|
HC PV JAK2V617F
|
Facility
|
IP
|
$329.51
|
|
|
Service Code
|
CPT 81270
|
| Hospital Charge Code |
31000147
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$214.18 |
| Max. Negotiated Rate |
$296.56 |
| Rate for Payer: Aetna Commercial |
$280.08
|
| Rate for Payer: BCBS Trust/PPO |
$268.98
|
| Rate for Payer: BCN Commercial |
$254.65
|
| Rate for Payer: Cash Price |
$263.61
|
| Rate for Payer: Cofinity Commercial |
$283.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.61
|
| Rate for Payer: Healthscope Commercial |
$296.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.08
|
| Rate for Payer: Nomi Health Commercial |
$270.20
|
| Rate for Payer: PHP Commercial |
$280.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.18
|
| Rate for Payer: Priority Health HMO/PPO |
$286.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$289.97
|
| Rate for Payer: UHC Core |
$275.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.13
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
OP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$24.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.64
|
| Rate for Payer: BCBS Complete |
$7.17
|
| Rate for Payer: BCBS MAPPO |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$77.98
|
| Rate for Payer: BCN Commercial |
$73.75
|
| Rate for Payer: BCN Medicare Advantage |
$23.72
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.72
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.14
|
| Rate for Payer: Mclaren Medicaid |
$6.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.90
|
| Rate for Payer: Meridian Medicaid |
$7.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: Nomi Health Commercial |
$77.79
|
| Rate for Payer: PACE Senior Care Partners |
$22.53
|
| Rate for Payer: PACE SWMI |
$23.72
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: PHP Medicare Advantage |
$23.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: Priority Health HMO/PPO |
$82.53
|
| Rate for Payer: Priority Health Medicare |
$23.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.56
|
| Rate for Payer: Railroad Medicare Medicare |
$23.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.48
|
| Rate for Payer: UHC Core |
$79.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.72
|
| Rate for Payer: UHC Exchange |
$23.72
|
| Rate for Payer: UHC Medicare Advantage |
$23.72
|
| Rate for Payer: UHCCP Medicaid |
$6.83
|
| Rate for Payer: VA VA |
$23.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.14
|
|
|
HC PYRUVATE KINASE RBC
|
Facility
|
IP
|
$94.86
|
|
|
Service Code
|
CPT 84220
|
| Hospital Charge Code |
30100415
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$85.37 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: BCBS Trust/PPO |
$77.43
|
| Rate for Payer: BCN Commercial |
$73.31
|
| Rate for Payer: Cash Price |
$75.89
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.89
|
| Rate for Payer: Healthscope Commercial |
$85.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.63
|
| Rate for Payer: Nomi Health Commercial |
$77.79
|
| Rate for Payer: PHP Commercial |
$80.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.66
|
| Rate for Payer: Priority Health HMO/PPO |
$82.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.48
|
| Rate for Payer: UHC Core |
$79.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.14
|
|
|
HC PYRUVATE PYRUVIC ACID
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
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 PYRUVATE PYRUVIC ACID
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
30100414
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.47 |
| 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 |
$10.99
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| 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 |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$10.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$10.99
|
| 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 |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.47
|
| 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 |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$10.47
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
OP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: Aetna Medicare |
$24.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.34
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$23.47
|
| Rate for Payer: BCBS Trust/PPO |
$77.19
|
| Rate for Payer: BCN Commercial |
$73.00
|
| Rate for Payer: BCN Medicare Advantage |
$23.47
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.47
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.42
|
| Rate for Payer: Mclaren Medicaid |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.65
|
| Rate for Payer: Meridian Medicaid |
$9.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: Nomi Health Commercial |
$76.99
|
| Rate for Payer: PACE Senior Care Partners |
$22.30
|
| Rate for Payer: PACE SWMI |
$23.47
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: PHP Medicare Advantage |
$23.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health HMO/PPO |
$81.68
|
| Rate for Payer: Priority Health Medicare |
$23.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.91
|
| Rate for Payer: Railroad Medicare Medicare |
