|
HC PHOSPHOLIPASE A2 SCREEN
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200430
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.52
|
| Rate for Payer: BCN Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
OP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.66
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: BCBS MAPPO |
$52.53
|
| Rate for Payer: BCBS Trust/PPO |
$172.74
|
| Rate for Payer: BCN Commercial |
$163.37
|
| Rate for Payer: BCN Medicare Advantage |
$52.53
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.53
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Mclaren Medicaid |
$8.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.16
|
| Rate for Payer: Meridian Medicaid |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PACE Senior Care Partners |
$49.90
|
| Rate for Payer: PACE SWMI |
$52.53
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: PHP Medicare Advantage |
$52.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Medicare |
$53.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: Railroad Medicare Medicare |
$52.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.53
|
| Rate for Payer: UHC Exchange |
$52.53
|
| Rate for Payer: UHC Medicare Advantage |
$52.53
|
| Rate for Payer: UHCCP Medicaid |
$8.71
|
| Rate for Payer: VA VA |
$52.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOLIPASE A2 TITER
|
Facility
|
IP
|
$210.12
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
30200431
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$136.58 |
| Max. Negotiated Rate |
$189.11 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: BCBS Trust/PPO |
$171.52
|
| Rate for Payer: BCN Commercial |
$162.38
|
| Rate for Payer: Cash Price |
$168.10
|
| Rate for Payer: Cofinity Commercial |
$180.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.10
|
| Rate for Payer: Healthscope Commercial |
$189.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.60
|
| Rate for Payer: Nomi Health Commercial |
$172.30
|
| Rate for Payer: PHP Commercial |
$178.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health HMO/PPO |
$182.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.91
|
| Rate for Payer: UHC Core |
$175.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.59
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC PHOSPHOROUS SERUM
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
30100392
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.54
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$13.23
|
| Rate for Payer: BCBS Trust/PPO |
$43.52
|
| Rate for Payer: BCN Commercial |
$41.16
|
| Rate for Payer: BCN Medicare Advantage |
$13.23
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: Mclaren Medicaid |
$4.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Medicaid |
$4.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: PACE Senior Care Partners |
$12.57
|
| Rate for Payer: PACE SWMI |
$13.23
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health HMO/PPO |
$46.06
|
| Rate for Payer: Priority Health Medicare |
$13.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.47
|
| Rate for Payer: Railroad Medicare Medicare |
$13.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.59
|
| Rate for Payer: UHC Core |
$44.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.23
|
| Rate for Payer: UHC Exchange |
$13.23
|
| Rate for Payer: UHC Medicare Advantage |
$13.23
|
| Rate for Payer: UHCCP Medicaid |
$4.18
|
| Rate for Payer: VA VA |
$13.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HC PHOSPHOROUS URINE
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
30100393
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.41 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$43.21
|
| Rate for Payer: BCN Commercial |
$40.91
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.35
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.00
|
| Rate for Payer: Nomi Health Commercial |
$43.41
|
| Rate for Payer: PHP Commercial |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.41
|
| Rate for Payer: Priority Health HMO/PPO |
$46.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.59
|
| Rate for Payer: UHC Core |
$44.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.70
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$76.44
|
| Rate for Payer: BCN Commercial |
$72.36
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC PHYSICAL PERF TEST EA 15 MIN
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
42000038
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.26
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.81
|
| Rate for Payer: BCN Medicare Advantage |
$23.41
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.41
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.24
|
| Rate for Payer: PACE SWMI |
$23.41
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.87
|
| Rate for Payer: Priority Health HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.74
|
| Rate for Payer: Railroad Medicare Medicare |
$23.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.40
|
| Rate for Payer: UHC Core |
$78.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.41
|
| Rate for Payer: UHC Exchange |
$23.41
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC PICC INTRODUCER
|
Facility
|
IP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.91 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$83.57
