|
HC SENSORY INTEGRATION
|
Facility
|
OP
|
$92.60
|
|
|
Service Code
|
CPT 97533
|
| Hospital Charge Code |
42000029
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$83.34 |
| Rate for Payer: Aetna Commercial |
$78.71
|
| Rate for Payer: Aetna Medicare |
$24.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.94
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$76.13
|
| Rate for Payer: BCN Commercial |
$76.13
|
| Rate for Payer: BCN Medicare Advantage |
$23.15
|
| Rate for Payer: Cash Price |
$74.08
|
| Rate for Payer: Cofinity Commercial |
$79.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$83.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.45
|
| Rate for Payer: Mclaren Medicaid |
$16.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.31
|
| Rate for Payer: Meridian Medicaid |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.71
|
| Rate for Payer: Nomi Health Commercial |
$75.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.45
|
| Rate for Payer: PACE Senior Care Partners |
$21.99
|
| Rate for Payer: PACE SWMI |
$23.15
|
| Rate for Payer: PHP Commercial |
$78.71
|
| Rate for Payer: PHP Medicare Advantage |
$23.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.56
|
| Rate for Payer: Priority Health Medicare |
$23.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.45
|
| Rate for Payer: Railroad Medicare Medicare |
$23.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.49
|
| Rate for Payer: UHC Core |
$77.32
|
| Rate for Payer: UHC Exchange |
$23.15
|
| Rate for Payer: UHC Medicaid |
$16.33
|
| Rate for Payer: UHC Medicare Advantage |
$23.15
|
| Rate for Payer: UHCCP Medicaid |
$16.33
|
| Rate for Payer: VA VA |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.45
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
IP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$703.79 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: BCBS Trust/PPO |
$835.14
|
| Rate for Payer: BCN Commercial |
$835.14
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$879.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$703.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.85
|
| Rate for Payer: UHC Core |
$844.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.39
|
|
|
HC SENTINEL NODE INJ NON RADIOACTIVE
|
Facility
|
OP
|
$1,011.19
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
36000090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.27 |
| Max. Negotiated Rate |
$910.07 |
| Rate for Payer: Aetna Commercial |
$859.51
|
| Rate for Payer: Aetna Medicare |
$262.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$316.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$316.00
|
| Rate for Payer: BCBS Complete |
$187.17
|
| Rate for Payer: BCBS MAPPO |
$252.80
|
| Rate for Payer: BCBS Trust/PPO |
$831.30
|
| Rate for Payer: BCN Commercial |
$831.30
|
| Rate for Payer: BCN Medicare Advantage |
$252.80
|
| Rate for Payer: Cash Price |
$808.95
|
| Rate for Payer: Cofinity Commercial |
$869.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$808.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.80
|
| Rate for Payer: Healthscope Commercial |
$910.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$758.39
|
| Rate for Payer: Mclaren Medicaid |
$178.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.44
|
| Rate for Payer: Meridian Medicaid |
$187.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$278.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.51
|
| Rate for Payer: Nomi Health Commercial |
$829.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$758.39
|
| Rate for Payer: PACE Senior Care Partners |
$240.16
|
| Rate for Payer: PACE SWMI |
$252.80
|
| Rate for Payer: PHP Commercial |
$859.51
|
| Rate for Payer: PHP Medicare Advantage |
$252.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$879.74
|
| Rate for Payer: Priority Health Medicare |
$255.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$703.79
|
| Rate for Payer: Railroad Medicare Medicare |
$252.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$889.85
|
| Rate for Payer: UHC Core |
$844.34
|
| Rate for Payer: UHC Exchange |
$252.80
|
| Rate for Payer: UHC Medicaid |
$178.27
|
| Rate for Payer: UHC Medicare Advantage |
$252.80
|
| Rate for Payer: UHCCP Medicaid |
$178.27
|
| Rate for Payer: VA VA |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$758.39
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
OP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.51 |
| 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 |
$17.33
|
| Rate for Payer: BCBS MAPPO |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$76.98
|
| 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: Mclaren Medicaid |
$16.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.58
|
| Rate for Payer: Meridian Medicaid |
$17.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Nomi Health Commercial |
$76.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| 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 Choice Medicaid |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| 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 Exchange |
$23.41
|
| Rate for Payer: UHC Medicaid |
$16.51
|
| Rate for Payer: UHC Medicare Advantage |
$23.41
|
| Rate for Payer: UHCCP Medicaid |
$16.51
|
| Rate for Payer: VA VA |
$23.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.23
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 1
|
Facility
|
IP
|
$93.64
|
|
|
Service Code
|
CPT 84163
|
| Hospital Charge Code |
30100655
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: BCBS Trust/PPO |
$77.34
|
| Rate for Payer: BCN Commercial |
$77.34
|
| 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: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.17
|