$23.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.62
|
| Rate for Payer: UHC Core |
$78.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.47
|
| Rate for Payer: UHC Exchange |
$23.47
|
| Rate for Payer: UHC Medicare Advantage |
$23.47
|
| Rate for Payer: UHCCP Medicaid |
$8.76
|
| Rate for Payer: VA VA |
$23.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.42
|
|
|
HC Q FEVER AB (COXIELLA BURNETTI)
|
Facility
|
IP
|
$93.89
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
30200247
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$79.81
|
| Rate for Payer: BCBS Trust/PPO |
$76.64
|
| Rate for Payer: BCN Commercial |
$72.56
|
| Rate for Payer: Cash Price |
$75.11
|
| Rate for Payer: Cofinity Commercial |
$80.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.11
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.81
|
| Rate for Payer: Nomi Health Commercial |
$76.99
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.03
|
| Rate for Payer: Priority Health HMO/PPO |
$81.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.62
|
| Rate for Payer: UHC Core |
$78.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.42
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
IP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna Commercial |
$289.94
|
| Rate for Payer: BCBS Trust/PPO |
$278.45
|
| Rate for Payer: BCN Commercial |
$263.61
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$293.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Healthscope Commercial |
$307.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: Nomi Health Commercial |
$279.71
|
| Rate for Payer: PHP Commercial |
$289.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: Priority Health HMO/PPO |
$296.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.18
|
| Rate for Payer: UHC Core |
$284.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.83
|
|
|
HC QUAD 16CM CATHETER
|
Facility
|
OP
|
$341.11
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200067
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$307.00 |
| Rate for Payer: Aetna Commercial |
$289.94
|
| Rate for Payer: Aetna Medicare |
$88.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.60
|
| Rate for Payer: BCBS Complete |
$136.44
|
| Rate for Payer: BCBS MAPPO |
$85.28
|
| Rate for Payer: BCBS Trust/PPO |
$280.43
|
| Rate for Payer: BCN Commercial |
$265.21
|
| Rate for Payer: BCN Medicare Advantage |
$85.28
|
| Rate for Payer: Cash Price |
$272.89
|
| Rate for Payer: Cofinity Commercial |
$293.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.28
|
| Rate for Payer: Healthscope Commercial |
$307.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.94
|
| Rate for Payer: Nomi Health Commercial |
$279.71
|
| Rate for Payer: PACE Senior Care Partners |
$81.01
|
| Rate for Payer: PACE SWMI |
$85.28
|
| Rate for Payer: PHP Commercial |
$289.94
|
| Rate for Payer: PHP Medicare Advantage |
$85.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.72
|
| Rate for Payer: Priority Health HMO/PPO |
$296.77
|
| Rate for Payer: Priority Health Medicare |
$86.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.54
|
| Rate for Payer: Railroad Medicare Medicare |
$85.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.18
|
| Rate for Payer: UHC Core |
$284.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.28
|
| Rate for Payer: UHC Exchange |
$85.28
|
| Rate for Payer: UHC Medicare Advantage |
$85.28
|
| Rate for Payer: VA VA |
$85.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.83
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
IP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.76 |
| Max. Negotiated Rate |
$312.59 |
| Rate for Payer: Aetna Commercial |
$295.22
|
| Rate for Payer: BCBS Trust/PPO |
$283.52
|
| Rate for Payer: BCN Commercial |
$268.41
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Healthscope Commercial |
$312.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: PHP Commercial |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health HMO/PPO |
$302.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.64
|
| Rate for Payer: UHC Core |
$290.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.49
|
|
|
HC QUAD 20CM CATHETER
|
Facility
|
OP
|
$347.32
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27200068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.49 |
| Max. Negotiated Rate |
$312.59 |
| Rate for Payer: Aetna Commercial |
$295.22
|
| Rate for Payer: Aetna Medicare |
$90.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.54
|
| Rate for Payer: BCBS Complete |
$138.93
|
| Rate for Payer: BCBS MAPPO |
$86.83
|
| Rate for Payer: BCBS Trust/PPO |
$285.53
|
| Rate for Payer: BCN Commercial |
$270.04
|
| Rate for Payer: BCN Medicare Advantage |
$86.83
|
| Rate for Payer: Cash Price |
$277.86
|
| Rate for Payer: Cofinity Commercial |
$298.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.83
|
| Rate for Payer: Healthscope Commercial |
$312.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.22
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: PACE Senior Care Partners |
$82.49
|
| Rate for Payer: PACE SWMI |
$86.83
|
| Rate for Payer: PHP Commercial |
$295.22
|
| Rate for Payer: PHP Medicare Advantage |
$86.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.76
|
