|
HC PET WMC CT WHOLE BODY
|
Facility
|
IP
|
$7,236.90
|
|
|
Service Code
|
CPT 78816
|
| Hospital Charge Code |
40400008
|
|
Hospital Revenue Code
|
404
|
| Min. Negotiated Rate |
$4,703.98 |
| Max. Negotiated Rate |
$6,513.21 |
| Rate for Payer: Aetna Commercial |
$6,151.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,907.48
|
| Rate for Payer: BCN Commercial |
$5,592.68
|
| Rate for Payer: Cash Price |
$5,789.52
|
| Rate for Payer: Cofinity Commercial |
$6,223.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,789.52
|
| Rate for Payer: Healthscope Commercial |
$6,513.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,427.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,151.36
|
| Rate for Payer: Nomi Health Commercial |
$5,934.26
|
| Rate for Payer: PHP Commercial |
$6,151.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,703.98
|
| Rate for Payer: Priority Health HMO/PPO |
$6,296.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,848.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,368.47
|
| Rate for Payer: UHC Core |
$6,042.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,427.68
|
|
|
HC PFO
|
Facility
|
OP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,418.21 |
| Max. Negotiated Rate |
$24,321.65 |
| Rate for Payer: Aetna Commercial |
$22,970.45
|
| Rate for Payer: Aetna Medicare |
$7,026.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,445.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,445.02
|
| Rate for Payer: BCBS Complete |
$13,357.09
|
| Rate for Payer: BCBS MAPPO |
$6,756.02
|
| Rate for Payer: BCBS Trust/PPO |
$22,216.48
|
| Rate for Payer: BCN Commercial |
$21,011.21
|
| Rate for Payer: BCN Medicare Advantage |
$6,756.02
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$23,240.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,756.02
|
| Rate for Payer: Healthscope Commercial |
$24,321.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,268.04
|
| Rate for Payer: Mclaren Medicaid |
$12,720.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,093.82
|
| Rate for Payer: Meridian Medicaid |
$13,357.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,769.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: PACE Senior Care Partners |
$6,418.21
|
| Rate for Payer: PACE SWMI |
$6,756.02
|
| Rate for Payer: PHP Commercial |
$22,970.45
|
| Rate for Payer: PHP Medicare Advantage |
$6,756.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,720.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: Priority Health HMO/PPO |
$23,510.93
|
| Rate for Payer: Priority Health Medicare |
$6,823.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18,106.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6,756.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,781.17
|
| Rate for Payer: UHC Core |
$22,565.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,756.02
|
| Rate for Payer: UHC Exchange |
$6,756.02
|
| Rate for Payer: UHC Medicare Advantage |
$6,756.02
|
| Rate for Payer: UHCCP Medicaid |
$12,720.20
|
| Rate for Payer: VA VA |
$6,756.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,268.04
|
|
|
HC PFO
|
Facility
|
IP
|
$27,024.06
|
|
|
Service Code
|
CPT 93580
|
| Hospital Charge Code |
48100111
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$17,565.64 |
| Max. Negotiated Rate |
$24,321.65 |
| Rate for Payer: Aetna Commercial |
$22,970.45
|
| Rate for Payer: BCBS Trust/PPO |
$22,059.74
|
| Rate for Payer: BCN Commercial |
$20,884.19
|
| Rate for Payer: Cash Price |
$21,619.25
|
| Rate for Payer: Cofinity Commercial |
$23,240.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,619.25
|
| Rate for Payer: Healthscope Commercial |
$24,321.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,268.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,970.45
|
| Rate for Payer: Nomi Health Commercial |
$22,159.73
|
| Rate for Payer: PHP Commercial |
$22,970.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,565.64
|
| Rate for Payer: Priority Health HMO/PPO |
$23,510.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18,106.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,781.17
|
| Rate for Payer: UHC Core |
$22,565.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,268.04
|
|
|
HC PFO OCCLUDER
|
Facility
|
IP
|
$11,470.41
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,455.77 |
| Max. Negotiated Rate |
$10,323.37 |
| Rate for Payer: Aetna Commercial |
$9,749.85
|
| Rate for Payer: BCBS Trust/PPO |
$9,363.30
|
| Rate for Payer: BCN Commercial |
$8,864.33
|
| Rate for Payer: Cash Price |
$9,176.33
|
| Rate for Payer: Cofinity Commercial |
$9,864.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,176.33
|
| Rate for Payer: Healthscope Commercial |
$10,323.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,602.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,749.85
|
| Rate for Payer: Nomi Health Commercial |
$9,405.74
|
| Rate for Payer: PHP Commercial |
$9,749.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,455.77
|
| Rate for Payer: Priority Health HMO/PPO |
$9,979.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,685.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,093.96
