|
HC NEUTROPHIL OXIDATIVE BURST CMP
|
Facility
|
OP
|
$56.18
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31000012
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$50.56 |
| Rate for Payer: Aetna Commercial |
$47.75
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.56
|
| Rate for Payer: BCBS Complete |
$22.47
|
| Rate for Payer: BCBS MAPPO |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$46.19
|
| Rate for Payer: BCN Commercial |
$43.68
|
| Rate for Payer: BCN Medicare Advantage |
$14.04
|
| Rate for Payer: Cash Price |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.04
|
| Rate for Payer: Healthscope Commercial |
$50.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.75
|
| Rate for Payer: Nomi Health Commercial |
$46.07
|
| Rate for Payer: PACE Senior Care Partners |
$13.34
|
| Rate for Payer: PACE SWMI |
$14.04
|
| Rate for Payer: PHP Commercial |
$47.75
|
| Rate for Payer: PHP Medicare Advantage |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.52
|
| Rate for Payer: Priority Health HMO/PPO |
$48.88
|
| Rate for Payer: Priority Health Medicare |
$14.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Core |
$46.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.04
|
| Rate for Payer: UHC Exchange |
$14.04
|
| Rate for Payer: UHC Medicare Advantage |
$14.04
|
| Rate for Payer: VA VA |
$14.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.14
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
OP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.82
|
| Rate for Payer: BCBS Complete |
$67.61
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCBS Trust/PPO |
$138.95
|
| Rate for Payer: BCCCP Commercial |
$68.62
|
| Rate for Payer: BCN Commercial |
$131.41
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: PACE Senior Care Partners |
$40.14
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: Priority Health HMO/PPO |
$147.05
|
| Rate for Payer: Priority Health Medicare |
$42.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.24
|
| Rate for Payer: Railroad Medicare Medicare |
$42.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Exchange |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: VA VA |
$42.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99202
|
Facility
|
IP
|
$169.02
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
51000077
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.86 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Aetna Commercial |
$143.67
|
| Rate for Payer: BCBS Trust/PPO |
$137.97
|
| Rate for Payer: BCN Commercial |
$130.62
|
| Rate for Payer: Cash Price |
$135.22
|
| Rate for Payer: Cofinity Commercial |
$145.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.22
|
| Rate for Payer: Healthscope Commercial |
$152.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.67
|
| Rate for Payer: Nomi Health Commercial |
$138.60
|
| Rate for Payer: PHP Commercial |
$143.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.86
|
| Rate for Payer: Priority Health HMO/PPO |
$147.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.74
|
| Rate for Payer: UHC Core |
$141.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.76
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
OP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.71 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: Aetna Medicare |
$53.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.09
|
| Rate for Payer: BCBS Complete |
$82.04
|
| Rate for Payer: BCBS MAPPO |
$51.28
|
| Rate for Payer: BCBS Trust/PPO |
$168.61
|
| Rate for Payer: BCCCP Commercial |
$108.06
|
| Rate for Payer: BCN Commercial |
$159.47
|
| Rate for Payer: BCN Medicare Advantage |
$51.28
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.28
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: PACE Senior Care Partners |
$48.71
|
| Rate for Payer: PACE SWMI |
$51.28
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$51.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health HMO/PPO |
$178.44
|
| Rate for Payer: Priority Health Medicare |
$51.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.42
|
| Rate for Payer: Railroad Medicare Medicare |
$51.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.28
|
| Rate for Payer: UHC Exchange |
$51.28
|
| Rate for Payer: UHC Medicare Advantage |
$51.28
|
| Rate for Payer: VA VA |
$51.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99203
|
Facility
|
IP
|
$205.10
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
51000078
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.32 |
| Max. Negotiated Rate |
$184.59 |
| Rate for Payer: Aetna Commercial |
$174.34
|
| Rate for Payer: BCBS Trust/PPO |
$167.42
|
| Rate for Payer: BCN Commercial |
$158.50
|
| Rate for Payer: Cash Price |
$164.08
|
| Rate for Payer: Cofinity Commercial |
$176.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.08
|
| Rate for Payer: Healthscope Commercial |
$184.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.34
|
| Rate for Payer: Nomi Health Commercial |
$168.18
|
| Rate for Payer: PHP Commercial |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.32
|
| Rate for Payer: Priority Health HMO/PPO |
$178.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.49
|
| Rate for Payer: UHC Core |
$171.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.82
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
IP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: BCBS Trust/PPO |
$240.42
|
| Rate for Payer: BCN Commercial |
$227.61
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: Priority Health HMO/PPO |
$256.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99204
|
Facility
|
OP
|
$294.53
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
51000079
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.95 |
| Max. Negotiated Rate |
$265.08 |
| Rate for Payer: Aetna Commercial |
$250.35
|
| Rate for Payer: Aetna Medicare |
$76.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.04
