|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
OP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$22.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.46
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS MAPPO |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$69.60
|
| Rate for Payer: BCN Commercial |
$65.82
|
| Rate for Payer: BCN Medicare Advantage |
$21.16
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.16
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.49
|
| Rate for Payer: Mclaren Medicaid |
$1.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.22
|
| Rate for Payer: Meridian Medicaid |
$1.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PACE Senior Care Partners |
$20.11
|
| Rate for Payer: PACE SWMI |
$21.16
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: PHP Medicare Advantage |
$21.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Medicare |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: Railroad Medicare Medicare |
$21.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.16
|
| Rate for Payer: UHC Exchange |
$21.16
|
| Rate for Payer: UHC Medicare Advantage |
$21.16
|
| Rate for Payer: UHCCP Medicaid |
$1.57
|
| Rate for Payer: VA VA |
$21.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.49
|
|
|
HC PROTOPORPHYRIN FREE WB
|
Facility
|
IP
|
$84.66
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
30100619
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.03 |
| Max. Negotiated Rate |
$76.19 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: BCBS Trust/PPO |
$69.11
|
| Rate for Payer: BCN Commercial |
$65.43
|
| Rate for Payer: Cash Price |
$67.73
|
| Rate for Payer: Cofinity Commercial |
$72.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.73
|
| Rate for Payer: Healthscope Commercial |
$76.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.96
|
| Rate for Payer: Nomi Health Commercial |
$69.42
|
| Rate for Payer: PHP Commercial |
$71.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.03
|
| Rate for Payer: Priority Health HMO/PPO |
$73.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.50
|
| Rate for Payer: UHC Core |
$70.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.49
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
OP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$22.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.98
|
| Rate for Payer: BCBS Complete |
$18.29
|
| Rate for Payer: BCBS MAPPO |
$21.59
|
| Rate for Payer: BCBS Trust/PPO |
$70.99
|
| Rate for Payer: BCN Commercial |
$67.14
|
| Rate for Payer: BCN Medicare Advantage |
$21.59
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.59
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.76
|
| Rate for Payer: Mclaren Medicaid |
$17.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.67
|
| Rate for Payer: Meridian Medicaid |
$18.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: PACE Senior Care Partners |
$20.51
|
| Rate for Payer: PACE SWMI |
$21.59
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: PHP Medicare Advantage |
$21.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: Priority Health HMO/PPO |
$75.12
|
| Rate for Payer: Priority Health Medicare |
$21.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.85
|
| Rate for Payer: Railroad Medicare Medicare |
$21.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.99
|
| Rate for Payer: UHC Core |
$72.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.59
|
| Rate for Payer: UHC Exchange |
$21.59
|
| Rate for Payer: UHC Medicare Advantage |
$21.59
|
| Rate for Payer: UHCCP Medicaid |
$17.42
|
| Rate for Payer: VA VA |
$21.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.76
|
|
|
HC PROTOPORPHYRINS, FRACTIONATION, WB
|
Facility
|
IP
|
$86.35
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
30100692
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$77.72 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: BCBS Trust/PPO |
$70.49
|
| Rate for Payer: BCN Commercial |
$66.73
|
| Rate for Payer: Cash Price |
$69.08
|
| Rate for Payer: Cofinity Commercial |
$74.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.08
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.40
|
| Rate for Payer: Nomi Health Commercial |
$70.81
|
| Rate for Payer: PHP Commercial |
$73.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.13
|
| Rate for Payer: Priority Health HMO/PPO |
$75.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.99
|
| Rate for Payer: UHC Core |
$72.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.76
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.77
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS MAPPO |
$17.42
|
| Rate for Payer: BCBS Trust/PPO |
$57.28
|
| Rate for Payer: BCN Commercial |
$54.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.42
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$13.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.29
|
| Rate for Payer: Meridian Medicaid |
$14.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Senior Care Partners |
$16.55
|
| Rate for Payer: PACE SWMI |
$17.42
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$17.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.42
|
| Rate for Payer: UHC Exchange |
$17.42
|
| Rate for Payer: UHC Medicare Advantage |
$17.42
|
| Rate for Payer: UHCCP Medicaid |
$13.96
|
| Rate for Payer: VA VA |
$17.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA ANNUAL SCREEN