|
| Rate for Payer: UHC Core |
$9,577.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,602.81
|
|
|
HC PFO OCCLUDER
|
Facility
|
OP
|
$11,470.41
|
|
|
Service Code
|
HCPCS C1817
|
| Hospital Charge Code |
27800116
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,724.22 |
| Max. Negotiated Rate |
$10,323.37 |
| Rate for Payer: Aetna Commercial |
$9,749.85
|
| Rate for Payer: Aetna Medicare |
$2,982.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,584.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,584.50
|
| Rate for Payer: BCBS Complete |
$4,588.16
|
| Rate for Payer: BCBS MAPPO |
$2,867.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,429.82
|
| Rate for Payer: BCN Commercial |
$8,918.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,867.60
|
| Rate for Payer: Cash Price |
$9,176.33
|
| Rate for Payer: Cofinity Commercial |
$9,864.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,176.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,867.60
|
| Rate for Payer: Healthscope Commercial |
$10,323.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,602.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,010.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,297.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,749.85
|
| Rate for Payer: Nomi Health Commercial |
$9,405.74
|
| Rate for Payer: PACE Senior Care Partners |
$2,724.22
|
| Rate for Payer: PACE SWMI |
$2,867.60
|
| Rate for Payer: PHP Commercial |
$9,749.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,867.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,455.77
|
| Rate for Payer: Priority Health HMO/PPO |
$9,979.26
|
| Rate for Payer: Priority Health Medicare |
$2,896.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,685.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,867.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,093.96
|
| Rate for Payer: UHC Core |
$9,577.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,867.60
|
| Rate for Payer: UHC Exchange |
$2,867.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,867.60
|
| Rate for Payer: VA VA |
$2,867.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,602.81
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
OP
|
$3,878.57
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$921.16 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: Aetna Medicare |
$1,008.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,212.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,212.05
|
| Rate for Payer: BCBS Complete |
$1,551.43
|
| Rate for Payer: BCBS MAPPO |
$969.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,188.57
|
| Rate for Payer: BCN Commercial |
$3,015.59
|
| Rate for Payer: BCN Medicare Advantage |
$969.64
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$969.64
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,018.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,115.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: PACE Senior Care Partners |
$921.16
|
| Rate for Payer: PACE SWMI |
$969.64
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: PHP Medicare Advantage |
$969.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,374.36
|
| Rate for Payer: Priority Health Medicare |
$979.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,598.64
|
| Rate for Payer: Railroad Medicare Medicare |
$969.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,413.14
|
| Rate for Payer: UHC Core |
$3,238.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$969.64
|
| Rate for Payer: UHC Exchange |
$969.64
|
| Rate for Payer: UHC Medicare Advantage |
$969.64
|
| Rate for Payer: VA VA |
$969.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC PHARMA AGENT CHALLENGE
|
Facility
|
IP
|
$3,878.57
|
|
|
Service Code
|
CPT 93463
|
| Hospital Charge Code |
48100022
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,521.07 |
| Max. Negotiated Rate |
$3,490.71 |
| Rate for Payer: Aetna Commercial |
$3,296.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,166.08
|
| Rate for Payer: BCN Commercial |
$2,997.36
|
| Rate for Payer: Cash Price |
$3,102.86
|
| Rate for Payer: Cofinity Commercial |
$3,335.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,102.86
|
| Rate for Payer: Healthscope Commercial |
$3,490.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,908.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,296.78
|
| Rate for Payer: Nomi Health Commercial |
$3,180.43
|
| Rate for Payer: PHP Commercial |
$3,296.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,521.07
|
| Rate for Payer: Priority Health HMO/PPO |
$3,374.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,598.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,413.14
|
| Rate for Payer: UHC Core |
$3,238.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,908.93
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
OP
|
$276.82
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$249.14 |
| Rate for Payer: Aetna Commercial |
$235.30
|
| Rate for Payer: Aetna Medicare |
$71.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.51
|
| Rate for Payer: BCBS Complete |
