|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
OP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$1,131.38 |
| Rate for Payer: Aetna Commercial |
$1,068.53
|
| Rate for Payer: Aetna Medicare |
$326.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.84
|
| Rate for Payer: BCBS Complete |
$190.28
|
| Rate for Payer: BCBS MAPPO |
$314.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,033.45
|
| Rate for Payer: BCN Commercial |
$977.39
|
| Rate for Payer: BCN Medicare Advantage |
$314.27
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,081.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.27
|
| Rate for Payer: Healthscope Commercial |
$1,131.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.82
|
| Rate for Payer: Mclaren Medicaid |
$181.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.99
|
| Rate for Payer: Meridian Medicaid |
$190.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: PACE Senior Care Partners |
$298.56
|
| Rate for Payer: PACE SWMI |
$314.27
|
| Rate for Payer: PHP Commercial |
$1,068.53
|
| Rate for Payer: PHP Medicare Advantage |
$314.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,093.67
|
| Rate for Payer: Priority Health Medicare |
$317.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.25
|
| Rate for Payer: Railroad Medicare Medicare |
$314.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,106.24
|
| Rate for Payer: UHC Core |
$1,049.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.27
|
| Rate for Payer: UHC Exchange |
$314.27
|
| Rate for Payer: UHC Medicare Advantage |
$314.27
|
| Rate for Payer: UHCCP Medicaid |
$181.21
|
| Rate for Payer: VA VA |
$314.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.82
|
|
|
HC PACKED CELLS DIRECT LRIR
|
Facility
|
IP
|
$1,257.09
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
39000080
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$817.11 |
| Max. Negotiated Rate |
$1,131.38 |
| Rate for Payer: Aetna Commercial |
$1,068.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,026.16
|
| Rate for Payer: BCN Commercial |
$971.48
|
| Rate for Payer: Cash Price |
$1,005.67
|
| Rate for Payer: Cofinity Commercial |
$1,081.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,005.67
|
| Rate for Payer: Healthscope Commercial |
$1,131.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$942.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,068.53
|
| Rate for Payer: Nomi Health Commercial |
$1,030.81
|
| Rate for Payer: PHP Commercial |
$1,068.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1,093.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$842.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,106.24
|
| Rate for Payer: UHC Core |
$1,049.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$942.82
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
IP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.65 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: BCBS Trust/PPO |
$79.93
|
| Rate for Payer: BCN Commercial |
$75.67
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health HMO/PPO |
$85.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.17
|
| Rate for Payer: UHC Core |
$81.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.44
|
|
|
HC PACK LEFT HEART BYPASS
|
Facility
|
OP
|
$97.92
|
|
| Hospital Charge Code |
27000654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$88.13 |
| Rate for Payer: Aetna Commercial |
$83.23
|
| Rate for Payer: Aetna Medicare |
$25.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.60
|
| Rate for Payer: BCBS Complete |
$39.17
|
| Rate for Payer: BCBS MAPPO |
$24.48
|
| Rate for Payer: BCBS Trust/PPO |
$80.50
|
| Rate for Payer: BCN Commercial |
$76.13
|
| Rate for Payer: BCN Medicare Advantage |
$24.48
|
| Rate for Payer: Cash Price |
$78.34
|
| Rate for Payer: Cofinity Commercial |
$84.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.48
|
| Rate for Payer: Healthscope Commercial |
$88.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.23
|
| Rate for Payer: Nomi Health Commercial |
$80.29
|
| Rate for Payer: PACE Senior Care Partners |
$23.26
|
| Rate for Payer: PACE SWMI |
$24.48
|
| Rate for Payer: PHP Commercial |
$83.23
|
| Rate for Payer: PHP Medicare Advantage |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.65
|
| Rate for Payer: Priority Health HMO/PPO |
$85.19
|
| Rate for Payer: Priority Health Medicare |
$24.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.61
|
| Rate for Payer: Railroad Medicare Medicare |
$24.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.17
|
| Rate for Payer: UHC Core |
$81.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.48
|
| Rate for Payer: UHC Exchange |
$24.48
|
| Rate for Payer: UHC Medicare Advantage |
$24.48
|
| Rate for Payer: VA VA |
$24.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.44
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
OP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$163.52 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna Medicare |
$179.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.16
|
| Rate for Payer: BCBS Complete |
$275.40
|
| Rate for Payer: BCBS MAPPO |
$172.12
|
| Rate for Payer: BCBS Trust/PPO |