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30000044
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: BCBS Trust/PPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$53.85
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA FREE
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: BCBS Trust/PPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$53.85
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA FREE
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
30100405
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.77
|
| Rate for Payer: BCBS Complete |
$13.96
|
| Rate for Payer: BCBS MAPPO |
$17.42
|
| Rate for Payer: BCBS Trust/PPO |
$57.28
|
| Rate for Payer: BCN Commercial |
$54.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.42
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$13.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.29
|
| Rate for Payer: Meridian Medicaid |
$13.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Senior Care Partners |
$16.55
|
| Rate for Payer: PACE SWMI |
$17.42
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$17.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.42
|
| Rate for Payer: UHC Exchange |
$17.42
|
| Rate for Payer: UHC Medicare Advantage |
$17.42
|
| Rate for Payer: UHCCP Medicaid |
$13.30
|
| Rate for Payer: VA VA |
$17.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA TOTAL
|
Facility
|
IP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.29 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: BCBS Trust/PPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$53.85
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSA TOTAL
|
Facility
|
OP
|
$69.68
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
30100403
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$62.71 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$18.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.77
|
| Rate for Payer: BCBS Complete |
$13.96
|
| Rate for Payer: BCBS MAPPO |
$17.42
|
| Rate for Payer: BCBS Trust/PPO |
$57.28
|
| Rate for Payer: BCN Commercial |
$54.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.42
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cash Price |
$55.74
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.42
|
| Rate for Payer: Healthscope Commercial |
$62.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$13.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.29
|
| Rate for Payer: Meridian Medicaid |
$13.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.23
|
| Rate for Payer: Nomi Health Commercial |
$57.14
|
| Rate for Payer: PACE Senior Care Partners |
$16.55
|
| Rate for Payer: PACE SWMI |
$17.42
|
| Rate for Payer: PHP Commercial |
$59.23
|
| Rate for Payer: PHP Medicare Advantage |
$17.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health HMO/PPO |
$60.62
|
| Rate for Payer: Priority Health Medicare |
$17.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.32
|
| Rate for Payer: UHC Core |
$58.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.42
|
| Rate for Payer: UHC Exchange |
$17.42
|
| Rate for Payer: UHC Medicare Advantage |
$17.42
|
| Rate for Payer: UHCCP Medicaid |
$13.30
|
| Rate for Payer: VA VA |
$17.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.26
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
OP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$246.99 |
| Max. Negotiated Rate |
$935.96 |
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: Aetna Medicare |
$270.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.99
|
| Rate for Payer: BCBS Complete |
$469.38
|
| Rate for Payer: BCBS MAPPO |
$259.99
|
| Rate for Payer: BCBS Trust/PPO |
$854.95
|
| Rate for Payer: BCN Commercial |
$808.57
|
| Rate for Payer: BCN Medicare Advantage |
$259.99
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.99
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.97
|
| Rate for Payer: Mclaren Medicaid |
$447.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.99
|
| Rate for Payer: Meridian Medicaid |
$469.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: PACE Senior Care Partners |
$246.99
|
| Rate for Payer: PACE SWMI |
$259.99
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: PHP Medicare Advantage |
$259.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health HMO/PPO |
$904.77
|
| Rate for Payer: Priority Health Medicare |
$262.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$696.77
|
| Rate for Payer: Railroad Medicare Medicare |
$259.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$915.16
|
| Rate for Payer: UHC Core |
$868.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.99
|
| Rate for Payer: UHC Exchange |
$259.99
|
| Rate for Payer: UHC Medicare Advantage |
$259.99
|
| Rate for Payer: UHCCP Medicaid |
$447.00
|
| Rate for Payer: VA VA |
$259.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.97
|
|
|
HC PSEUDOANEURYSM INJECTION
|
Facility
|
IP
|
$1,039.96
|
|
|
Service Code
|
CPT 36002
|
| Hospital Charge Code |
36100094
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.97 |
| Max. Negotiated Rate |
$935.96 |
| Rate for Payer: Aetna Commercial |
$883.97
|
| Rate for Payer: BCBS Trust/PPO |
$848.92
|
| Rate for Payer: BCN Commercial |
$803.68
|
| Rate for Payer: Cash Price |
$831.97
|
| Rate for Payer: Cofinity Commercial |
$894.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$831.97
|
| Rate for Payer: Healthscope Commercial |
