|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$6,140.04
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,744.81 |
| Max. Negotiated Rate |
$5,526.04 |
| Rate for Payer: Aetna Commercial |
$5,219.03
|
| Rate for Payer: BCBS Trust/PPO |
$4,745.02
|
| Rate for Payer: BCN Commercial |
$4,745.02
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cofinity Commercial |
$5,280.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.03
|
| Rate for Payer: Healthscope Commercial |
$5,526.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,605.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.03
|
| Rate for Payer: PHP Commercial |
$5,219.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,341.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,744.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,403.24
|
| Rate for Payer: UHC Core |
$5,126.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,605.03
|
|
|
HC VERTEBROPLASTY SACRUM BIL W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$6,140.04
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
36100298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,458.26 |
| Max. Negotiated Rate |
$5,526.04 |
| Rate for Payer: Aetna Commercial |
$5,219.03
|
| Rate for Payer: Aetna Medicare |
$1,596.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,918.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,918.76
|
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: BCBS MAPPO |
$1,535.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,773.88
|
| Rate for Payer: BCN Commercial |
$4,773.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.01
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cash Price |
$4,912.03
|
| Rate for Payer: Cofinity Commercial |
$5,280.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,912.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.01
|
| Rate for Payer: Healthscope Commercial |
$5,526.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,605.03
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,611.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,765.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,219.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,458.26
|
| Rate for Payer: PACE SWMI |
$1,535.01
|
| Rate for Payer: PHP Commercial |
$5,219.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,298.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,341.83
|
| Rate for Payer: Priority Health Medicare |
$1,535.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,744.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1,535.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,403.24
|
| Rate for Payer: UHC Core |
$5,126.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,535.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,581.06
|
| Rate for Payer: VA VA |
$1,535.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,605.03
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
IP
|
$4,912.03
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,995.85 |
| Max. Negotiated Rate |
$4,420.83 |
| Rate for Payer: Aetna Commercial |
$4,175.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,796.02
|
| Rate for Payer: BCN Commercial |
$3,796.02
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cofinity Commercial |
$4,224.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,929.62
|
| Rate for Payer: Healthscope Commercial |
$4,420.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,684.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,175.23
|
| Rate for Payer: PHP Commercial |
$4,175.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,438.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,273.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,995.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,322.59
|
| Rate for Payer: UHC Core |
$4,101.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,684.02
|
|
|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$4,912.03
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,166.61 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: Aetna Commercial |
$4,175.23
|
| Rate for Payer: Aetna Medicare |
$1,277.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,535.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,535.01
|
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: BCBS MAPPO |
$1,228.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,819.10
|
| Rate for Payer: BCN Commercial |
$3,819.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,228.01
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cash Price |
$3,929.62
|
| Rate for Payer: Cofinity Commercial |
$4,224.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,929.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,228.01
|
| Rate for Payer: Healthscope Commercial |
$4,420.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,684.02
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,289.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,412.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,175.23
|
| Rate for Payer: PACE Senior Care Partners |
$1,166.61
|
| Rate for Payer: PACE SWMI |
$1,228.01
|
| Rate for Payer: PHP Commercial |
$4,175.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,228.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,438.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,273.47
|
| Rate for Payer: Priority Health Medicare |
$1,228.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,995.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1,228.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,322.59
|
| Rate for Payer: UHC Core |
$4,101.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,228.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,264.85
|
| Rate for Payer: VA VA |
$1,228.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,684.02
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$455.60
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$410.04 |
| Rate for Payer: Aetna Commercial |
$387.26
|
| Rate for Payer: Aetna Medicare |
$118.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.38
|
| Rate for Payer: BCBS Complete |
$182.24
|
| Rate for Payer: BCBS MAPPO |
$113.90
|
| Rate for Payer: BCBS Trust/PPO |
$354.23
|
| Rate for Payer: BCN Commercial |
$354.23
|
| Rate for Payer: BCN Medicare Advantage |
$113.90
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cofinity Commercial |
$391.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.90
|
| Rate for Payer: Healthscope Commercial |
$410.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.26
|
| Rate for Payer: PACE Senior Care Partners |
$108.20
|
| Rate for Payer: PACE SWMI |
$113.90
|
| Rate for Payer: PHP Commercial |
$387.26
|
| Rate for Payer: PHP Medicare Advantage |
$113.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.37
|
| Rate for Payer: Priority Health Medicare |
$113.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.87
|
| Rate for Payer: Railroad Medicare Medicare |
$113.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.93
|
| Rate for Payer: UHC Core |
$380.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.90
|
| Rate for Payer: UHC Medicare Advantage |
$117.32
|
| Rate for Payer: VA VA |
$113.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.70