$566.02
|
| Rate for Payer: BCN Commercial |
$535.31
|
| Rate for Payer: BCN Medicare Advantage |
$172.12
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.12
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: Nomi Health Commercial |
$564.57
|
| Rate for Payer: PACE Senior Care Partners |
$163.52
|
| Rate for Payer: PACE SWMI |
$172.12
|
| Rate for Payer: PHP Commercial |
$585.22
|
| Rate for Payer: PHP Medicare Advantage |
$172.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health HMO/PPO |
$599.00
|
| Rate for Payer: Priority Health Medicare |
$173.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.30
|
| Rate for Payer: Railroad Medicare Medicare |
$172.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.88
|
| Rate for Payer: UHC Core |
$574.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.12
|
| Rate for Payer: UHC Exchange |
$172.12
|
| Rate for Payer: UHC Medicare Advantage |
$172.12
|
| Rate for Payer: VA VA |
$172.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
HC PACK QUEST CARDIOPLEGIA
|
Facility
|
IP
|
$688.50
|
|
| Hospital Charge Code |
27000457
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$447.52 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: BCBS Trust/PPO |
$562.02
|
| Rate for Payer: BCN Commercial |
$532.07
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cofinity Commercial |
$592.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.80
|
| Rate for Payer: Healthscope Commercial |
$619.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.22
|
| Rate for Payer: Nomi Health Commercial |
$564.57
|
| Rate for Payer: PHP Commercial |
$585.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.52
|
| Rate for Payer: Priority Health HMO/PPO |
$599.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.88
|
| Rate for Payer: UHC Core |
$574.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.38
|
|
|
HC PACK TABLE LINE
|
Facility
|
IP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$133.26 |
| Max. Negotiated Rate |
$184.52 |
| Rate for Payer: Aetna Commercial |
$174.27
|
| Rate for Payer: BCBS Trust/PPO |
$167.36
|
| Rate for Payer: BCN Commercial |
$158.44
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$176.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Healthscope Commercial |
$184.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: Nomi Health Commercial |
$168.12
|
| Rate for Payer: PHP Commercial |
$174.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: Priority Health HMO/PPO |
$178.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.42
|
| Rate for Payer: UHC Core |
$171.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.76
|
|
|
HC PACK TABLE LINE
|
Facility
|
OP
|
$205.02
|
|
| Hospital Charge Code |
27000676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$184.52 |
| Rate for Payer: Aetna Commercial |
$174.27
|
| Rate for Payer: Aetna Medicare |
$53.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.07
|
| Rate for Payer: BCBS Complete |
$82.01
|
| Rate for Payer: BCBS MAPPO |
$51.26
|
| Rate for Payer: BCBS Trust/PPO |
$168.55
|
| Rate for Payer: BCN Commercial |
$159.40
|
| Rate for Payer: BCN Medicare Advantage |
$51.26
|
| Rate for Payer: Cash Price |
$164.02
|
| Rate for Payer: Cofinity Commercial |
$176.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$184.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.27
|
| Rate for Payer: Nomi Health Commercial |
$168.12
|
| Rate for Payer: PACE Senior Care Partners |
$48.69
|
| Rate for Payer: PACE SWMI |
$51.26
|
| Rate for Payer: PHP Commercial |
$174.27
|
| Rate for Payer: PHP Medicare Advantage |
$51.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.26
|
| Rate for Payer: Priority Health HMO/PPO |
$178.37
|
| Rate for Payer: Priority Health Medicare |
$51.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.36
|
| Rate for Payer: Railroad Medicare Medicare |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.42
|
| Rate for Payer: UHC Core |
$171.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.26
|
| Rate for Payer: UHC Exchange |
$51.26
|
| Rate for Payer: UHC Medicare Advantage |
$51.26
|
| Rate for Payer: VA VA |
$51.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.76
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
IP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$715.28
|
| Rate for Payer: BCBS Trust/PPO |
$686.92
|
| Rate for Payer: BCN Commercial |
$650.31
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$723.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.28
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: PHP Commercial |
$715.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health HMO/PPO |
$732.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$563.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.52
|
| Rate for Payer: UHC Core |
$702.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.12
|
|
|
HC PACK W/O RESERV TERUMO
|
Facility
|
OP
|
$841.50
|
|
| Hospital Charge Code |
27000648
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$199.86 |
| Max. Negotiated Rate |
$757.35 |
| Rate for Payer: Aetna Commercial |
$715.28
|
| Rate for Payer: Aetna Medicare |
$218.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.97