|
| Rate for Payer: BCBS Complete |
$117.81
|
| Rate for Payer: BCBS MAPPO |
$73.63
|
| Rate for Payer: BCBS Trust/PPO |
$242.13
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$229.00
|
| Rate for Payer: BCN Medicare Advantage |
$73.63
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cash Price |
$235.62
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.63
|
| Rate for Payer: Healthscope Commercial |
$265.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.35
|
| Rate for Payer: Nomi Health Commercial |
$241.51
|
| Rate for Payer: PACE Senior Care Partners |
$69.95
|
| Rate for Payer: PACE SWMI |
$73.63
|
| Rate for Payer: PHP Commercial |
$250.35
|
| Rate for Payer: PHP Medicare Advantage |
$73.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.44
|
| Rate for Payer: Priority Health HMO/PPO |
$256.24
|
| Rate for Payer: Priority Health Medicare |
$74.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.34
|
| Rate for Payer: Railroad Medicare Medicare |
$73.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.19
|
| Rate for Payer: UHC Core |
$245.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.63
|
| Rate for Payer: UHC Exchange |
$73.63
|
| Rate for Payer: UHC Medicare Advantage |
$73.63
|
| Rate for Payer: VA VA |
$73.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.90
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
OP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$115.00 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.26
|
| Rate for Payer: BCBS Complete |
$196.17
|
| Rate for Payer: BCBS MAPPO |
$122.61
|
| Rate for Payer: BCBS Trust/PPO |
$403.18
|
| Rate for Payer: BCCCP Commercial |
$115.00
|
| Rate for Payer: BCN Commercial |
$381.31
|
| Rate for Payer: BCN Medicare Advantage |
$122.61
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: PACE Senior Care Partners |
$116.48
|
| Rate for Payer: PACE SWMI |
$122.61
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: PHP Medicare Advantage |
$122.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: Priority Health HMO/PPO |
$426.67
|
| Rate for Payer: Priority Health Medicare |
$123.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.59
|
| Rate for Payer: Railroad Medicare Medicare |
$122.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.61
|
| Rate for Payer: UHC Exchange |
$122.61
|
| Rate for Payer: UHC Medicare Advantage |
$122.61
|
| Rate for Payer: VA VA |
$122.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NEW PATIENT VISIT 99205
|
Facility
|
IP
|
$490.43
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.78 |
| Max. Negotiated Rate |
$441.39 |
| Rate for Payer: Aetna Commercial |
$416.87
|
| Rate for Payer: BCBS Trust/PPO |
$400.34
|
| Rate for Payer: BCN Commercial |
$379.00
|
| Rate for Payer: Cash Price |
$392.34
|
| Rate for Payer: Cofinity Commercial |
$421.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$392.34
|
| Rate for Payer: Healthscope Commercial |
$441.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$367.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.87
|
| Rate for Payer: Nomi Health Commercial |
$402.15
|
| Rate for Payer: PHP Commercial |
$416.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.78
|
| Rate for Payer: Priority Health HMO/PPO |
$426.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.58
|
| Rate for Payer: UHC Core |
$409.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$367.82
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.44
|
| Rate for Payer: BCBS Complete |
$24.89
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$51.15
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.78
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO |
$54.13
|
| Rate for Payer: Priority Health Medicare |
$15.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Core |
$51.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.56
|
| Rate for Payer: UHC Exchange |
$15.56
|
| Rate for Payer: UHC Medicare Advantage |
$15.56
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC NICOTINE AND METABOLITES BLD
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100599
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Aetna Commercial |
$52.89
|
| Rate for Payer: BCBS Trust/PPO |
$50.79
|
| Rate for Payer: BCN Commercial |
$48.08
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$53.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$56.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$52.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO |
$54.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.75
|
| Rate for Payer: UHC Core |
$51.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
|
|
HC NICOTINE AND METABOLITES URN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$41.63
|
| 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 Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| 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 NICOTINE AND METABOLITES URN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
30100613
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| 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 |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Nomi Health Commercial |
$41.82
|
| 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 Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.17
|
| 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 Exchange |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$12.75
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC NICU LEVEL 2 R&B
|
Facility
|
IP
|
$3,430.50
|
|
| Hospital Charge Code |
17200001
|
|
Hospital Revenue Code
|
172
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$3,087.45 |
| Rate for Payer: Aetna Commercial |
$2,915.92
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,800.32
|
| Rate for Payer: BCN Commercial |
$2,651.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$2,744.40
|
| Rate for Payer: Cash Price |
$2,744.40
|
| Rate for Payer: Cofinity Commercial |