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$455.60
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$277.87 |
| Max. Negotiated Rate |
$410.04 |
| Rate for Payer: Aetna Commercial |
$387.26
|
| Rate for Payer: BCBS Trust/PPO |
$352.09
|
| Rate for Payer: BCN Commercial |
$352.09
|
| Rate for Payer: Cash Price |
$364.48
|
| Rate for Payer: Cofinity Commercial |
$391.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.48
|
| Rate for Payer: Healthscope Commercial |
$410.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.26
|
| Rate for Payer: PHP Commercial |
$387.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.93
|
| Rate for Payer: UHC Core |
$380.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.70
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$7,954.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,889.29 |
| Max. Negotiated Rate |
$7,159.41 |
| Rate for Payer: Aetna Commercial |
$6,761.66
|
| Rate for Payer: Aetna Medicare |
$2,068.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,485.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,485.91
|
| Rate for Payer: BCBS Complete |
$3,181.96
|
| Rate for Payer: BCBS MAPPO |
$1,988.72
|
| Rate for Payer: BCBS Trust/PPO |
$6,184.93
|
| Rate for Payer: BCN Commercial |
$6,184.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,988.72
|
| Rate for Payer: Cash Price |
$6,363.92
|
| Rate for Payer: Cofinity Commercial |
$6,841.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,363.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,988.72
|
| Rate for Payer: Healthscope Commercial |
$7,159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,966.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,088.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,287.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,761.66
|
| Rate for Payer: PACE Senior Care Partners |
$1,889.29
|
| Rate for Payer: PACE SWMI |
$1,988.72
|
| Rate for Payer: PHP Commercial |
$6,761.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,988.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,568.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,920.76
|
| Rate for Payer: Priority Health Medicare |
$1,988.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,851.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,988.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,000.31
|
| Rate for Payer: UHC Core |
$6,642.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,988.72
|
| Rate for Payer: UHC Medicare Advantage |
$2,048.39
|
| Rate for Payer: VA VA |
$1,988.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,966.18
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$7,954.90
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,851.69 |
| Max. Negotiated Rate |
$7,159.41 |
| Rate for Payer: Aetna Commercial |
$6,761.66
|
| Rate for Payer: BCBS Trust/PPO |
$6,147.55
|
| Rate for Payer: BCN Commercial |
$6,147.55
|
| Rate for Payer: Cash Price |
$6,363.92
|
| Rate for Payer: Cofinity Commercial |
$6,841.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,363.92
|
| Rate for Payer: Healthscope Commercial |
$7,159.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,966.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,761.66
|
| Rate for Payer: PHP Commercial |
$6,761.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,568.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,920.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,851.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,000.31
|
| Rate for Payer: UHC Core |
$6,642.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,966.18
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.68
|
| Rate for Payer: BCBS Complete |
$9.04
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$53.93
|
| Rate for Payer: BCN Commercial |
$53.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Mclaren Medicaid |
$8.61
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PACE Senior Care Partners |
$16.47
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.34
|
| Rate for Payer: UHC Medicare Advantage |
$17.86
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$53.60
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.96
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.78
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.87
|
| Rate for Payer: BCBS Complete |
$1.11
|
| Rate for Payer: BCBS MAPPO |
$0.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: BCN Medicare Advantage |
$0.70
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
| Rate for Payer: PACE Senior Care Partners |
$0.66
|
| Rate for Payer: PACE SWMI |
$0.70
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.42
|
| Rate for Payer: Priority Health Medicare |
$0.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.70
|
| Rate for Payer: Railroad Medicare Medicare |
$0.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: VA VA |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.08
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$38.95
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.17
|
| Rate for Payer: BCBS Complete |
$15.58
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCBS Trust/PPO |
$30.28
|
| Rate for Payer: BCN Commercial |
$30.28
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Healthscope Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.11
|
| Rate for Payer: PACE Senior Care Partners |
$9.25
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Commercial |
$33.11
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.89
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.76
|
| Rate for Payer: Railroad Medicare Medicare |
$9.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.28
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$10.03
|
| Rate for Payer: VA VA |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.21
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$38.95
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$30.10
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: Cash Price |
$31.16
|
| Rate for Payer: Cofinity Commercial |
$33.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.16
|
| Rate for Payer: Healthscope Commercial |
$35.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.11
|
| Rate for Payer: PHP Commercial |
$33.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.28
|
| Rate for Payer: UHC Core |
$32.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.21
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: BCBS Trust/PPO |
$160.75
|
| Rate for Payer: BCN Commercial |
$160.75
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.05
|
| Rate for Payer: UHC Core |
$173.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.01
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$208.01
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$187.21 |
| Rate for Payer: Aetna Commercial |
$176.81
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.73
|
| Rate for Payer: BCN Commercial |
$161.73
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cash Price |
$166.41
|
| Rate for Payer: Cofinity Commercial |
$178.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.01
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.81
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.81
