|
HC TISSUE TRANSGLUTAMINASE IGG
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
30200008
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: BCBS Trust/PPO |
$27.59
|
| Rate for Payer: BCN Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.42
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
HC TL 201 PER MCI
|
Facility
|
OP
|
$189.47
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: Aetna Medicare |
$49.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.21
|
| Rate for Payer: BCBS Complete |
$75.79
|
| Rate for Payer: BCBS MAPPO |
$47.37
|
| Rate for Payer: BCBS Trust/PPO |
$147.31
|
| Rate for Payer: BCN Commercial |
$147.31
|
| Rate for Payer: BCN Medicare Advantage |
$47.37
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.37
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PACE Senior Care Partners |
$45.00
|
| Rate for Payer: PACE SWMI |
$47.37
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: PHP Medicare Advantage |
$47.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.84
|
| Rate for Payer: Priority Health Medicare |
$47.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.56
|
| Rate for Payer: Railroad Medicare Medicare |
$47.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.73
|
| Rate for Payer: UHC Core |
$158.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.37
|
| Rate for Payer: UHC Medicare Advantage |
$48.79
|
| Rate for Payer: VA VA |
$47.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC TL 201 PER MCI
|
Facility
|
IP
|
$189.47
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
34300022
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$170.52 |
| Rate for Payer: Aetna Commercial |
$161.05
|
| Rate for Payer: BCBS Trust/PPO |
$146.42
|
| Rate for Payer: BCN Commercial |
$146.42
|
| Rate for Payer: Cash Price |
$151.58
|
| Rate for Payer: Cofinity Commercial |
$162.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.58
|
| Rate for Payer: Healthscope Commercial |
$170.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$161.05
|
| Rate for Payer: PHP Commercial |
$161.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.73
|
| Rate for Payer: UHC Core |
$158.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.10
|
|
|
HC TOBRAMYCIN LEVEL
|
Facility
|
IP
|
$105.40
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
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 TOBRAMYCIN LEVEL
|
Facility
|
OP
|
$105.40
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
30100049
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.90 |
| 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 |
$12.50
|
| 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 |
$11.90
|
| Rate for Payer: Meridian Medicaid |
$12.50
|
| 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 |
$11.90
|
| 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 TOMATO IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TOMATO IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
OP
|
$4,639.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$4,175.10 |
| Rate for Payer: Aetna Commercial |
$3,943.15
|
| Rate for Payer: Aetna Medicare |
$1,206.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,449.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,449.69
|
| Rate for Payer: BCBS Complete |
$2,625.49
|
| Rate for Payer: BCBS MAPPO |
$1,159.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,606.82
|
| Rate for Payer: BCN Commercial |
$3,606.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,159.75
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$3,989.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,711.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,159.75
|
| Rate for Payer: Healthscope Commercial |
$4,175.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,479.25
|
| Rate for Payer: Mclaren Medicaid |
$2,500.47
|
| Rate for Payer: Meridian Medicaid |
$2,625.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,217.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,333.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,943.15
|
| Rate for Payer: PACE Senior Care Partners |
$1,101.76
|
| Rate for Payer: PACE SWMI |
$1,159.75
|
| Rate for Payer: PHP Commercial |
$3,943.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,159.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,500.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,035.93
|
| Rate for Payer: Priority Health Medicare |
$1,159.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,829.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,159.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,082.32
|
| Rate for Payer: UHC Core |
$3,873.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,159.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,194.54
|
| Rate for Payer: VA VA |
$1,159.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,479.25
|
|
|
HC TOMO GUIDED BREAST BIOPSY
|
Facility
|
IP
|
$4,639.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100566
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,829.33 |
| Max. Negotiated Rate |
$4,175.10 |
| Rate for Payer: Aetna Commercial |
$3,943.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.02
|
| Rate for Payer: BCN Commercial |
$3,585.02
|
| Rate for Payer: Cash Price |
$3,711.20
|
| Rate for Payer: Cofinity Commercial |
$3,989.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,711.20
|
| Rate for Payer: Healthscope Commercial |
$4,175.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,479.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,943.15
|
| Rate for Payer: PHP Commercial |
$3,943.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,247.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,035.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,829.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,082.32
|
| Rate for Payer: UHC Core |
$3,873.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,479.25
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
OP
|
$3,093.22
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$734.64 |
| Max. Negotiated Rate |
$2,783.90 |
| Rate for Payer: Aetna Commercial |
$2,629.24
|
| Rate for Payer: Aetna Medicare |
$804.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$966.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$966.63
|
| Rate for Payer: BCBS Complete |
$2,625.49
|
| Rate for Payer: BCBS MAPPO |
$773.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,404.98
|
| Rate for Payer: BCN Commercial |
$2,404.98
|
| Rate for Payer: BCN Medicare Advantage |
$773.30
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cofinity Commercial |
$2,660.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,474.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.30
|
| Rate for Payer: Healthscope Commercial |
$2,783.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,319.92
|
| Rate for Payer: Mclaren Medicaid |
$2,500.47
|
| Rate for Payer: Meridian Medicaid |
$2,625.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$811.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,629.24
|
| Rate for Payer: PACE Senior Care Partners |
$734.64
|
| Rate for Payer: PACE SWMI |