$2,950.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,744.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$3,087.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,572.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.92
|
| Rate for Payer: Nomi Health Commercial |
$2,813.01
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,915.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,229.82
|
| Rate for Payer: Priority Health HMO/PPO |
$2,984.54
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,298.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,018.84
|
| Rate for Payer: UHC Core |
$2,864.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,572.88
|
|
|
HC NICU LEVEL 3 R&B
|
Facility
|
IP
|
$5,085.75
|
|
| Hospital Charge Code |
17300001
|
|
Hospital Revenue Code
|
173
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$4,577.18 |
| Rate for Payer: Aetna Commercial |
$4,322.89
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,151.50
|
| Rate for Payer: BCN Commercial |
$3,930.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$4,068.60
|
| Rate for Payer: Cash Price |
$4,068.60
|
| Rate for Payer: Cofinity Commercial |
$4,373.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,068.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$4,577.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,814.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,322.89
|
| Rate for Payer: Nomi Health Commercial |
$4,170.32
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$4,322.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,305.74
|
| Rate for Payer: Priority Health HMO/PPO |
$4,424.60
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,407.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,475.46
|
| Rate for Payer: UHC Core |
$4,246.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,814.31
|
|
|
HC NICU LEVEL 4 R&B
|
Facility
|
IP
|
$5,325.60
|
|
| Hospital Charge Code |
17400001
|
|
Hospital Revenue Code
|
174
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$4,793.04 |
| Rate for Payer: Aetna Commercial |
$4,526.76
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,347.29
|
| Rate for Payer: BCN Commercial |
$4,115.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cash Price |
$4,260.48
|
| Rate for Payer: Cofinity Commercial |
$4,580.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,260.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$4,793.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,994.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,526.76
|
| Rate for Payer: Nomi Health Commercial |
$4,366.99
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$4,526.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,461.64
|
| Rate for Payer: Priority Health HMO/PPO |
$4,633.27
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,568.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,686.53
|
| Rate for Payer: UHC Core |
$4,446.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,994.20
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.79
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS MAPPO |
$50.24
|
| Rate for Payer: BCBS Trust/PPO |
$165.19
|
| Rate for Payer: BCN Commercial |
$156.23
|
| Rate for Payer: BCN Medicare Advantage |
$50.24
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.24
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PACE Senior Care Partners |
$47.72
|
| Rate for Payer: PACE SWMI |
$50.24
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: PHP Medicare Advantage |
$50.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: Railroad Medicare Medicare |
$50.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.24
|
| Rate for Payer: UHC Exchange |
$50.24
|
| Rate for Payer: UHC Medicare Advantage |
$50.24
|
| Rate for Payer: VA VA |
$50.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC NICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200013
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.03
|
| Rate for Payer: BCN Commercial |
$155.29
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.70
|
|
|
HC NICU OR OB NURSERY R&B
|
Facility
|
IP
|
$2,362.67
|
|
| Hospital Charge Code |
17000001
|
|
Hospital Revenue Code
|
170
|
| Min. Negotiated Rate |
$1,535.74 |
| Max. Negotiated Rate |
$2,337.50 |
| Rate for Payer: Aetna Commercial |
$2,008.27
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,928.65
|
| Rate for Payer: BCN Commercial |
$1,825.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cash Price |
$1,890.14
|
| Rate for Payer: Cofinity Commercial |
$2,031.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,890.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$2,126.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,772.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,008.27
|
| Rate for Payer: Nomi Health Commercial |
$1,937.39
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$2,008.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2,055.52
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,582.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,079.15
|
| Rate for Payer: UHC Core |
$1,972.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,772.00
|
|
|
HC NIFOMETER
|
Facility
|
IP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$54.68 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: BCBS Trust/PPO |
$68.68
|
| Rate for Payer: BCN Commercial |
$65.02
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health HMO/PPO |
$73.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.03
|
| Rate for Payer: UHC Core |
$70.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.10
|
|
|
HC NIFOMETER
|
Facility
|
OP
|
$84.13
|
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$75.72 |
| Rate for Payer: Aetna Commercial |
$71.51
|
| Rate for Payer: Aetna Medicare |
$21.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.29
|
| Rate for Payer: BCBS Complete |
$33.65
|
