|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.63 |
| 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 |
$11.17
|
| 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 |
$10.63
|
| Rate for Payer: Meridian Medicaid |
$11.17
|
| 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 |
$10.63
|
| 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
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
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 TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
IP
|
$2,287.36
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,395.06 |
| Max. Negotiated Rate |
$2,058.62 |
| Rate for Payer: Aetna Commercial |
$1,944.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.67
|
| Rate for Payer: BCN Commercial |
$1,767.67
|
| Rate for Payer: Cash Price |
$1,829.89
|
| Rate for Payer: Cofinity Commercial |
$1,967.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,829.89
|
| Rate for Payer: Healthscope Commercial |
$2,058.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,715.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,944.26
|
| Rate for Payer: PHP Commercial |
$1,944.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,990.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,395.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,012.88
|
| Rate for Payer: UHC Core |
$1,909.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,715.52
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
OP
|
$2,287.36
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$543.25 |
| Max. Negotiated Rate |
$2,058.62 |
| Rate for Payer: Aetna Commercial |
$1,944.26
|
| Rate for Payer: Aetna Medicare |
$594.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$714.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$714.80
|
| Rate for Payer: BCBS Complete |
$978.06
|
| Rate for Payer: BCBS MAPPO |
$571.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,778.42
|
| Rate for Payer: BCN Commercial |
$1,778.42
|
| Rate for Payer: BCN Medicare Advantage |
$571.84
|
| Rate for Payer: Cash Price |
$1,829.89
|
| Rate for Payer: Cash Price |
$1,829.89
|
| Rate for Payer: Cofinity Commercial |
$1,967.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,829.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.84
|
| Rate for Payer: Healthscope Commercial |
$2,058.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,715.52
|
| Rate for Payer: Mclaren Medicaid |
$931.49
|
| Rate for Payer: Meridian Medicaid |
$978.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$600.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$657.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,944.26
|
| Rate for Payer: PACE Senior Care Partners |
$543.25
|
| Rate for Payer: PACE SWMI |
$571.84
|
| Rate for Payer: PHP Commercial |
$1,944.26
|
| Rate for Payer: PHP Medicare Advantage |
$571.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$931.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,990.00
|
| Rate for Payer: Priority Health Medicare |
$571.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,395.06
|
| Rate for Payer: Railroad Medicare Medicare |
$571.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,012.88
|
| Rate for Payer: UHC Core |
$1,909.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.84
|
| Rate for Payer: UHC Medicare Advantage |
$589.00
|
| Rate for Payer: VA VA |
$571.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,715.52
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$9.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$38.10
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.44
|
| Rate for Payer: BCN Commercial |
$29.44
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$38.10
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.91
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$29.62
|
| Rate for Payer: BCN Commercial |
$29.62
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Senior Care Partners |
$9.05
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.81
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
OP
|
$38.10
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.91
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$29.62
|
| Rate for Payer: BCN Commercial |
$29.62
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Meridian Medicaid |
$3.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Senior Care Partners |
$9.05
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.81
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
IP
|
$38.10
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.44
|
| Rate for Payer: BCN Commercial |
$29.44
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
OP
|
$38.10
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.91
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$29.62
|
| Rate for Payer: BCN Commercial |
$29.62
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PACE Senior Care Partners |
$9.05
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.81
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
IP
|
$38.10
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: BCBS Trust/PPO |
$29.44
|
| Rate for Payer: BCN Commercial |
$29.44
|
| Rate for Payer: Cash Price |
$30.48
|
| Rate for Payer: Cofinity Commercial |
$32.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.48
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.38
|
| Rate for Payer: PHP Commercial |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.53
|
| Rate for Payer: UHC Core |
$31.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.58
|
|
|
HC TOTAL T3
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$10.99
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$36.40
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$10.46
|
| Rate for Payer: Meridian Medicaid |
$10.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.56
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.06
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TOTAL T3
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.18
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.80
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
OP
|
$163.20
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Medicare |
$42.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.00
|
| Rate for Payer: BCBS Complete |
$48.15
|
| Rate for Payer: BCBS MAPPO |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$126.89
|
| Rate for Payer: BCN Commercial |
$126.89
|
| Rate for Payer: BCN Medicare Advantage |
$40.80
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Medicaid |
$48.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PACE Senior Care Partners |
$38.76
|
| Rate for Payer: PACE SWMI |
$40.80
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: PHP Medicare Advantage |
$40.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.98
|
| Rate for Payer: Priority Health Medicare |
$40.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.54
|
| Rate for Payer: Railroad Medicare Medicare |
$40.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.80
|
| Rate for Payer: UHC Medicare Advantage |
$42.02
|
| Rate for Payer: VA VA |
$40.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC TOXICOLOGY SCREEN SALIVA
|
Facility
|
IP
|
$163.20
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100665
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.54 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: BCBS Trust/PPO |
$126.12
|
| Rate for Payer: BCN Commercial |
$126.12
|
| Rate for Payer: Cash Price |
$130.56
|
| Rate for Payer: Cofinity Commercial |
$140.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.56
|
| Rate for Payer: Healthscope Commercial |
$146.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.72
|