$132.42
|
| Rate for Payer: BCBS MAPPO |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$227.57
|
| Rate for Payer: BCN Commercial |
$215.23
|
| Rate for Payer: BCN Medicare Advantage |
$69.20
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cofinity Commercial |
$238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.20
|
| Rate for Payer: Healthscope Commercial |
$249.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.62
|
| Rate for Payer: Mclaren Medicaid |
$126.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.67
|
| Rate for Payer: Meridian Medicaid |
$132.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.30
|
| Rate for Payer: Nomi Health Commercial |
$226.99
|
| Rate for Payer: PACE Senior Care Partners |
$65.74
|
| Rate for Payer: PACE SWMI |
$69.20
|
| Rate for Payer: PHP Commercial |
$235.30
|
| Rate for Payer: PHP Medicare Advantage |
$69.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.93
|
| Rate for Payer: Priority Health HMO/PPO |
$240.83
|
| Rate for Payer: Priority Health Medicare |
$69.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.47
|
| Rate for Payer: Railroad Medicare Medicare |
$69.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.60
|
| Rate for Payer: UHC Core |
$231.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.20
|
| Rate for Payer: UHC Exchange |
$69.20
|
| Rate for Payer: UHC Medicare Advantage |
$69.20
|
| Rate for Payer: UHCCP Medicaid |
$126.11
|
| Rate for Payer: VA VA |
$69.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.62
|
|
|
HC PHARYNX AND OR CERVICAL ESOPHAGUS
|
Facility
|
IP
|
$276.82
|
|
|
Service Code
|
CPT 74210
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.93 |
| Max. Negotiated Rate |
$249.14 |
| Rate for Payer: Aetna Commercial |
$235.30
|
| Rate for Payer: BCBS Trust/PPO |
$225.97
|
| Rate for Payer: BCN Commercial |
$213.93
|
| Rate for Payer: Cash Price |
$221.46
|
| Rate for Payer: Cofinity Commercial |
$238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.46
|
| Rate for Payer: Healthscope Commercial |
$249.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.30
|
| Rate for Payer: Nomi Health Commercial |
$226.99
|
| Rate for Payer: PHP Commercial |
$235.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.93
|
| Rate for Payer: Priority Health HMO/PPO |
$240.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.60
|
| Rate for Payer: UHC Core |
$231.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.62
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$40.82
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC PHASE III REHAB FULL MONTH
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
99000048
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$41.10
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.50
|
| Rate for Payer: Nomi Health Commercial |
$41.00
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Exchange |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.50
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.41
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health HMO/PPO |
$21.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC PHASE III REHAB PARTIAL MONTH
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
99000049
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$21.25
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.81
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$6.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.55
|
| Rate for Payer: BCN Commercial |
$19.44
|
| Rate for Payer: BCN Medicare Advantage |
$6.25
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$22.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$20.50
|
| Rate for Payer: PACE Senior Care Partners |
$5.94
|
| Rate for Payer: PACE SWMI |
$6.25
|
| Rate for Payer: PHP Commercial |
$21.25
|
| Rate for Payer: PHP Medicare Advantage |
$6.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.25
|
| Rate for Payer: Priority Health HMO/PPO |
$21.75
|
| Rate for Payer: Priority Health Medicare |
$6.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.00
|
| Rate for Payer: UHC Core |
$20.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.25
|
| Rate for Payer: UHC Exchange |
$6.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.25
|
| Rate for Payer: VA VA |
$6.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.75
|
|
|
HC PH BLOOD
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.95 |
| 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 |
$8.35
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| 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 |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$8.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| 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 |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.47
|
| 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 Exchange |
$17.34
|
| Rate for Payer: UHC Medicare Advantage |
$17.34
|
| Rate for Payer: UHCCP Medicaid |
$7.95
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC PH BLOOD
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 82800
|
| Hospital Charge Code |
30100215