| 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 SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
IP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: BCBS Trust/PPO |
$226.95
|
| Rate for Payer: BCN Commercial |
$226.95
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.82
|
| Rate for Payer: UHC Core |
$229.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.09
|
|
|
HC SEQUENTIAL MATERNAL SCRN PART 2
|
Facility
|
OP
|
$274.79
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
30100656
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$247.31 |
| Rate for Payer: Aetna Commercial |
$233.57
|
| Rate for Payer: Aetna Medicare |
$71.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.87
|
| Rate for Payer: BCBS Complete |
$50.86
|
| Rate for Payer: BCBS MAPPO |
$68.70
|
| Rate for Payer: BCBS Trust/PPO |
$225.90
|
| Rate for Payer: BCN Commercial |
$225.90
|
| Rate for Payer: BCN Medicare Advantage |
$68.70
|
| Rate for Payer: Cash Price |
$219.83
|
| Rate for Payer: Cofinity Commercial |
$236.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.70
|
| Rate for Payer: Healthscope Commercial |
$247.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.09
|
| Rate for Payer: Mclaren Medicaid |
$48.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.13
|
| Rate for Payer: Meridian Medicaid |
$50.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.57
|
| Rate for Payer: Nomi Health Commercial |
$225.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.09
|
| Rate for Payer: PACE Senior Care Partners |
$65.26
|
| Rate for Payer: PACE SWMI |
$68.70
|
| Rate for Payer: PHP Commercial |
$233.57
|
| Rate for Payer: PHP Medicare Advantage |
$68.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.07
|
| Rate for Payer: Priority Health Medicare |
$69.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.25
|
| Rate for Payer: Railroad Medicare Medicare |
$68.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.82
|
| Rate for Payer: UHC Core |
$229.45
|
| Rate for Payer: UHC Exchange |
$68.70
|
| Rate for Payer: UHC Medicaid |
$48.45
|
| Rate for Payer: UHC Medicare Advantage |
$68.70
|
| Rate for Payer: UHCCP Medicaid |
$48.45
|
| Rate for Payer: VA VA |
$68.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.09
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
IP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,548.71 |
| Max. Negotiated Rate |
$2,002.64 |
| Rate for Payer: Aetna Commercial |
$1,891.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,837.76
|
| Rate for Payer: BCN Commercial |
$1,837.76
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Commercial |
$1,913.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Healthscope Commercial |
$2,002.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,668.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Nomi Health Commercial |
$1,824.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: PHP Commercial |
$1,891.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,935.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,548.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,958.14
|
| Rate for Payer: UHC Core |
$1,858.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,668.87
|
|
|
HC SERIAL LOOP EXPLANT
|
Facility
|
OP
|
$2,225.16
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
36100082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$392.30 |
| Max. Negotiated Rate |
$2,002.64 |
| Rate for Payer: Aetna Commercial |
$1,891.39
|
| Rate for Payer: Aetna Medicare |
$578.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$695.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$695.36
|
| Rate for Payer: BCBS Complete |
$411.88
|
| Rate for Payer: BCBS MAPPO |
$556.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,829.30
|
| Rate for Payer: BCN Commercial |
$1,829.30
|
| Rate for Payer: BCN Medicare Advantage |
$556.29
|
| Rate for Payer: Cash Price |
$1,780.13
|
| Rate for Payer: Cofinity Commercial |
$1,913.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,780.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.29
|
| Rate for Payer: Healthscope Commercial |
$2,002.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,668.87
|
| Rate for Payer: Mclaren Medicaid |
$392.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$584.10
|
| Rate for Payer: Meridian Medicaid |
$411.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$639.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$611.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,891.39
|
| Rate for Payer: Nomi Health Commercial |
$1,824.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.87
|
| Rate for Payer: PACE Senior Care Partners |
$528.48
|
| Rate for Payer: PACE SWMI |
$556.29
|
| Rate for Payer: PHP Commercial |
$1,891.39
|
| Rate for Payer: PHP Medicare Advantage |
$556.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$392.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,935.89
|
| Rate for Payer: Priority Health Medicare |
$561.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,548.71
|
| Rate for Payer: Railroad Medicare Medicare |
$556.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,958.14
|
| Rate for Payer: UHC Core |
$1,858.01
|
| Rate for Payer: UHC Exchange |
$556.29
|
| Rate for Payer: UHC Medicaid |
$392.30
|
| Rate for Payer: UHC Medicare Advantage |
$556.29
|
| Rate for Payer: UHCCP Medicaid |
$392.30
|
| Rate for Payer: VA VA |
$556.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,668.87
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
IP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,128.93 |
| Max. Negotiated Rate |
$4,046.03 |
| Rate for Payer: Aetna Commercial |
$3,821.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,712.91
|
| Rate for Payer: BCN Commercial |
$3,712.91