| Rate for Payer: Priority Health HMO/PPO |
$302.17
|
| Rate for Payer: Priority Health Medicare |
$87.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.70
|
| Rate for Payer: Railroad Medicare Medicare |
$86.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.64
|
| Rate for Payer: UHC Core |
$290.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.83
|
| Rate for Payer: UHC Exchange |
$86.83
|
| Rate for Payer: UHC Medicare Advantage |
$86.83
|
| Rate for Payer: VA VA |
$86.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.49
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
IP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$163.22 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: BCBS Trust/PPO |
$204.97
|
| Rate for Payer: BCN Commercial |
$194.05
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health HMO/PPO |
$218.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.97
|
| Rate for Payer: UHC Core |
$209.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.32
|
|
|
HC QUAD SCREEN MATERNAL
|
Facility
|
OP
|
$251.10
|
|
|
Service Code
|
CPT 81511
|
| Hospital Charge Code |
31000104
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$225.99 |
| Rate for Payer: Aetna Commercial |
$213.44
|
| Rate for Payer: Aetna Medicare |
$65.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.47
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: BCBS MAPPO |
$62.78
|
| Rate for Payer: BCBS Trust/PPO |
$206.43
|
| Rate for Payer: BCN Commercial |
$195.23
|
| Rate for Payer: BCN Medicare Advantage |
$62.78
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cash Price |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$215.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.78
|
| Rate for Payer: Healthscope Commercial |
$225.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.32
|
| Rate for Payer: Mclaren Medicaid |
$110.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.91
|
| Rate for Payer: Meridian Medicaid |
$116.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.44
|
| Rate for Payer: Nomi Health Commercial |
$205.90
|
| Rate for Payer: PACE Senior Care Partners |
$59.64
|
| Rate for Payer: PACE SWMI |
$62.78
|
| Rate for Payer: PHP Commercial |
$213.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.22
|
| Rate for Payer: Priority Health HMO/PPO |
$218.46
|
| Rate for Payer: Priority Health Medicare |
$63.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.24
|
| Rate for Payer: Railroad Medicare Medicare |
$62.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.97
|
| Rate for Payer: UHC Core |
$209.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.78
|
| Rate for Payer: UHC Exchange |
$62.78
|
| Rate for Payer: UHC Medicare Advantage |
$62.78
|
| Rate for Payer: UHCCP Medicaid |
$110.98
|
| Rate for Payer: VA VA |
$62.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.32
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
IP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$147.64 |
| Rate for Payer: Aetna Commercial |
$139.44
|
| Rate for Payer: BCBS Trust/PPO |
$133.91
|
| Rate for Payer: BCN Commercial |
$126.78
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$141.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Healthscope Commercial |
$147.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: Nomi Health Commercial |
$134.52
|
| Rate for Payer: PHP Commercial |
$139.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: Priority Health HMO/PPO |
$142.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.36
|
| Rate for Payer: UHC Core |
$136.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.04
|
|
|
HC QUANTIFERON_TB GOLD
|
Facility
|
OP
|
$164.05
|
|
|
Service Code
|
CPT 86481
|
| Hospital Charge Code |
30200456
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$147.64 |
| Rate for Payer: Aetna Commercial |
$139.44
|
| Rate for Payer: Aetna Medicare |
$42.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.27
|
| Rate for Payer: BCBS Complete |
$75.92
|
| Rate for Payer: BCBS MAPPO |
$41.01
|
| Rate for Payer: BCBS Trust/PPO |
$134.87
|
| Rate for Payer: BCN Commercial |
$127.55
|
| Rate for Payer: BCN Medicare Advantage |
$41.01
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cofinity Commercial |
$141.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.01
|
| Rate for Payer: Healthscope Commercial |
$147.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.04
|
| Rate for Payer: Mclaren Medicaid |
$72.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.06
|
| Rate for Payer: Meridian Medicaid |
$75.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.44
|
| Rate for Payer: Nomi Health Commercial |
$134.52
|
| Rate for Payer: PACE Senior Care Partners |
$38.96
|
| Rate for Payer: PACE SWMI |
$41.01
|
| Rate for Payer: PHP Commercial |
$139.44
|
| Rate for Payer: PHP Medicare Advantage |
$41.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.63
|
| Rate for Payer: Priority Health HMO/PPO |
$142.72
|
| Rate for Payer: Priority Health Medicare |
$41.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.91
|
| Rate for Payer: Railroad Medicare Medicare |
$41.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.36
|
| Rate for Payer: UHC Core |
$136.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.01
|