|
| Rate for Payer: BCBS Trust/PPO |
$80.26
|
| Rate for Payer: BCN Commercial |
$75.98
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$84.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Healthscope Commercial |
$88.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: PHP Commercial |
$83.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO |
$85.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.52
|
| Rate for Payer: UHC Core |
$82.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.74
|
|
|
HC PICC INTRODUCER
|
Facility
|
OP
|
$98.32
|
|
| Hospital Charge Code |
27200147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$88.49 |
| Rate for Payer: Aetna Commercial |
$83.57
|
| Rate for Payer: Aetna Medicare |
$25.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.73
|
| Rate for Payer: BCBS Complete |
$39.33
|
| Rate for Payer: BCBS MAPPO |
$24.58
|
| Rate for Payer: BCBS Trust/PPO |
$80.83
|
| Rate for Payer: BCN Commercial |
$76.44
|
| Rate for Payer: BCN Medicare Advantage |
$24.58
|
| Rate for Payer: Cash Price |
$78.66
|
| Rate for Payer: Cofinity Commercial |
$84.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.58
|
| Rate for Payer: Healthscope Commercial |
$88.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.57
|
| Rate for Payer: Nomi Health Commercial |
$80.62
|
| Rate for Payer: PACE Senior Care Partners |
$23.35
|
| Rate for Payer: PACE SWMI |
$24.58
|
| Rate for Payer: PHP Commercial |
$83.57
|
| Rate for Payer: PHP Medicare Advantage |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.91
|
| Rate for Payer: Priority Health HMO/PPO |
$85.54
|
| Rate for Payer: Priority Health Medicare |
$24.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.87
|
| Rate for Payer: Railroad Medicare Medicare |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.52
|
| Rate for Payer: UHC Core |
$82.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.58
|
| Rate for Payer: UHC Exchange |
$24.58
|
| Rate for Payer: UHC Medicare Advantage |
$24.58
|
| Rate for Payer: VA VA |
$24.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.74
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
OP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$26.74 |
| Max. Negotiated Rate |
$101.33 |
| Rate for Payer: Aetna Commercial |
$95.70
|
| Rate for Payer: Aetna Medicare |
$29.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.18
|
| Rate for Payer: BCBS Complete |
$45.04
|
| Rate for Payer: BCBS MAPPO |
$28.15
|
| Rate for Payer: BCBS Trust/PPO |
$92.56
|
| Rate for Payer: BCN Commercial |
$87.54
|
| Rate for Payer: BCN Medicare Advantage |
$28.15
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: PACE Senior Care Partners |
$26.74
|
| Rate for Payer: PACE SWMI |
$28.15
|
| Rate for Payer: PHP Commercial |
$95.70
|
| Rate for Payer: PHP Medicare Advantage |
$28.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO |
$97.95
|
| Rate for Payer: Priority Health Medicare |
$28.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.44
|
| Rate for Payer: Railroad Medicare Medicare |
$28.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.08
|
| Rate for Payer: UHC Core |
$94.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.15
|
| Rate for Payer: UHC Exchange |
$28.15
|
| Rate for Payer: UHC Medicare Advantage |
$28.15
|
| Rate for Payer: VA VA |
$28.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.44
|
|
|
HC PICU 30" NITROUS OXIDE SED RECOVERY
|
Facility
|
IP
|
$112.59
|
|
| Hospital Charge Code |
37000019
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$101.33 |
| Rate for Payer: Aetna Commercial |
$95.70
|
| Rate for Payer: BCBS Trust/PPO |
$91.91
|
| Rate for Payer: BCN Commercial |
$87.01
|
| Rate for Payer: Cash Price |
$90.07
|
| Rate for Payer: Cofinity Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.07
|
| Rate for Payer: Healthscope Commercial |
$101.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.70
|
| Rate for Payer: Nomi Health Commercial |
$92.32
|
| Rate for Payer: PHP Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.18
|
| Rate for Payer: Priority Health HMO/PPO |
$97.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.08
|
| Rate for Payer: UHC Core |
$94.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.44
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
OP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: Aetna Medicare |
$52.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.79
|
| Rate for Payer: BCBS Complete |
$80.38
|
| Rate for Payer: BCBS MAPPO |
$50.23
|
| Rate for Payer: BCBS Trust/PPO |
$165.19
|
| Rate for Payer: BCN Commercial |
$156.23
|
| Rate for Payer: BCN Medicare Advantage |
$50.23
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PACE Senior Care Partners |
$47.72
|
| Rate for Payer: PACE SWMI |
$50.23
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: PHP Medicare Advantage |
$50.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Medicare |
$50.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: Railroad Medicare Medicare |
$50.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.23
|
| Rate for Payer: UHC Exchange |
$50.23
|
| Rate for Payer: UHC Medicare Advantage |
$50.23
|
| Rate for Payer: VA VA |
$50.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC PICU OBSERVATION PER HOUR
|
Facility
|
IP
|
$200.94
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200017