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Commercial |
$3,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Healthscope Commercial |
$4,046.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,371.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Nomi Health Commercial |
$3,686.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: PHP Commercial |
$3,821.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,911.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,128.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,956.12
|
| Rate for Payer: UHC Core |
$3,753.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,371.69
|
|
|
HC SERIAL LOOP IMPLANT
|
Facility
|
OP
|
$4,495.59
|
|
|
Service Code
|
CPT 33285
|
| Hospital Charge Code |
36100081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$792.57 |
| Max. Negotiated Rate |
$4,046.03 |
| Rate for Payer: Aetna Commercial |
$3,821.25
|
| Rate for Payer: Aetna Medicare |
$1,168.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,404.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,404.87
|
| Rate for Payer: BCBS Complete |
$832.13
|
| Rate for Payer: BCBS MAPPO |
$1,123.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,695.82
|
| Rate for Payer: BCN Commercial |
$3,695.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.90
|
| Rate for Payer: Cash Price |
$3,596.47
|
| Rate for Payer: Cofinity Commercial |
$3,866.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,596.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.90
|
| Rate for Payer: Healthscope Commercial |
$4,046.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,371.69
|
| Rate for Payer: Mclaren Medicaid |
$792.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,180.09
|
| Rate for Payer: Meridian Medicaid |
$832.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,292.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,236.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,821.25
|
| Rate for Payer: Nomi Health Commercial |
$3,686.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,371.69
|
| Rate for Payer: PACE Senior Care Partners |
$1,067.70
|
| Rate for Payer: PACE SWMI |
$1,123.90
|
| Rate for Payer: PHP Commercial |
$3,821.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$792.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,911.16
|
| Rate for Payer: Priority Health Medicare |
$1,135.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,128.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,123.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,956.12
|
| Rate for Payer: UHC Core |
$3,753.82
|
| Rate for Payer: UHC Exchange |
$1,123.90
|
| Rate for Payer: UHC Medicaid |
$792.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,123.90
|
| Rate for Payer: UHCCP Medicaid |
$792.57
|
| Rate for Payer: VA VA |
$1,123.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,371.69
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
IP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,419.25 |
| Max. Negotiated Rate |
$9,593.86 |
| Rate for Payer: Aetna Commercial |
$9,060.86
|
| Rate for Payer: BCBS Trust/PPO |
$8,803.96
|
| Rate for Payer: BCN Commercial |
$8,803.96
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Commercial |
$9,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Healthscope Commercial |
$9,593.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,994.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Nomi Health Commercial |
$8,741.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: PHP Commercial |
$9,060.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,274.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,419.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,380.66
|
| Rate for Payer: UHC Core |
$8,900.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,994.88
|
|
|
HC SERIAL LOOP RECORDER
|
Facility
|
OP
|
$10,659.84
|
|
|
Service Code
|
HCPCS C1764
|
| Hospital Charge Code |
27800025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,879.33 |
| Max. Negotiated Rate |
$9,593.86 |
| Rate for Payer: Aetna Commercial |
$9,060.86
|
| Rate for Payer: Aetna Medicare |
$2,771.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,331.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,331.20
|
| Rate for Payer: BCBS Complete |
$1,973.14
|
| Rate for Payer: BCBS MAPPO |
$2,664.96
|
| Rate for Payer: BCBS Trust/PPO |
$8,763.45
|
| Rate for Payer: BCN Commercial |
$8,763.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,664.96
|
| Rate for Payer: Cash Price |
$8,527.87
|
| Rate for Payer: Cofinity Commercial |
$9,167.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,527.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,664.96
|
| Rate for Payer: Healthscope Commercial |
$9,593.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,994.88
|
| Rate for Payer: Mclaren Medicaid |
$1,879.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,798.21
|
| Rate for Payer: Meridian Medicaid |
$1,973.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,064.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,931.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,060.86
|
| Rate for Payer: Nomi Health Commercial |
$8,741.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,994.88
|
| Rate for Payer: PACE Senior Care Partners |
$2,531.71
|
| Rate for Payer: PACE SWMI |
$2,664.96
|
| Rate for Payer: PHP Commercial |
$9,060.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,664.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,879.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9,274.06
|
| Rate for Payer: Priority Health Medicare |
$2,691.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,419.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2,664.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,380.66