$935.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$779.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$883.97
|
| Rate for Payer: Nomi Health Commercial |
$852.77
|
| Rate for Payer: PHP Commercial |
$883.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.97
|
| Rate for Payer: Priority Health HMO/PPO |
$904.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$696.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$915.16
|
| Rate for Payer: UHC Core |
$868.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$779.97
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$5.97
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$5.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: UHCCP Medicaid |
$5.69
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC PSEUDOCHOLINESTERASE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 82480
|
| Hospital Charge Code |
30100156
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,766.26 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: BCBS Trust/PPO |
$4,729.85
|
| Rate for Payer: BCN Commercial |
$4,477.80
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,345.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health HMO/PPO |
$5,041.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,882.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,098.94
|
| Rate for Payer: UHC Core |
$4,838.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,345.69
|
|
|
HC PSG PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,794.25
|
|
|
Service Code
|
CPT 95782
|
| Hospital Charge Code |
92000017
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.57 |
| Max. Negotiated Rate |
$5,214.82 |
| Rate for Payer: Aetna Commercial |
$4,925.11
|
| Rate for Payer: Aetna Medicare |
$1,506.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,810.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,810.70
|
| Rate for Payer: BCBS Complete |
$772.40
|
| Rate for Payer: BCBS MAPPO |
$1,448.56
|
| Rate for Payer: BCBS Trust/PPO |
$4,763.45
|
| Rate for Payer: BCN Commercial |
$4,505.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,448.56
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cash Price |
$4,635.40
|
| Rate for Payer: Cofinity Commercial |
$4,983.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,448.56
|
| Rate for Payer: Healthscope Commercial |
$5,214.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,345.69
|
| Rate for Payer: Mclaren Medicaid |
$735.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,520.99
|
| Rate for Payer: Meridian Medicaid |
$772.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,665.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,925.11
|
| Rate for Payer: Nomi Health Commercial |
$4,751.28
|
| Rate for Payer: PACE Senior Care Partners |
$1,376.13
|
| Rate for Payer: PACE SWMI |
$1,448.56
|
| Rate for Payer: PHP Commercial |
$4,925.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,448.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$735.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,766.26
|
| Rate for Payer: Priority Health HMO/PPO |
$5,041.00
|
| Rate for Payer: Priority Health Medicare |
$1,463.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,882.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,448.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,098.94
|
| Rate for Payer: UHC Core |
$4,838.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,448.56
|
| Rate for Payer: UHC Exchange |
$1,448.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,448.56
|
| Rate for Payer: UHCCP Medicaid |
$735.57
|
| Rate for Payer: VA VA |
$1,448.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,345.69
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
OP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$735.57 |
| Max. Negotiated Rate |
$5,384.72 |
| Rate for Payer: Aetna Commercial |
$5,085.57
|
| Rate for Payer: Aetna Medicare |
$1,555.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,869.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,869.69
|
| Rate for Payer: BCBS Complete |
$772.40
|
| Rate for Payer: BCBS MAPPO |
$1,495.76
|
| Rate for Payer: BCBS Trust/PPO |
$4,918.64
|
| Rate for Payer: BCN Commercial |
$4,651.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,495.76
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,145.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,495.76
|
| Rate for Payer: Healthscope Commercial |
$5,384.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,487.27
|
| Rate for Payer: Mclaren Medicaid |
$735.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,570.54
|
| Rate for Payer: Meridian Medicaid |
$772.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,720.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: PACE Senior Care Partners |
$1,420.97
|
| Rate for Payer: PACE SWMI |
$1,495.76
|
| Rate for Payer: PHP Commercial |
$5,085.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,495.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$735.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health HMO/PPO |
$5,205.23
|
| Rate for Payer: Priority Health Medicare |
$1,510.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,008.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,495.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,265.06
|
| Rate for Payer: UHC Core |
$4,995.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,495.76
|