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$180.85 |
| Rate for Payer: Aetna Commercial |
$170.80
|
| Rate for Payer: BCBS Trust/PPO |
$164.03
|
| Rate for Payer: BCN Commercial |
$155.29
|
| Rate for Payer: Cash Price |
$160.75
|
| Rate for Payer: Cofinity Commercial |
$172.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.75
|
| Rate for Payer: Healthscope Commercial |
$180.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.80
|
| Rate for Payer: Nomi Health Commercial |
$164.77
|
| Rate for Payer: PHP Commercial |
$170.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.61
|
| Rate for Payer: Priority Health HMO/PPO |
$174.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.83
|
| Rate for Payer: UHC Core |
$167.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.71
|
|
|
HC PICU OR PED CRITICAL CARE R&B
|
Facility
|
IP
|
$7,801.90
|
|
| Hospital Charge Code |
20300001
|
|
Hospital Revenue Code
|
203
|
| Min. Negotiated Rate |
$5,071.23 |
| Max. Negotiated Rate |
$7,021.71 |
| Rate for Payer: Aetna Commercial |
$6,631.61
|
| Rate for Payer: BCBS Trust/PPO |
$6,368.69
|
| Rate for Payer: BCN Commercial |
$6,029.31
|
| Rate for Payer: Cash Price |
$6,241.52
|
| Rate for Payer: Cofinity Commercial |
$6,709.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,241.52
|
| Rate for Payer: Healthscope Commercial |
$7,021.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,851.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,631.61
|
| Rate for Payer: Nomi Health Commercial |
$6,397.56
|
| Rate for Payer: PHP Commercial |
$6,631.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,071.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6,787.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,227.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,865.67
|
| Rate for Payer: UHC Core |
$6,514.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,851.43
|
|
|
HC PICU OR PED INTERMEDIATE CARE R&B
|
Facility
|
IP
|
$6,510.25
|
|
| Hospital Charge Code |
20600002
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$4,231.66 |
| Max. Negotiated Rate |
$5,859.23 |
| Rate for Payer: Aetna Commercial |
$5,533.71
|
| Rate for Payer: BCBS Trust/PPO |
$5,314.32
|
| Rate for Payer: BCN Commercial |
$5,031.12
|
| Rate for Payer: Cash Price |
$5,208.20
|
| Rate for Payer: Cofinity Commercial |
$5,598.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,208.20
|
| Rate for Payer: Healthscope Commercial |
$5,859.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,882.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,533.71
|
| Rate for Payer: Nomi Health Commercial |
$5,338.40
|
| Rate for Payer: PHP Commercial |
$5,533.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,231.66
|
| Rate for Payer: Priority Health HMO/PPO |
$5,663.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,361.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,729.02
|
| Rate for Payer: UHC Core |
$5,436.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,882.69
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
IP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: BCBS Trust/PPO |
$257.18
|
| Rate for Payer: BCN Commercial |
$243.48
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: Priority Health HMO/PPO |
$274.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.25
|
| Rate for Payer: UHC Core |
$263.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
|
HC PICU/PEDS 30" SEDATION RECOVERY
|
Facility
|
OP
|
$315.06
|
|
| Hospital Charge Code |
71000009
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$74.83 |
| Max. Negotiated Rate |
$283.55 |
| Rate for Payer: Aetna Commercial |
$267.80
|
| Rate for Payer: Aetna Medicare |
$81.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.46
|
| Rate for Payer: BCBS Complete |
$126.02
|
| Rate for Payer: BCBS MAPPO |
$78.77
|
| Rate for Payer: BCBS Trust/PPO |
$259.01
|
| Rate for Payer: BCN Commercial |
$244.96
|
| Rate for Payer: BCN Medicare Advantage |
$78.77
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.77
|
| Rate for Payer: Healthscope Commercial |
$283.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$258.35
|
| Rate for Payer: PACE Senior Care Partners |
$74.83
|
| Rate for Payer: PACE SWMI |
$78.77
|
| Rate for Payer: PHP Commercial |
$267.80
|
| Rate for Payer: PHP Medicare Advantage |
$78.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.79
|
| Rate for Payer: Priority Health HMO/PPO |
$274.10
|
| Rate for Payer: Priority Health Medicare |
$79.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.09
|
| Rate for Payer: Railroad Medicare Medicare |
$78.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.25
|
| Rate for Payer: UHC Core |
$263.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.77
|
| Rate for Payer: UHC Exchange |
$78.77
|
| Rate for Payer: UHC Medicare Advantage |
$78.77
|
| Rate for Payer: VA VA |
$78.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.29
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
OP
|
$1,560.60
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$240.35 |
| Max. Negotiated Rate |
$1,404.54 |
| Rate for Payer: Aetna Commercial |
$1,326.51
|
| Rate for Payer: Aetna Medicare |
$405.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.69
|
| Rate for Payer: BCBS Complete |
$252.39
|
| Rate for Payer: BCBS MAPPO |
$390.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,282.97