| Rate for Payer: UHC Exchange |
$41.01
|
| Rate for Payer: UHC Medicare Advantage |
$41.01
|
| Rate for Payer: UHCCP Medicaid |
$72.30
|
| Rate for Payer: VA VA |
$41.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.04
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
IP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$76.28 |
| Max. Negotiated Rate |
$105.62 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: BCBS Trust/PPO |
$95.80
|
| Rate for Payer: BCN Commercial |
$90.70
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Healthscope Commercial |
$105.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: Nomi Health Commercial |
$96.24
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: Priority Health HMO/PPO |
$102.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.28
|
| Rate for Payer: UHC Core |
$98.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.02
|
|
|
HC QUANTIFERON - TB GOLD PLUS
|
Facility
|
OP
|
$117.36
|
|
|
Service Code
|
CPT 86480
|
| Hospital Charge Code |
30200414
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$105.62 |
| Rate for Payer: Aetna Commercial |
$99.76
|
| Rate for Payer: Aetna Medicare |
$30.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.68
|
| Rate for Payer: BCBS Complete |
$47.06
|
| Rate for Payer: BCBS MAPPO |
$29.34
|
| Rate for Payer: BCBS Trust/PPO |
$96.48
|
| Rate for Payer: BCN Commercial |
$91.25
|
| Rate for Payer: BCN Medicare Advantage |
$29.34
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cash Price |
$93.89
|
| Rate for Payer: Cofinity Commercial |
$100.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.34
|
| Rate for Payer: Healthscope Commercial |
$105.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.02
|
| Rate for Payer: Mclaren Medicaid |
$44.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.81
|
| Rate for Payer: Meridian Medicaid |
$47.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.76
|
| Rate for Payer: Nomi Health Commercial |
$96.24
|
| Rate for Payer: PACE Senior Care Partners |
$27.87
|
| Rate for Payer: PACE SWMI |
$29.34
|
| Rate for Payer: PHP Commercial |
$99.76
|
| Rate for Payer: PHP Medicare Advantage |
$29.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.28
|
| Rate for Payer: Priority Health HMO/PPO |
$102.10
|
| Rate for Payer: Priority Health Medicare |
$29.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.63
|
| Rate for Payer: Railroad Medicare Medicare |
$29.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.28
|
| Rate for Payer: UHC Core |
$98.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.34
|
| Rate for Payer: UHC Exchange |
$29.34
|
| Rate for Payer: UHC Medicare Advantage |
$29.34
|
| Rate for Payer: UHCCP Medicaid |
$44.81
|
| Rate for Payer: VA VA |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.02
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
IP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: BCBS Trust/PPO |
$46.63
|
| Rate for Payer: BCN Commercial |
$44.14
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC QUINIDINE LEVEL
|
Facility
|
OP
|
$57.12
|
|
|
Service Code
|
CPT 80194
|
| Hospital Charge Code |
30100044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$51.41 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$14.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.85
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS MAPPO |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.96
|
| Rate for Payer: BCN Commercial |
$44.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.28
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cash Price |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$49.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.28
|
| Rate for Payer: Healthscope Commercial |
$51.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.84
|
| Rate for Payer: Mclaren Medicaid |
$10.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.99
|
| Rate for Payer: Meridian Medicaid |
$11.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.55
|
| Rate for Payer: Nomi Health Commercial |
$46.84
|
| Rate for Payer: PACE Senior Care Partners |
$13.57
|
| Rate for Payer: PACE SWMI |
$14.28
|
| Rate for Payer: PHP Commercial |
$48.55
|
| Rate for Payer: PHP Medicare Advantage |
$14.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.13
|
| Rate for Payer: Priority Health HMO/PPO |
$49.69
|
| Rate for Payer: Priority Health Medicare |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.27
|
| Rate for Payer: Railroad Medicare Medicare |
$14.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.27
|
| Rate for Payer: UHC Core |
$47.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.28
|
| Rate for Payer: UHC Exchange |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$14.28
|
| Rate for Payer: UHCCP Medicaid |
$10.56
|
| Rate for Payer: VA VA |
$14.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.84
|
|
|
HC RABIES VACCINE IM
|
Facility
|
OP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$236.98 |
| Max. Negotiated Rate |
$933.52 |
| Rate for Payer: Aetna Commercial |
$881.65
|
| Rate for Payer: Aetna Medicare |
$269.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$324.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$324.14
|
| Rate for Payer: BCBS Complete |
