medicare Advantage |
$19.38
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$19.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC MUMPS IGM ANTIBODY
|
Facility
|
IP
|
$77.52
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
30200306
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$69.77 |
| Rate for Payer: Aetna Commercial |
$65.89
|
| Rate for Payer: BCBS Trust/PPO |
$63.28
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$62.02
|
| Rate for Payer: Cofinity Commercial |
$66.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.02
|
| Rate for Payer: Healthscope Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.89
|
| Rate for Payer: Nomi Health Commercial |
$63.57
|
| Rate for Payer: PHP Commercial |
$65.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.39
|
| Rate for Payer: Priority Health HMO/PPO |
$67.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.22
|
| Rate for Payer: UHC Core |
$64.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.14
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS, RIFAMPIN RESISTANCE, AMP PROBE
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
30600345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.72
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$96.60
|
| Rate for Payer: BCN Commercial |
$91.36
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Mclaren Medicaid |
$55.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.84
|
| Rate for Payer: Meridian Medicaid |
$58.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Nomi Health Commercial |
$96.35
|
| Rate for Payer: PACE Senior Care Partners |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health HMO/PPO |
$102.22
|
| Rate for Payer: Priority Health Medicare |
$29.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.72
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.40
|
| Rate for Payer: UHC Core |
$98.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$29.38
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$55.50
|
| Rate for Payer: VA VA |
$29.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
HC MYCOBACTERIUM TUBERCULOSIS, RIFAMPIN RESISTANCE, AMP PROBE
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
CPT 87564
|
| Hospital Charge Code |
30600345
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$95.92
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Nomi Health Commercial |
$96.35
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.38
|
| Rate for Payer: Priority Health HMO/PPO |
$102.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.40
|
| Rate for Payer: UHC Core |
$98.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
30100062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$13.70
|
| Rate for Payer: BCBS MAPPO |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$48.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.60
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Mclaren Medicaid |
$13.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$13.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.60
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.60
|
| Rate for Payer: UHC Exchange |
$15.60
|
| Rate for Payer: UHC Medicare Advantage |
$15.60
|
| Rate for Payer: UHCCP Medicaid |
$13.05
|
| Rate for Payer: VA VA |
$15.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC MYCOPHENOLIC ACID
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
30100062
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.82
|
|
|
HC MYCOPLASMA AB IGG & IGM CMPT
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200311
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: BCBS Complete |
$10.05
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Mclaren Medicaid |
$9.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$10.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.19
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Medicare |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHCCP Medicaid |
$9.57
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC MYCOPLASMA AB IGG & IGM CMPT
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200311
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$17.84
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC MYCOPLASMA AB IGM
|
Facility
|
OP
|
$21.66
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: Aetna Medicare |
$5.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.77
|
| Rate for Payer: BCBS Complete |
$10.05
|
| Rate for Payer: BCBS MAPPO |
$5.42
|
| Rate for Payer: BCBS Trust/PPO |
$17.81
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: BCN Medicare Advantage |
$5.42
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.42
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Mclaren Medicaid |
$9.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.69
|
| Rate for Payer: Meridian Medicaid |
$10.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: Nomi Health Commercial |
$17.76
|
| Rate for Payer: PACE Senior Care Partners |
$5.14
|
| Rate for Payer: PACE SWMI |
$5.42
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: PHP Medicare Advantage |
$5.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health HMO/PPO |
$18.84
|
| Rate for Payer: Priority Health Medicare |
$5.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.51
|
| Rate for Payer: Railroad Medicare Medicare |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.06
|
| Rate for Payer: UHC Core |
$18.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.42
|
| Rate for Payer: UHC Exchange |
$5.42
|
| Rate for Payer: UHC Medicare Advantage |
$5.42
|
| Rate for Payer: UHCCP Medicaid |
$9.57
|
| Rate for Payer: VA VA |
$5.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
|
|
HC MYCOPLASMA AB IGM
|
Facility
|
IP
|
$21.66
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
30200312
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$19.49 |
| Rate for Payer: Aetna Commercial |
$18.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$16.74
|
| Rate for Payer: Cash Price |
$17.33
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.41
|
| Rate for Payer: Nomi Health Commercial |
$17.76
|
| Rate for Payer: PHP Commercial |
$18.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health HMO/PPO |
$18.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.06
|
| Rate for Payer: UHC Core |
$18.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
|