|
| Rate for Payer: BCBS Complete |
$336.60
|
| Rate for Payer: BCBS MAPPO |
$210.38
|
| Rate for Payer: BCBS Trust/PPO |
$691.80
|
| Rate for Payer: BCN Commercial |
$654.27
|
| Rate for Payer: BCN Medicare Advantage |
$210.38
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: Cofinity Commercial |
$723.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$673.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.38
|
| Rate for Payer: Healthscope Commercial |
$757.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$631.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$715.28
|
| Rate for Payer: Nomi Health Commercial |
$690.03
|
| Rate for Payer: PACE Senior Care Partners |
$199.86
|
| Rate for Payer: PACE SWMI |
$210.38
|
| Rate for Payer: PHP Commercial |
$715.28
|
| Rate for Payer: PHP Medicare Advantage |
$210.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.98
|
| Rate for Payer: Priority Health HMO/PPO |
$732.10
|
| Rate for Payer: Priority Health Medicare |
$212.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$563.80
|
| Rate for Payer: Railroad Medicare Medicare |
$210.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.52
|
| Rate for Payer: UHC Core |
$702.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.38
|
| Rate for Payer: UHC Exchange |
$210.38
|
| Rate for Payer: UHC Medicare Advantage |
$210.38
|
| Rate for Payer: VA VA |
$210.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$631.12
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
IP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.85 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: BCBS Trust/PPO |
$134.18
|
| Rate for Payer: BCN Commercial |
$127.03
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health HMO/PPO |
$143.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Core |
$137.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC PAIN CLINIC DRUG SCREEN, U
|
Facility
|
OP
|
$164.38
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30100680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.04 |
| Max. Negotiated Rate |
$147.94 |
| Rate for Payer: Aetna Commercial |
$139.72
|
| Rate for Payer: Aetna Medicare |
$42.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.37
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$41.10
|
| Rate for Payer: BCBS Trust/PPO |
$135.14
|
| Rate for Payer: BCN Commercial |
$127.81
|
| Rate for Payer: BCN Medicare Advantage |
$41.10
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cofinity Commercial |
$141.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.10
|
| Rate for Payer: Healthscope Commercial |
$147.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.28
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.15
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.72
|
| Rate for Payer: Nomi Health Commercial |
$134.79
|
| Rate for Payer: PACE Senior Care Partners |
$39.04
|
| Rate for Payer: PACE SWMI |
$41.10
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$41.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.85
|
| Rate for Payer: Priority Health HMO/PPO |
$143.01
|
| Rate for Payer: Priority Health Medicare |
$41.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.13
|
| Rate for Payer: Railroad Medicare Medicare |
$41.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.65
|
| Rate for Payer: UHC Core |
$137.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.10
|
| Rate for Payer: UHC Exchange |
$41.10
|
| Rate for Payer: UHC Medicare Advantage |
$41.10
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$41.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.28
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.66 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: BCBS Trust/PPO |
$123.91
|
| Rate for Payer: BCN Commercial |
$117.30
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Nomi Health Commercial |
$124.47
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: Priority Health HMO/PPO |
$132.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC PAIN PUMP ADJUSTMENT
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
76100028
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$39.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$60.72
|
| Rate for Payer: BCBS MAPPO |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$124.79
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$118.02
|
| Rate for Payer: BCN Medicare Advantage |
$37.95
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.95
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.02
|
| Rate for Payer: Nomi Health Commercial |
$124.47
|
| Rate for Payer: PACE Senior Care Partners |
$36.05
|
| Rate for Payer: PACE SWMI |
$37.95
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: PHP Medicare Advantage |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.66
|
| Rate for Payer: Priority Health HMO/PPO |
$132.06
|
| Rate for Payer: Priority Health Medicare |
$38.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.70
|
| Rate for Payer: Railroad Medicare Medicare |
$37.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.95
|
| Rate for Payer: UHC Exchange |
$37.95
|
| Rate for Payer: UHC Medicare Advantage |