|
| Rate for Payer: BCN Commercial |
$1,213.37
|
| Rate for Payer: BCN Medicare Advantage |
$390.15
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cofinity Commercial |
$1,342.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.15
|
| Rate for Payer: Healthscope Commercial |
$1,404.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,170.45
|
| Rate for Payer: Mclaren Medicaid |
$240.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.66
|
| Rate for Payer: Meridian Medicaid |
$252.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.51
|
| Rate for Payer: Nomi Health Commercial |
$1,279.69
|
| Rate for Payer: PACE Senior Care Partners |
$370.64
|
| Rate for Payer: PACE SWMI |
$390.15
|
| Rate for Payer: PHP Commercial |
$1,326.51
|
| Rate for Payer: PHP Medicare Advantage |
$390.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.39
|
| Rate for Payer: Priority Health HMO/PPO |
$1,357.72
|
| Rate for Payer: Priority Health Medicare |
$394.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,045.60
|
| Rate for Payer: Railroad Medicare Medicare |
$390.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,373.33
|
| Rate for Payer: UHC Core |
$1,303.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.15
|
| Rate for Payer: UHC Exchange |
$390.15
|
| Rate for Payer: UHC Medicare Advantage |
$390.15
|
| Rate for Payer: UHCCP Medicaid |
$240.35
|
| Rate for Payer: VA VA |
$390.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,170.45
|
|
|
HC PIFLUFOLASTAT PER MILLICURIE
|
Facility
|
IP
|
$1,560.60
|
|
|
Service Code
|
CPT A9595
|
| Hospital Charge Code |
34300369
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,014.39 |
| Max. Negotiated Rate |
$1,404.54 |
| Rate for Payer: Aetna Commercial |
$1,326.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.92
|
| Rate for Payer: BCN Commercial |
$1,206.03
|
| Rate for Payer: Cash Price |
$1,248.48
|
| Rate for Payer: Cofinity Commercial |
$1,342.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,248.48
|
| Rate for Payer: Healthscope Commercial |
$1,404.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,170.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.51
|
| Rate for Payer: Nomi Health Commercial |
$1,279.69
|
| Rate for Payer: PHP Commercial |
$1,326.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,014.39
|
| Rate for Payer: Priority Health HMO/PPO |
$1,357.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,045.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,373.33
|
| Rate for Payer: UHC Core |
$1,303.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,170.45
|
|
|
HC PIGWEED IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 PIGWEED IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200098
|
|
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 PI LINKED ANTIGEN
|
Facility
|
OP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$273.10 |
| Rate for Payer: Aetna Commercial |
$145.16
|
| Rate for Payer: Aetna Medicare |
$44.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.37
|
| Rate for Payer: BCBS Complete |
$273.10
|
| Rate for Payer: BCBS MAPPO |
$42.70
|
| Rate for Payer: BCBS Trust/PPO |
$140.40
|
| Rate for Payer: BCN Commercial |
$132.78
|
| Rate for Payer: BCN Medicare Advantage |
$42.70
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$146.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.70
|
| Rate for Payer: Healthscope Commercial |
$153.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.09
|
| Rate for Payer: Mclaren Medicaid |
$260.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.83
|
| Rate for Payer: Meridian Medicaid |
$273.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: PACE Senior Care Partners |
$40.56
|
| Rate for Payer: PACE SWMI |
$42.70
|
| Rate for Payer: PHP Commercial |
$145.16
|
| Rate for Payer: PHP Medicare Advantage |
$42.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health HMO/PPO |
$148.58
|
| Rate for Payer: Priority Health Medicare |
$43.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.42
|
| Rate for Payer: Railroad Medicare Medicare |
$42.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.29
|
| Rate for Payer: UHC Core |
$142.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.70
|
| Rate for Payer: UHC Exchange |
$42.70
|
| Rate for Payer: UHC Medicare Advantage |
$42.70
|
| Rate for Payer: UHCCP Medicaid |
$260.08
|
| Rate for Payer: VA VA |
$42.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.09
|
|
|
HC PI LINKED ANTIGEN
|
Facility
|
IP
|
$170.78
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31000004
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$153.70 |
| Rate for Payer: Aetna Commercial |
$145.16
|
| Rate for Payer: BCBS Trust/PPO |
$139.41
|
| Rate for Payer: BCN Commercial |
$131.98
|
| Rate for Payer: Cash Price |
$136.62
|
| Rate for Payer: Cofinity Commercial |
$146.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.62
|
| Rate for Payer: Healthscope Commercial |
$153.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.16
|
| Rate for Payer: Nomi Health Commercial |
$140.04
|
| Rate for Payer: PHP Commercial |
$145.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.01
|
| Rate for Payer: Priority Health HMO/PPO |
$148.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.29
|
| Rate for Payer: UHC Core |
$142.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.09
|
|