| Rate for Payer: UHC Exchange |
$1,495.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,495.76
|
| Rate for Payer: UHCCP Medicaid |
$735.57
|
| Rate for Payer: VA VA |
$1,495.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,487.27
|
|
|
HC PSG W CPAP PEDS 5 AND UNDER
|
Facility
|
IP
|
$5,983.02
|
|
|
Service Code
|
CPT 95783
|
| Hospital Charge Code |
92000018
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$3,888.96 |
| Max. Negotiated Rate |
$5,384.72 |
| Rate for Payer: Aetna Commercial |
$5,085.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,883.94
|
| Rate for Payer: BCN Commercial |
$4,623.68
|
| Rate for Payer: Cash Price |
$4,786.42
|
| Rate for Payer: Cofinity Commercial |
$5,145.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,786.42
|
| Rate for Payer: Healthscope Commercial |
$5,384.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,487.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,085.57
|
| Rate for Payer: Nomi Health Commercial |
$4,906.08
|
| Rate for Payer: PHP Commercial |
$5,085.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,888.96
|
| Rate for Payer: Priority Health HMO/PPO |
$5,205.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,008.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,265.06
|
| Rate for Payer: UHC Core |
$4,995.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,487.27
|
|
|
HC PSORALEN
|
Facility
|
IP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,401.99 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.69
|
| Rate for Payer: BCN Commercial |
$1,666.86
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,876.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,445.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,898.08
|
| Rate for Payer: UHC Core |
$1,801.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.68
|
|
|
HC PSORALEN
|
Facility
|
OP
|
$2,156.91
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000085
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$1,941.22 |
| Rate for Payer: Aetna Commercial |
$1,833.37
|
| Rate for Payer: Aetna Medicare |
$560.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$674.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$674.03
|
| Rate for Payer: BCBS Complete |
$445.86
|
| Rate for Payer: BCBS MAPPO |
$539.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.20
|
| Rate for Payer: BCN Commercial |
$1,677.00
|
| Rate for Payer: BCN Medicare Advantage |
$539.23
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cash Price |
$1,725.53
|
| Rate for Payer: Cofinity Commercial |
$1,854.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,725.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.23
|
| Rate for Payer: Healthscope Commercial |
$1,941.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,617.68
|
| Rate for Payer: Mclaren Medicaid |
$424.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.19
|
| Rate for Payer: Meridian Medicaid |
$445.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$620.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.37
|
| Rate for Payer: Nomi Health Commercial |
$1,768.67
|
| Rate for Payer: PACE Senior Care Partners |
$512.27
|
| Rate for Payer: PACE SWMI |
$539.23
|
| Rate for Payer: PHP Commercial |
$1,833.37
|
| Rate for Payer: PHP Medicare Advantage |
$539.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,401.99
|
| Rate for Payer: Priority Health HMO/PPO |
$1,876.51
|
| Rate for Payer: Priority Health Medicare |
$544.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,445.13
|
| Rate for Payer: Railroad Medicare Medicare |
$539.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,898.08
|
| Rate for Payer: UHC Core |
$1,801.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$539.23
|
| Rate for Payer: UHC Exchange |
$539.23
|
| Rate for Payer: UHC Medicare Advantage |
$539.23
|
| Rate for Payer: UHCCP Medicaid |
$424.60
|
| Rate for Payer: VA VA |
$539.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,617.68
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
OP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$424.60 |
| Max. Negotiated Rate |
$2,014.66 |
| Rate for Payer: Aetna Commercial |
$1,902.73
|
| Rate for Payer: Aetna Medicare |
$582.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$699.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$699.53
|
| Rate for Payer: BCBS Complete |
$445.86
|
| Rate for Payer: BCBS MAPPO |
$559.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.28
|
| Rate for Payer: BCN Commercial |
$1,740.44
|
| Rate for Payer: BCN Medicare Advantage |
$559.63
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$1,925.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.63
|
| Rate for Payer: Healthscope Commercial |
$2,014.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,678.88
|
| Rate for Payer: Mclaren Medicaid |
$424.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.61
|
| Rate for Payer: Meridian Medicaid |
$445.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$643.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: Nomi Health Commercial |
$1,835.58
|
| Rate for Payer: PACE Senior Care Partners |
$531.65
|
| Rate for Payer: PACE SWMI |
$559.63
|
| Rate for Payer: PHP Commercial |
$1,902.73
|
| Rate for Payer: PHP Medicare Advantage |
$559.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,947.50
|
| Rate for Payer: Priority Health Medicare |
$565.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,499.80