|
| Rate for Payer: UHC Core |
$8,900.97
|
| Rate for Payer: UHC Exchange |
$2,664.96
|
| Rate for Payer: UHC Medicaid |
$1,879.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,664.96
|
| Rate for Payer: UHCCP Medicaid |
$1,879.33
|
| Rate for Payer: VA VA |
$2,664.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,994.88
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
IP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: BCBS Trust/PPO |
$56.10
|
| Rate for Payer: BCN Commercial |
$56.10
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.77
|
| Rate for Payer: UHC Core |
$56.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC SEROTONIN HIAA BLOOD
|
Facility
|
OP
|
$67.92
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
30100421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$57.73
|
| Rate for Payer: Aetna Medicare |
$17.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.23
|
| Rate for Payer: BCBS Complete |
$12.57
|
| Rate for Payer: BCBS MAPPO |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$55.84
|
| Rate for Payer: BCN Commercial |
$55.84
|
| Rate for Payer: BCN Medicare Advantage |
$16.98
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$61.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.94
|
| Rate for Payer: Mclaren Medicaid |
$11.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.83
|
| Rate for Payer: Meridian Medicaid |
$12.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$55.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.94
|
| Rate for Payer: PACE Senior Care Partners |
$16.13
|
| Rate for Payer: PACE SWMI |
$16.98
|
| Rate for Payer: PHP Commercial |
$57.73
|
| Rate for Payer: PHP Medicare Advantage |
$16.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.09
|
| Rate for Payer: Priority Health Medicare |
$17.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.27
|
| Rate for Payer: Railroad Medicare Medicare |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.77
|
| Rate for Payer: UHC Core |
$56.71
|
| Rate for Payer: UHC Exchange |
$16.98
|
| Rate for Payer: UHC Medicaid |
$11.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.98
|
| Rate for Payer: UHCCP Medicaid |
$11.97
|
| Rate for Payer: VA VA |
$16.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.94
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
IP
|
$352.32
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$245.21 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: BCBS Trust/PPO |
$290.98
|
| Rate for Payer: BCN Commercial |
$290.98
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Nomi Health Commercial |
$288.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.24
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$306.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.04
|
| Rate for Payer: UHC Core |
$294.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.24
|
|
|
HC SEROTONIN RELEASE ASSAY
|
Facility
|
OP
|
$352.32
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200393
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.11 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna Commercial |
$299.47
|
| Rate for Payer: Aetna Medicare |
$91.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.10
|
| Rate for Payer: BCBS Complete |
$65.21
|
| Rate for Payer: BCBS MAPPO |
$88.08
|
| Rate for Payer: BCBS Trust/PPO |
$289.64
|
| Rate for Payer: BCN Commercial |
$289.64
|
| Rate for Payer: BCN Medicare Advantage |
$88.08
|
| Rate for Payer: Cash Price |
$281.86
|
| Rate for Payer: Cofinity Commercial |
$303.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.08
|
| Rate for Payer: Healthscope Commercial |
$317.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.24
|
| Rate for Payer: Mclaren Medicaid |
$62.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.48
|
| Rate for Payer: Meridian Medicaid |
$65.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.47
|
| Rate for Payer: Nomi Health Commercial |
$288.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.24
|
| Rate for Payer: PACE Senior Care Partners |
$83.68
|
| Rate for Payer: PACE SWMI |
$88.08
|
| Rate for Payer: PHP Commercial |
$299.47
|
| Rate for Payer: PHP Medicare Advantage |
$88.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$306.52
|
| Rate for Payer: Priority Health Medicare |
$88.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.21
|
| Rate for Payer: Railroad Medicare Medicare |
$88.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.04
|
| Rate for Payer: UHC Core |
$294.19
|
| Rate for Payer: UHC Exchange |
$88.08
|
| Rate for Payer: UHC Medicaid |
$62.11
|
| Rate for Payer: UHC Medicare Advantage |
$88.08
|
| Rate for Payer: UHCCP Medicaid |
$62.11
|
| Rate for Payer: VA VA |
$88.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.24
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
OP
|
$107.18
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: Aetna Medicare |
$27.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.49
|
| Rate for Payer: BCBS Complete |
$19.84
|
| Rate for Payer: BCBS MAPPO |
$26.80
|
| Rate for Payer: BCBS Trust/PPO |
$88.11
|
| Rate for Payer: BCN Commercial |
$88.11
|
| Rate for Payer: BCN Medicare Advantage |
$26.80
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.39
|
| Rate for Payer: Mclaren Medicaid |
$18.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.13
|
| Rate for Payer: Meridian Medicaid |
$19.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Nomi Health Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PACE Senior Care Partners |
$25.46
|
| Rate for Payer: PACE SWMI |
$26.80
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: PHP Medicare Advantage |
$26.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.25
|
| Rate for Payer: Priority Health Medicare |