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.97
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.87
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.05
|
| Rate for Payer: UHC Core |
$173.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.01
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$160.28 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$223.37
|
| Rate for Payer: BCBS Trust/PPO |
$203.08
|
| Rate for Payer: BCN Commercial |
$203.08
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$226.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.23
|
| Rate for Payer: Healthscope Commercial |
$236.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: PHP Commercial |
$223.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.26
|
| Rate for Payer: UHC Core |
$219.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$262.79
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$236.51 |
| Rate for Payer: Aetna Commercial |
$223.37
|
| Rate for Payer: Aetna Medicare |
$68.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.12
|
| Rate for Payer: BCBS Complete |
$107.59
|
| Rate for Payer: BCBS MAPPO |
$65.70
|
| Rate for Payer: BCBS Trust/PPO |
$204.32
|
| Rate for Payer: BCN Commercial |
$204.32
|
| Rate for Payer: BCN Medicare Advantage |
$65.70
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cash Price |
$210.23
|
| Rate for Payer: Cofinity Commercial |
$226.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.70
|
| Rate for Payer: Healthscope Commercial |
$236.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.09
|
| Rate for Payer: Mclaren Medicaid |
$102.47
|
| Rate for Payer: Meridian Medicaid |
$107.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.37
|
| Rate for Payer: PACE Senior Care Partners |
$62.41
|
| Rate for Payer: PACE SWMI |
$65.70
|
| Rate for Payer: PHP Commercial |
$223.37
|
| Rate for Payer: PHP Medicare Advantage |
$65.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.63
|
| Rate for Payer: Priority Health Medicare |
$65.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.28
|
| Rate for Payer: Railroad Medicare Medicare |
$65.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.26
|
| Rate for Payer: UHC Core |
$219.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.70
|
| Rate for Payer: UHC Medicare Advantage |
$67.67
|
| Rate for Payer: VA VA |
$65.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.09
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$35.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$45.90
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: BCBS MAPPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$35.69
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.48
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Mclaren Medicaid |
$8.57
|
| Rate for Payer: Meridian Medicaid |
$9.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.48
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.48
|
| Rate for Payer: UHC Medicare Advantage |
$11.82
|
| Rate for Payer: VA VA |
$11.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
OP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.12
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS MAPPO |
$15.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.58
|
| Rate for Payer: BCN Commercial |
$47.58
|
| Rate for Payer: BCN Medicare Advantage |
$15.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Mclaren Medicaid |
$11.13
|
| Rate for Payer: Meridian Medicaid |
$11.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PACE Senior Care Partners |
$14.54
|
| Rate for Payer: PACE SWMI |
$15.30
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: PHP Medicare Advantage |
$15.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Medicare |
$15.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: Railroad Medicare Medicare |
$15.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.30
|
| Rate for Payer: UHC Medicare Advantage |
$15.76
|
| Rate for Payer: VA VA |
$15.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.33 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$52.02
|
| Rate for Payer: BCBS Trust/PPO |
$47.30
|
| Rate for Payer: BCN Commercial |
$47.30
|
| Rate for Payer: Cash Price |
$48.96
|
| Rate for Payer: Cofinity Commercial |
$52.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.02
|
| Rate for Payer: PHP Commercial |
$52.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.86
|
| Rate for Payer: UHC Core |
$51.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.90
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
IP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$166.28 |
| Rate for Payer: Aetna Commercial |
$157.04
|
| Rate for Payer: BCBS Trust/PPO |
$142.77
|
| Rate for Payer: BCN Commercial |
$142.77
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.80
|
| Rate for Payer: Healthscope Commercial |
$166.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: PHP Commercial |
$157.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.58
|
| Rate for Payer: UHC Core |
$154.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.56
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
OP
|
$184.75
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$166.28 |
| Rate for Payer: Aetna Commercial |
$157.04
|
| Rate for Payer: Aetna Medicare |
$48.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.73
|
| Rate for Payer: BCBS Complete |
$13.22
|
| Rate for Payer: BCBS MAPPO |
$46.19
|
| Rate for Payer: BCBS Trust/PPO |
$143.64
|
| Rate for Payer: BCN Commercial |
$143.64
|
| Rate for Payer: BCN Medicare Advantage |
$46.19
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cash Price |
$147.80
|
| Rate for Payer: Cofinity Commercial |
$158.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.19
|
| Rate for Payer: Healthscope Commercial |
$166.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.56
|
| Rate for Payer: Mclaren Medicaid |
$12.59
|
| Rate for Payer: Meridian Medicaid |
$13.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.04
|
| Rate for Payer: PACE Senior Care Partners |
$43.88
|
| Rate for Payer: PACE SWMI |
$46.19
|
| Rate for Payer: PHP Commercial |
$157.04
|
| Rate for Payer: PHP Medicare Advantage |
$46.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.73
|
| Rate for Payer: Priority Health Medicare |
$46.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.68
|
| Rate for Payer: Railroad Medicare Medicare |
$46.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.58
|
| Rate for Payer: UHC Core |
$154.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.19
|
| Rate for Payer: UHC Medicare Advantage |
$47.57
|
| Rate for Payer: VA VA |
$46.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.56
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
IP
|
$56.10
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: BCBS Trust/PPO |
$43.35
|
| Rate for Payer: BCN Commercial |
$43.35
|
| Rate for Payer: Cash Price |
$44.88
|
| Rate for Payer: Cofinity Commercial |
$48.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$50.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.68
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.37
|
| Rate for Payer: UHC Core |
$46.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.08
|
|