$37.95
|
| Rate for Payer: VA VA |
$37.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
IP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$600.35 |
| Max. Negotiated Rate |
$831.26 |
| Rate for Payer: Aetna Commercial |
$785.08
|
| Rate for Payer: BCBS Trust/PPO |
$753.95
|
| Rate for Payer: BCN Commercial |
$713.77
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$794.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Healthscope Commercial |
$831.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: Nomi Health Commercial |
$757.37
|
| Rate for Payer: PHP Commercial |
$785.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: Priority Health HMO/PPO |
$803.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.79
|
| Rate for Payer: UHC Core |
$771.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.72
|
|
|
HC PAIN PUMP SUPPLY
|
Facility
|
OP
|
$923.62
|
|
| Hospital Charge Code |
27000130
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$219.36 |
| Max. Negotiated Rate |
$831.26 |
| Rate for Payer: Aetna Commercial |
$785.08
|
| Rate for Payer: Aetna Medicare |
$240.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.63
|
| Rate for Payer: BCBS Complete |
$369.45
|
| Rate for Payer: BCBS MAPPO |
$230.90
|
| Rate for Payer: BCBS Trust/PPO |
$759.31
|
| Rate for Payer: BCN Commercial |
$718.11
|
| Rate for Payer: BCN Medicare Advantage |
$230.90
|
| Rate for Payer: Cash Price |
$738.90
|
| Rate for Payer: Cofinity Commercial |
$794.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$738.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.90
|
| Rate for Payer: Healthscope Commercial |
$831.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$692.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.08
|
| Rate for Payer: Nomi Health Commercial |
$757.37
|
| Rate for Payer: PACE Senior Care Partners |
$219.36
|
| Rate for Payer: PACE SWMI |
$230.90
|
| Rate for Payer: PHP Commercial |
$785.08
|
| Rate for Payer: PHP Medicare Advantage |
$230.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.35
|
| Rate for Payer: Priority Health HMO/PPO |
$803.55
|
| Rate for Payer: Priority Health Medicare |
$233.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.83
|
| Rate for Payer: Railroad Medicare Medicare |
$230.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.79
|
| Rate for Payer: UHC Core |
$771.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.90
|
| Rate for Payer: UHC Exchange |
$230.90
|
| Rate for Payer: UHC Medicare Advantage |
$230.90
|
| Rate for Payer: VA VA |
$230.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$692.72
|
|
|
HC PANCREATIC AMYLASE
|
Facility
|
IP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$57.22
|
| Rate for Payer: BCBS Trust/PPO |
$54.95
|
| 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 Commercial |
$57.22
|
| Rate for Payer: Nomi Health Commercial |
$55.20
|
| Rate for Payer: PHP Commercial |
$57.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health HMO/PPO |
$58.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.10
|
| 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 PANCREATIC AMYLASE
|
Facility
|
OP
|
$67.32
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
30100100
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.69 |
| 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 |
$4.92
|
| Rate for Payer: BCBS MAPPO |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$55.34
|
| 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 |
$4.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.67
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.22
|
| Rate for Payer: Nomi Health Commercial |
$55.20
|
| 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 |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.76
|
| Rate for Payer: Priority Health HMO/PPO |
$58.57
|
| Rate for Payer: Priority Health Medicare |
$17.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.10
|
| 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 Exchange |
$16.83
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: UHCCP Medicaid |
$4.69
|
| Rate for Payer: VA VA |
$16.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.49
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
IP
|
$117.30
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.24 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: BCBS Trust/PPO |
$95.75
|
| Rate for Payer: BCN Commercial |
$90.65
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC PANCREATIC ELAST IN STOOL
|
Facility
|
OP
|
$117.30
|
|
|
Service Code
|
CPT 82653
|
| Hospital Charge Code |
30100632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$105.57 |
| Rate for Payer: Aetna Commercial |
$99.70
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.66
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$29.32
|
| Rate for Payer: BCBS Trust/PPO |
$96.43
|
| Rate for Payer: BCN Commercial |
$91.20
|
| Rate for Payer: BCN Medicare Advantage |
$29.32
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cash Price |
$93.84
|
| Rate for Payer: Cofinity Commercial |
$100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.32
|
| Rate for Payer: Healthscope Commercial |