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$56.62
|
| 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 Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.47
|
| 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 PH BODY FLUID
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.87
|
| Rate for Payer: BCBS Complete |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$6.29
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCN Commercial |
$19.57
|
| Rate for Payer: BCN Medicare Advantage |
$6.29
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Mclaren Medicaid |
$2.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.61
|
| Rate for Payer: Meridian Medicaid |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: PACE Senior Care Partners |
$5.98
|
| Rate for Payer: PACE SWMI |
$6.29
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Medicare Advantage |
$6.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health Medicare |
$6.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: Railroad Medicare Medicare |
$6.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.29
|
| Rate for Payer: UHC Exchange |
$6.29
|
| Rate for Payer: UHC Medicare Advantage |
$6.29
|
| Rate for Payer: UHCCP Medicaid |
$2.59
|
| Rate for Payer: VA VA |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
|
|
HC PH BODY FLUID
|
Facility
|
IP
|
$25.17
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
30100384
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: BCBS Trust/PPO |
$20.55
|
| Rate for Payer: BCN Commercial |
$19.45
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Nomi Health Commercial |
$20.64
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.36
|
| Rate for Payer: Priority Health HMO/PPO |
$21.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.15
|
| Rate for Payer: UHC Core |
$21.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.88
|
|
|
HC PHENOBARB LVL
|
Facility
|
OP
|
$100.57
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$85.48
|
| Rate for Payer: Aetna Medicare |
$26.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.43
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$25.14
|
| Rate for Payer: BCBS Trust/PPO |
$82.68
|
| Rate for Payer: BCN Commercial |
$78.19
|
| Rate for Payer: BCN Medicare Advantage |
$25.14
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cofinity Commercial |
$86.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.14
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.43
|
| Rate for Payer: Mclaren Medicaid |
$11.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.40
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.48
|
| Rate for Payer: Nomi Health Commercial |
$82.47
|
| Rate for Payer: PACE Senior Care Partners |
$23.89
|
| Rate for Payer: PACE SWMI |
$25.14
|
| Rate for Payer: PHP Commercial |
$85.48
|
| Rate for Payer: PHP Medicare Advantage |
$25.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.37
|
| Rate for Payer: Priority Health HMO/PPO |
$87.50
|
| Rate for Payer: Priority Health Medicare |
$25.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.50
|
| Rate for Payer: UHC Core |
$83.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.14
|
| Rate for Payer: UHC Exchange |
$25.14
|
| Rate for Payer: UHC Medicare Advantage |
$25.14
|
| Rate for Payer: UHCCP Medicaid |
$11.06
|
| Rate for Payer: VA VA |
$25.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.43
|
|
|
HC PHENOBARB LVL
|
Facility
|
IP
|
$100.57
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
30100587
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$90.51 |
| Rate for Payer: Aetna Commercial |
$85.48
|
| Rate for Payer: BCBS Trust/PPO |
$82.10
|
| Rate for Payer: BCN Commercial |
$77.72
|
| Rate for Payer: Cash Price |
$80.46
|
| Rate for Payer: Cofinity Commercial |
$86.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$90.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.48
|
| Rate for Payer: Nomi Health Commercial |
$82.47
|
| Rate for Payer: PHP Commercial |
$85.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.37
|
| Rate for Payer: Priority Health HMO/PPO |
$87.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.50
|
| Rate for Payer: UHC Core |
$83.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.43
|
|
|
HC PH GASTRIC
|
Facility
|
IP
|
$24.68
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$20.15
|
| Rate for Payer: BCN Commercial |
$19.07
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: Nomi Health Commercial |
$20.24
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health HMO/PPO |
$21.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.72
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.51
|
|
|
HC PH GASTRIC
|
Facility
|
OP
|
$24.68
|
|
|
Service Code
|
CPT 82930
|
| Hospital Charge Code |
30100219
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$22.21 |
| Rate for Payer: Aetna Commercial |
$20.98
|
| Rate for Payer: Aetna Medicare |
$6.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.71
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS MAPPO |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$19.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.17