$27.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.60
|
| Rate for Payer: Railroad Medicare Medicare |
$26.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.32
|
| Rate for Payer: UHC Core |
$89.50
|
| Rate for Payer: UHC Exchange |
$26.80
|
| Rate for Payer: UHC Medicaid |
$18.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.80
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: VA VA |
$26.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.39
|
|
|
HC SEROTONIN RELEASE ASSAY LOVENOX
|
Facility
|
IP
|
$107.18
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200131
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$96.46 |
| Rate for Payer: Aetna Commercial |
$91.10
|
| Rate for Payer: BCBS Trust/PPO |
$88.52
|
| Rate for Payer: BCN Commercial |
$88.52
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Cofinity Commercial |
$92.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.74
|
| Rate for Payer: Healthscope Commercial |
$96.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.10
|
| Rate for Payer: Nomi Health Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.39
|
| Rate for Payer: PHP Commercial |
$91.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.32
|
| Rate for Payer: UHC Core |
$89.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.39
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.34 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna Medicare |
$108.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.00
|
| Rate for Payer: BCBS Complete |
$77.00
|
| Rate for Payer: BCBS MAPPO |
$104.00
|
| Rate for Payer: BCBS Trust/PPO |
$341.99
|
| Rate for Payer: BCN Commercial |
$341.99
|
| Rate for Payer: BCN Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.00
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.00
|
| Rate for Payer: Mclaren Medicaid |
$73.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.20
|
| Rate for Payer: Meridian Medicaid |
$77.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PACE Senior Care Partners |
$98.80
|
| Rate for Payer: PACE SWMI |
$104.00
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: PHP Medicare Advantage |
$104.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$361.92
|
| Rate for Payer: Priority Health Medicare |
$105.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.54
|
| Rate for Payer: Railroad Medicare Medicare |
$104.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.08
|
| Rate for Payer: UHC Core |
$347.36
|
| Rate for Payer: UHC Exchange |
$104.00
|
| Rate for Payer: UHC Medicaid |
$73.34
|
| Rate for Payer: UHC Medicare Advantage |
$104.00
|
| Rate for Payer: UHCCP Medicaid |
$73.34
|
| Rate for Payer: VA VA |
$104.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.00
|
|
|
HC SEROTONIN RELEASE ASSAY PORCINE
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
30200132
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$289.54 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: BCBS Trust/PPO |
$343.57
|
| Rate for Payer: BCN Commercial |
$343.57
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$361.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.08
|
| Rate for Payer: UHC Core |
$347.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.00
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.68
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: BCN Medicare Advantage |
$19.74
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.73
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Senior Care Partners |
$18.76
|
| Rate for Payer: PACE SWMI |
$19.74
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$19.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$19.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: UHC Exchange |
$19.74
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHC Medicare Advantage |
$19.74
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
|
HC SERUM FREE LIGHT CHAIN
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
OP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.68
|
| Rate for Payer: BCBS Complete |
$14.62
|
| Rate for Payer: BCBS MAPPO |
$19.74
|
| Rate for Payer: BCBS Trust/PPO |
$64.92
|
| Rate for Payer: BCN Commercial |
$64.92
|
| Rate for Payer: BCN Medicare Advantage |
$19.74
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.74
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Mclaren Medicaid |
$13.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.73
|
| Rate for Payer: Meridian Medicaid |
$14.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PACE Senior Care Partners |
$18.76
|
| Rate for Payer: PACE SWMI |
$19.74
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: PHP Medicare Advantage |
$19.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$19.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: Railroad Medicare Medicare |
$19.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: UHC Exchange |
$19.74
|
| Rate for Payer: UHC Medicaid |
$13.92
|
| Rate for Payer: UHC Medicare Advantage |
$19.74
|
| Rate for Payer: UHCCP Medicaid |
$13.92
|
| Rate for Payer: VA VA |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
|
HC SERUM FREE LIGHT CHAIN CMPT
|
Facility
|
IP
|
$78.97
|
|
|
Service Code
|
CPT 83521
|
| Hospital Charge Code |
30100306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$71.07 |
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: BCBS Trust/PPO |
$65.22
|
| Rate for Payer: BCN Commercial |
$65.22
|
| Rate for Payer: Cash Price |
$63.18
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$71.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$64.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.23
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.49
|
| Rate for Payer: UHC Core |
$65.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.23
|
|