$105.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.98
|
| Rate for Payer: Mclaren Medicaid |
$16.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.79
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.70
|
| Rate for Payer: Nomi Health Commercial |
$96.19
|
| Rate for Payer: PACE Senior Care Partners |
$27.86
|
| Rate for Payer: PACE SWMI |
$29.32
|
| Rate for Payer: PHP Commercial |
$99.70
|
| Rate for Payer: PHP Medicare Advantage |
$29.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.24
|
| Rate for Payer: Priority Health HMO/PPO |
$102.05
|
| Rate for Payer: Priority Health Medicare |
$29.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.59
|
| Rate for Payer: Railroad Medicare Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.22
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.32
|
| Rate for Payer: UHC Exchange |
$29.32
|
| Rate for Payer: UHC Medicare Advantage |
$29.32
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
| Rate for Payer: VA VA |
$29.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.98
|
|
|
HC PANTOTHENIC ACID (B-5) BIOASSAY
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: Aetna Medicare |
$28.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.38
|
| Rate for Payer: BCBS Complete |
$12.95
|
| Rate for Payer: BCBS MAPPO |
$27.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.43
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$27.50
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.88
|
| Rate for Payer: Meridian Medicaid |
$12.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.50
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PACE Senior Care Partners |
$26.12
|
| Rate for Payer: PACE SWMI |
$27.50
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: PHP Medicare Advantage |
$27.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO |
$95.70
|
| Rate for Payer: Priority Health Medicare |
$27.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.50
|
| Rate for Payer: UHC Exchange |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$27.50
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC PANTOTHENIC ACID (B-5) BIOASSAY
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100762
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Commercial |
$93.50
|
| Rate for Payer: BCBS Trust/PPO |
$89.79
|
| Rate for Payer: BCN Commercial |
$85.01
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.00
|
| Rate for Payer: Healthscope Commercial |
$99.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.50
|
| Rate for Payer: Nomi Health Commercial |
$90.20
|
| Rate for Payer: PHP Commercial |
$93.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO |
$95.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.80
|
| Rate for Payer: UHC Core |
$91.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.50
|
|
|
HC PAPER WASP IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC PAPER WASP IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200096
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC PAP NAP
|
Facility
|
OP
|
$2,312.24
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
92000019
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$375.87 |
| Max. Negotiated Rate |
$2,081.02 |
| Rate for Payer: Aetna Commercial |
$1,965.40
|
| Rate for Payer: Aetna Medicare |
$601.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$722.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$722.58
|
| Rate for Payer: BCBS Complete |
$394.69
|
| Rate for Payer: BCBS MAPPO |
$578.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,900.89
|
| Rate for Payer: BCN Commercial |
$1,797.77
|
| Rate for Payer: BCN Medicare Advantage |
$578.06
|
| Rate for Payer: Cash Price |
$1,849.79
|
| Rate for Payer: Cash Price |
$1,849.79
|
| Rate for Payer: Cofinity Commercial |
$1,988.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,849.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.06
|
| Rate for Payer: Healthscope Commercial |
$2,081.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,734.18
|
| Rate for Payer: Mclaren Medicaid |
$375.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.96
|
| Rate for Payer: Meridian Medicaid |
$394.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$664.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,965.40
|
| Rate for Payer: Nomi Health Commercial |
$1,896.04
|
| Rate for Payer: PACE Senior Care Partners |
$549.16
|
| Rate for Payer: PACE SWMI |
$578.06
|
| Rate for Payer: PHP Commercial |
$1,965.40
|
| Rate for Payer: PHP Medicare Advantage |
$578.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,502.96
|
| Rate for Payer: Priority Health HMO/PPO |
$2,011.65
|
| Rate for Payer: Priority Health Medicare |
$583.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,549.20
|
| Rate for Payer: Railroad Medicare Medicare |
$578.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,034.77
|
| Rate for Payer: UHC Core |
$1,930.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.06
|
| Rate for Payer: UHC Exchange |
$578.06
|
| Rate for Payer: UHC Medicare Advantage |
$578.06
|
| Rate for Payer: UHCCP Medicaid |
$375.87
|
| Rate for Payer: VA VA |
$578.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,734.18
|
|