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cash Price |
$19.74
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.17
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.51
|
| Rate for Payer: Mclaren Medicaid |
$4.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.48
|
| Rate for Payer: Meridian Medicaid |
$5.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.98
|
| Rate for Payer: Nomi Health Commercial |
$20.24
|
| Rate for Payer: PACE Senior Care Partners |
$5.86
|
| Rate for Payer: PACE SWMI |
$6.17
|
| Rate for Payer: PHP Commercial |
$20.98
|
| Rate for Payer: PHP Medicare Advantage |
$6.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: Priority Health HMO/PPO |
$21.47
|
| Rate for Payer: Priority Health Medicare |
$6.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.54
|
| Rate for Payer: Railroad Medicare Medicare |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.72
|
| Rate for Payer: UHC Core |
$20.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.17
|
| Rate for Payer: UHC Exchange |
$6.17
|
| Rate for Payer: UHC Medicare Advantage |
$6.17
|
| Rate for Payer: UHCCP Medicaid |
$4.85
|
| Rate for Payer: VA VA |
$6.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.51
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
OP
|
$96.90
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: Aetna Medicare |
$25.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.28
|
| Rate for Payer: BCBS Complete |
$38.76
|
| Rate for Payer: BCBS MAPPO |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$79.66
|
| Rate for Payer: BCN Commercial |
$75.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.22
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: PACE Senior Care Partners |
$23.01
|
| Rate for Payer: PACE SWMI |
$24.22
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: PHP Medicare Advantage |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO |
$84.30
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.92
|
| Rate for Payer: Railroad Medicare Medicare |
$24.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.22
|
| Rate for Payer: UHC Exchange |
$24.22
|
| Rate for Payer: UHC Medicare Advantage |
$24.22
|
| Rate for Payer: VA VA |
$24.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC PHOSPHATIDYLETHANOL CONFIRMATION, BLOOD
|
Facility
|
IP
|
$96.90
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
30100743
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$82.36
|
| Rate for Payer: BCBS Trust/PPO |
$79.10
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$77.52
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.52
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.36
|
| Rate for Payer: Nomi Health Commercial |
$79.46
|
| Rate for Payer: PHP Commercial |
$82.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health HMO/PPO |
$84.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.27
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.68
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
IP
|
$75.48
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.06 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: BCBS Trust/PPO |
$61.61
|
| Rate for Payer: BCN Commercial |
$58.33
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO |
$65.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.42
|
| Rate for Payer: UHC Core |
$63.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
|
HC PHOSPHATIDYLGLYCEROL
|
Facility
|
OP
|
$75.48
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
30100635
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Aetna Medicare |
$19.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.59
|
| Rate for Payer: BCBS Complete |
$12.54
|
| Rate for Payer: BCBS MAPPO |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$62.05
|
| Rate for Payer: BCN Commercial |
$58.69
|
| Rate for Payer: BCN Medicare Advantage |
$18.87
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$64.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$67.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.61
|
| Rate for Payer: Mclaren Medicaid |
$11.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.81
|
| Rate for Payer: Meridian Medicaid |
$12.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.16
|
| Rate for Payer: Nomi Health Commercial |
$61.89
|
| Rate for Payer: PACE Senior Care Partners |
$17.93
|
| Rate for Payer: PACE SWMI |
$18.87
|
| Rate for Payer: PHP Commercial |
$64.16
|
| Rate for Payer: PHP Medicare Advantage |
$18.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.06
|
| Rate for Payer: Priority Health HMO/PPO |
$65.67
|
| Rate for Payer: Priority Health Medicare |
$19.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.57
|
| Rate for Payer: Railroad Medicare Medicare |
$18.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.42
|
| Rate for Payer: UHC Core |
$63.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.87
|
| Rate for Payer: UHC Exchange |
$18.87
|
| Rate for Payer: UHC Medicare Advantage |
$18.87
|
| Rate for Payer: UHCCP Medicaid |
$11.94
|
| Rate for Payer: VA VA |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.61
|
|