$773.30
|
| Rate for Payer: PHP Commercial |
$2,629.24
|
| Rate for Payer: PHP Medicare Advantage |
$773.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,500.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,165.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,691.10
|
| Rate for Payer: Priority Health Medicare |
$773.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,886.55
|
| Rate for Payer: Railroad Medicare Medicare |
$773.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,722.03
|
| Rate for Payer: UHC Core |
$2,582.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.30
|
| Rate for Payer: UHC Medicare Advantage |
$796.50
|
| Rate for Payer: VA VA |
$773.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,319.92
|
|
|
HC TOMO GUIDED BREAST LOCALIZATION
|
Facility
|
IP
|
$3,093.22
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
36100567
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,886.55 |
| Max. Negotiated Rate |
$2,783.90 |
| Rate for Payer: Aetna Commercial |
$2,629.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,390.44
|
| Rate for Payer: BCN Commercial |
$2,390.44
|
| Rate for Payer: Cash Price |
$2,474.58
|
| Rate for Payer: Cofinity Commercial |
$2,660.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,474.58
|
| Rate for Payer: Healthscope Commercial |
$2,783.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,319.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,629.24
|
| Rate for Payer: PHP Commercial |
$2,629.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,165.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,691.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,886.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,722.03
|
| Rate for Payer: UHC Core |
$2,582.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,319.92
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.15 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: BCBS Trust/PPO |
$43.28
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC TONE DECAY HEARING TEST
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 92563
|
| Hospital Charge Code |
76100501
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$14.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.50
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$43.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$48.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.00
|
| Rate for Payer: Healthscope Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.00
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.60
|
| Rate for Payer: PACE Senior Care Partners |
$13.30
|
| Rate for Payer: PACE SWMI |
$14.00
|
| Rate for Payer: PHP Commercial |
$47.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.72
|
| Rate for Payer: Priority Health Medicare |
$14.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.28
|
| Rate for Payer: UHC Core |
$46.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.00
|
| Rate for Payer: UHC Medicare Advantage |
$14.42
|
| Rate for Payer: VA VA |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.00
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
IP
|
$57.47
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.05 |
| Max. Negotiated Rate |
$51.72 |
| Rate for Payer: Aetna Commercial |
$48.85
|
| Rate for Payer: BCBS Trust/PPO |
$44.41
|
| Rate for Payer: BCN Commercial |
$44.41
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$49.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Healthscope Commercial |
$51.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.85
|
| Rate for Payer: PHP Commercial |
$48.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.57
|
| Rate for Payer: UHC Core |
$47.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.10
|
|
|
HC TOPIRAMATE LEVEL
|
Facility
|
OP
|
$57.47
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$51.72 |
| Rate for Payer: Aetna Commercial |
$48.85
|
| Rate for Payer: Aetna Medicare |
$14.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.96
|
| Rate for Payer: BCBS Complete |
$9.24
|
| Rate for Payer: BCBS MAPPO |
$14.37
|
| Rate for Payer: BCBS Trust/PPO |
$44.68
|
| Rate for Payer: BCN Commercial |
$44.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.37
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cash Price |
$45.98
|
| Rate for Payer: Cofinity Commercial |
$49.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$51.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.10
|
| Rate for Payer: Mclaren Medicaid |
$8.80
|
| Rate for Payer: Meridian Medicaid |
$9.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.85
|
| Rate for Payer: PACE Senior Care Partners |
$13.65
|
| Rate for Payer: PACE SWMI |
$14.37
|
| Rate for Payer: PHP Commercial |
$48.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.00
|
| Rate for Payer: Priority Health Medicare |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.05
|
| Rate for Payer: Railroad Medicare Medicare |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.57
|
| Rate for Payer: UHC Core |
$47.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.37
|
| Rate for Payer: UHC Medicare Advantage |
$14.80
|
| Rate for Payer: VA VA |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.10
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.68
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$10.22
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Mclaren Medicaid |
$9.73
|
| Rate for Payer: Meridian Medicaid |
$10.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.68
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$3.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.68
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.06 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: BCBS Trust/PPO |
$52.02
|
| Rate for Payer: BCN Commercial |
$52.02
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.24
|
| Rate for Payer: UHC Core |
$56.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.49
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.04
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$52.34
|
| Rate for Payer: BCN Commercial |
$52.34
|
| Rate for Payer: BCN Medicare Advantage |
$16.83
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cash Price |
$53.86
|
| Rate for Payer: Cofinity Commercial |
$57.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$60.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.49
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.22
|
| Rate for Payer: PACE Senior Care Partners |
$15.99
|
| Rate for Payer: PACE SWMI |
$16.83
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: PHP Medicare Advantage |
$16.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.57
|
| Rate for Payer: Priority Health Medicare |
$16.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.06
|
| Rate for Payer: Railroad Medicare Medicare |
$16.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.24
|
| Rate for Payer: UHC Core |
$56.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.83
|
| Rate for Payer: UHC Medicare Advantage |
$17.33
|
| Rate for Payer: VA VA |
$16.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.49
|
|