|
| Rate for Payer: Railroad Medicare Medicare |
$559.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,969.89
|
| Rate for Payer: UHC Core |
$1,869.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$559.63
|
| Rate for Payer: UHC Exchange |
$559.63
|
| Rate for Payer: UHC Medicare Advantage |
$559.63
|
| Rate for Payer: UHCCP Medicaid |
$424.60
|
| Rate for Payer: VA VA |
$559.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,678.88
|
|
|
HC PSORALEN TREATED WASHED PLATELETS
|
Facility
|
IP
|
$2,238.51
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
39000086
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,455.03 |
| Max. Negotiated Rate |
$2,014.66 |
| Rate for Payer: Aetna Commercial |
$1,902.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.30
|
| Rate for Payer: BCN Commercial |
$1,729.92
|
| Rate for Payer: Cash Price |
$1,790.81
|
| Rate for Payer: Cofinity Commercial |
$1,925.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,790.81
|
| Rate for Payer: Healthscope Commercial |
$2,014.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,678.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,902.73
|
| Rate for Payer: Nomi Health Commercial |
$1,835.58
|
| Rate for Payer: PHP Commercial |
$1,902.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,455.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,947.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,499.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,969.89
|
| Rate for Payer: UHC Core |
$1,869.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,678.88
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
IP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.16 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: BCBS Trust/PPO |
$73.03
|
| Rate for Payer: BCN Commercial |
$69.14
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health HMO/PPO |
$77.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.73
|
| Rate for Payer: UHC Core |
$74.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.10
|
|
|
HC PSYCH COLLAB CARE MGMT EA ADD 30 MIN
|
Facility
|
OP
|
$89.47
|
|
|
Service Code
|
CPT 99494
|
| Hospital Charge Code |
51000094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$80.52 |
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Medicare |
$23.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.96
|
| Rate for Payer: BCBS Complete |
$35.79
|
| Rate for Payer: BCBS MAPPO |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$73.55
|
| Rate for Payer: BCN Commercial |
$69.56
|
| Rate for Payer: BCN Medicare Advantage |
$22.37
|
| Rate for Payer: Cash Price |
$71.58
|
| Rate for Payer: Cofinity Commercial |
$76.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$80.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$73.37
|
| Rate for Payer: PACE Senior Care Partners |
$21.25
|
| Rate for Payer: PACE SWMI |
$22.37
|
| Rate for Payer: PHP Commercial |
$76.05
|
| Rate for Payer: PHP Medicare Advantage |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.16
|
| Rate for Payer: Priority Health HMO/PPO |
$77.84
|
| Rate for Payer: Priority Health Medicare |
$22.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.94
|
| Rate for Payer: Railroad Medicare Medicare |
$22.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.73
|
| Rate for Payer: UHC Core |
$74.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.37
|
| Rate for Payer: UHC Exchange |
$22.37
|
| Rate for Payer: UHC Medicare Advantage |
$22.37
|
| Rate for Payer: VA VA |
$22.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.10
|
|
|
HC PSYCH COLLAB CARE MGMT INIT 70 MIN
|
Facility
|
OP
|
$95.72
|
|
|
Service Code
|
CPT 99492
|
| Hospital Charge Code |
51000092
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$86.15 |
| Rate for Payer: Aetna Commercial |
$81.36
|
| Rate for Payer: Aetna Medicare |
$24.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.91
|
| Rate for Payer: BCBS Complete |
$70.23
|
| Rate for Payer: BCBS MAPPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.69
|
| Rate for Payer: BCN Commercial |
$74.42
|
| Rate for Payer: BCN Medicare Advantage |
$23.93
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cash Price |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$82.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$86.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.79
|
| Rate for Payer: Mclaren Medicaid |
$66.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.13
|
| Rate for Payer: Meridian Medicaid |
$70.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.36
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: PACE Senior Care Partners |
$22.73
|
| Rate for Payer: PACE SWMI |
$23.93
|
| Rate for Payer: PHP Commercial |
$81.36
|
| Rate for Payer: PHP Medicare Advantage |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.22
|
| Rate for Payer: Priority Health HMO/PPO |
$83.28
|
| Rate for Payer: Priority Health Medicare |
$24.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.13
|
| Rate for Payer: Railroad Medicare Medicare |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.23
|
| Rate for Payer: UHC Core |
$79.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.93
|
| Rate for Payer: UHC Exchange |
$23.93
|
| Rate for Payer: UHC Medicare Advantage |
$23.93
|
| Rate for Payer: UHCCP Medicaid |
$66.88
|
| Rate for Payer: VA VA |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.79
|
|