| Rate for Payer: PHP Commercial |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Core |
$136.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.40
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.31
|
| Rate for Payer: BCBS Complete |
$11.15
|
| Rate for Payer: BCBS MAPPO |
$28.25
|
| Rate for Payer: BCBS Trust/PPO |
$87.86
|
| Rate for Payer: BCN Commercial |
$87.86
|
| Rate for Payer: BCN Medicare Advantage |
$28.25
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.25
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Mclaren Medicaid |
$10.62
|
| Rate for Payer: Meridian Medicaid |
$11.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PACE Senior Care Partners |
$26.84
|
| Rate for Payer: PACE SWMI |
$28.25
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Medicare |
$28.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: Railroad Medicare Medicare |
$28.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.25
|
| Rate for Payer: UHC Medicare Advantage |
$29.10
|
| Rate for Payer: VA VA |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200321
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: BCBS Trust/PPO |
$87.33
|
| Rate for Payer: BCN Commercial |
$87.33
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$97.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.40
|
| Rate for Payer: Healthscope Commercial |
$101.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.05
|
| Rate for Payer: PHP Commercial |
$96.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.44
|
| Rate for Payer: UHC Core |
$94.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.75
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
IP
|
$40.80
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| 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 TOXOPLASMA AB IGM
|
Facility
|
OP
|
$40.80
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200323
|
|
Hospital Revenue Code
|
302
|
| 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 |
$11.17
|
| 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 |
$10.63
|
| Rate for Payer: Meridian Medicaid |
$11.17
|
| 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 |
$10.63
|
| 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 TPMT AND NUDT15 GENOTYPE
|
Facility
|
IP
|
$519.09
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$316.59 |
| Max. Negotiated Rate |
$467.18 |
| Rate for Payer: Aetna Commercial |
$441.23
|
| Rate for Payer: BCBS Trust/PPO |
$401.15
|
| Rate for Payer: BCN Commercial |
$401.15
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cofinity Commercial |
$446.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.27
|
| Rate for Payer: Healthscope Commercial |
$467.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.23
|
| Rate for Payer: PHP Commercial |
$441.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$451.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.80
|
| Rate for Payer: UHC Core |
$433.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.32
|
|
|
HC TPMT AND NUDT15 GENOTYPE
|
Facility
|
OP
|
$519.09
|
|
|
Service Code
|
CPT 0034U
|
| Hospital Charge Code |
31000138
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$123.28 |
| Max. Negotiated Rate |
$467.18 |
| Rate for Payer: Aetna Commercial |
$441.23
|
| Rate for Payer: Aetna Medicare |
$134.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.22
|
| Rate for Payer: BCBS Complete |
$361.24
|
| Rate for Payer: BCBS MAPPO |
$129.77
|
| Rate for Payer: BCBS Trust/PPO |
$403.59
|
| Rate for Payer: BCN Commercial |
$403.59
|
| Rate for Payer: BCN Medicare Advantage |
$129.77
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cash Price |
$415.27
|
| Rate for Payer: Cofinity Commercial |
$446.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$415.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.77
|
| Rate for Payer: Healthscope Commercial |
$467.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$389.32
|
| Rate for Payer: Mclaren Medicaid |
$344.03
|
| Rate for Payer: Meridian Medicaid |
$361.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$441.23
|
| Rate for Payer: PACE Senior Care Partners |
$123.28
|
| Rate for Payer: PACE SWMI |
$129.77
|
| Rate for Payer: PHP Commercial |
$441.23
|
| Rate for Payer: PHP Medicare Advantage |
$129.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$451.61
|
| Rate for Payer: Priority Health Medicare |
$129.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.59
|
| Rate for Payer: Railroad Medicare Medicare |
$129.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.80
|
| Rate for Payer: UHC Core |
$433.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.77
|
| Rate for Payer: UHC Medicare Advantage |
$133.67
|
| Rate for Payer: VA VA |
$129.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$389.32
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
OP
|
$293.45
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$69.69 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$249.43
|
| Rate for Payer: Aetna Medicare |
$76.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.70
|
| Rate for Payer: BCBS Complete |
$117.38
|
| Rate for Payer: BCBS MAPPO |
$73.36
|
| Rate for Payer: BCBS Trust/PPO |
$228.16
|
| Rate for Payer: BCN Commercial |
$228.16
|
| Rate for Payer: BCN Medicare Advantage |
$73.36
|
| Rate for Payer: Cash Price |
$234.76
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.36
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.43
|
| Rate for Payer: PACE Senior Care Partners |
$69.69
|
| Rate for Payer: PACE SWMI |
$73.36
|
| Rate for Payer: PHP Commercial |
$249.43
|
| Rate for Payer: PHP Medicare Advantage |
$73.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.30
|
| Rate for Payer: Priority Health Medicare |
$73.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.98
|
| Rate for Payer: Railroad Medicare Medicare |
$73.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.24
|
| Rate for Payer: UHC Core |
$245.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.36
|
| Rate for Payer: UHC Medicare Advantage |
$75.56
|
| Rate for Payer: VA VA |
$73.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.09
|
|
|
HC TRACH BUTTON SUPPLY
|
Facility
|
IP
|
$293.45
|
|
| Hospital Charge Code |
27000159
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.98 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$249.43
|
| Rate for Payer: BCBS Trust/PPO |
$226.78
|
| Rate for Payer: BCN Commercial |
$226.78
|
| Rate for Payer: Cash Price |
$234.76
|
| Rate for Payer: Cofinity Commercial |
$252.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.76
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.43
|
| Rate for Payer: PHP Commercial |
$249.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.24
|
| Rate for Payer: UHC Core |
$245.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.09
|
|
|
HC TRACHEOBRNCHSC THRU EST TRACHS INC
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
76100389
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$792.87 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Aetna Commercial |
$1,105.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.64
|
| Rate for Payer: BCN Commercial |
$1,004.64
|
| Rate for Payer: Cash Price |
$1,040.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,040.00
|
| Rate for Payer: Healthscope Commercial |
$1,170.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$975.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,105.00
|
| Rate for Payer: PHP Commercial |
$1,105.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,131.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$792.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.00
|
| Rate for Payer: UHC Core |
$1,085.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$975.00
|
|