| Rate for Payer: BCBS MAPPO |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$69.16
|
| Rate for Payer: BCN Commercial |
$65.41
|
| Rate for Payer: BCN Medicare Advantage |
$21.03
|
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Cofinity Commercial |
$72.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.03
|
| Rate for Payer: Healthscope Commercial |
$75.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.51
|
| Rate for Payer: Nomi Health Commercial |
$68.99
|
| Rate for Payer: PACE Senior Care Partners |
$19.98
|
| Rate for Payer: PACE SWMI |
$21.03
|
| Rate for Payer: PHP Commercial |
$71.51
|
| Rate for Payer: PHP Medicare Advantage |
$21.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health HMO/PPO |
$73.19
|
| Rate for Payer: Priority Health Medicare |
$21.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.37
|
| Rate for Payer: Railroad Medicare Medicare |
$21.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.03
|
| Rate for Payer: UHC Core |
$70.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.03
|
| Rate for Payer: UHC Exchange |
$21.03
|
| Rate for Payer: UHC Medicare Advantage |
$21.03
|
| Rate for Payer: VA VA |
$21.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.10
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
OP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$13.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.66
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$41.20
|
| Rate for Payer: BCN Commercial |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$12.53
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.59
|
| Rate for Payer: Mclaren Medicaid |
$27.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.16
|
| Rate for Payer: Meridian Medicaid |
$29.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: PACE Senior Care Partners |
$11.90
|
| Rate for Payer: PACE SWMI |
$12.53
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO |
$43.60
|
| Rate for Payer: Priority Health Medicare |
$12.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.11
|
| Rate for Payer: UHC Core |
$41.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.53
|
| Rate for Payer: UHC Exchange |
$12.53
|
| Rate for Payer: UHC Medicare Advantage |
$12.53
|
| Rate for Payer: UHCCP Medicaid |
$27.81
|
| Rate for Payer: VA VA |
$12.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
HC NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Facility
|
IP
|
$50.12
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
46000031
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$45.11 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: BCBS Trust/PPO |
$40.91
|
| Rate for Payer: BCN Commercial |
$38.73
|
| Rate for Payer: Cash Price |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$43.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.10
|
| Rate for Payer: Healthscope Commercial |
$45.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.60
|
| Rate for Payer: Nomi Health Commercial |
$41.10
|
| Rate for Payer: PHP Commercial |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.58
|
| Rate for Payer: Priority Health HMO/PPO |
$43.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.11
|
| Rate for Payer: UHC Core |
$41.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.59
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
OP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,162.80 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: Aetna Medicare |
$1,272.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,530.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,360.67
|
| Rate for Payer: BCBS MAPPO |
$1,224.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,025.00
|
| Rate for Payer: BCN Commercial |
$3,806.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,224.00
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,672.00
|
| Rate for Payer: Mclaren Medicaid |
$1,295.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,285.20
|
| Rate for Payer: Meridian Medicaid |
$1,360.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,407.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: PACE Senior Care Partners |
$1,162.80
|
| Rate for Payer: PACE SWMI |
$1,224.00
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,224.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,295.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO |
$4,259.52
|
| Rate for Payer: Priority Health Medicare |
$1,236.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,280.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,224.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,308.48
|
| Rate for Payer: UHC Core |
$4,088.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,224.00
|
| Rate for Payer: UHC Exchange |
$1,224.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,224.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.79
|
| Rate for Payer: VA VA |
$1,224.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,672.00
|
|
|
HC NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Facility
|
IP
|
$4,896.00
|
|
|
Service Code
|
CPT 36466
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,182.40 |
| Max. Negotiated Rate |
$4,406.40 |
| Rate for Payer: Aetna Commercial |
$4,161.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,996.60
|
| Rate for Payer: BCN Commercial |
$3,783.63
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cofinity Commercial |
$4,210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,916.80
|
| Rate for Payer: Healthscope Commercial |
$4,406.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,161.60
|
| Rate for Payer: Nomi Health Commercial |
$4,014.72
|
| Rate for Payer: PHP Commercial |
$4,161.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO |
$4,259.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,280.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,308.48
|
| Rate for Payer: UHC Core |
$4,088.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,672.00
|
|