$248.85
|
| Rate for Payer: BCBS MAPPO |
$259.31
|
| Rate for Payer: BCBS Trust/PPO |
$852.72
|
| Rate for Payer: BCN Commercial |
$806.45
|
| Rate for Payer: BCN Medicare Advantage |
$259.31
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$892.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.31
|
| Rate for Payer: Healthscope Commercial |
$933.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$777.93
|
| Rate for Payer: Mclaren Medicaid |
$236.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.28
|
| Rate for Payer: Meridian Medicaid |
$248.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: PACE Senior Care Partners |
$246.34
|
| Rate for Payer: PACE SWMI |
$259.31
|
| Rate for Payer: PHP Commercial |
$881.65
|
| Rate for Payer: PHP Medicare Advantage |
$259.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health HMO/PPO |
$902.40
|
| Rate for Payer: Priority Health Medicare |
$261.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$694.95
|
| Rate for Payer: Railroad Medicare Medicare |
$259.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.77
|
| Rate for Payer: UHC Core |
$866.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.31
|
| Rate for Payer: UHC Exchange |
$259.31
|
| Rate for Payer: UHC Medicare Advantage |
$259.31
|
| Rate for Payer: UHCCP Medicaid |
$236.98
|
| Rate for Payer: VA VA |
$259.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.93
|
|
|
HC RABIES VACCINE IM
|
Facility
|
IP
|
$1,037.24
|
|
|
Service Code
|
CPT 90675
|
| Hospital Charge Code |
63600234
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$674.21 |
| Max. Negotiated Rate |
$933.52 |
| Rate for Payer: Aetna Commercial |
$881.65
|
| Rate for Payer: BCBS Trust/PPO |
$846.70
|
| Rate for Payer: BCN Commercial |
$801.58
|
| Rate for Payer: Cash Price |
$829.79
|
| Rate for Payer: Cofinity Commercial |
$892.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.79
|
| Rate for Payer: Healthscope Commercial |
$933.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$777.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$881.65
|
| Rate for Payer: Nomi Health Commercial |
$850.54
|
| Rate for Payer: PHP Commercial |
$881.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.21
|
| Rate for Payer: Priority Health HMO/PPO |
$902.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$694.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.77
|
| Rate for Payer: UHC Core |
$866.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$777.93
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
OP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$169.76 |
| Rate for Payer: Aetna Commercial |
$160.33
|
| Rate for Payer: Aetna Medicare |
$49.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.94
|
| Rate for Payer: BCBS Complete |
$75.45
|
| Rate for Payer: BCBS MAPPO |
$47.16
|
| Rate for Payer: BCBS Trust/PPO |
$155.06
|
| Rate for Payer: BCN Commercial |
$146.65
|
| Rate for Payer: BCN Medicare Advantage |
$47.16
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$162.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.16
|
| Rate for Payer: Healthscope Commercial |
$169.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: PACE Senior Care Partners |
$44.80
|
| Rate for Payer: PACE SWMI |
$47.16
|
| Rate for Payer: PHP Commercial |
$160.33
|
| Rate for Payer: PHP Medicare Advantage |
$47.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health HMO/PPO |
$164.10
|
| Rate for Payer: Priority Health Medicare |
$47.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.38
|
| Rate for Payer: Railroad Medicare Medicare |
$47.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.99
|
| Rate for Payer: UHC Core |
$157.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.16
|
| Rate for Payer: UHC Exchange |
$47.16
|
| Rate for Payer: UHC Medicare Advantage |
$47.16
|
| Rate for Payer: VA VA |
$47.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.46
|
|
|
HC RADIAL COMPRESSION DEVICE
|
Facility
|
IP
|
$188.62
|
|
| Hospital Charge Code |
27000157
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$169.76 |
| Rate for Payer: Aetna Commercial |
$160.33
|
| Rate for Payer: BCBS Trust/PPO |
$153.97
|
| Rate for Payer: BCN Commercial |
$145.77
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cofinity Commercial |
$162.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.90
|
| Rate for Payer: Healthscope Commercial |
$169.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.33
|
| Rate for Payer: Nomi Health Commercial |
$154.67
|
| Rate for Payer: PHP Commercial |
$160.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.60
|
| Rate for Payer: Priority Health HMO/PPO |
$164.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.99
|
| Rate for Payer: UHC Core |
$157.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.46
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
IP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$386.72 |
| Rate for Payer: Aetna Commercial |
$365.24
|
| Rate for Payer: BCBS Trust/PPO |
$350.76
|
| Rate for Payer: BCN Commercial |
$332.06
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$369.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Healthscope Commercial |
$386.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: PHP Commercial |
$365.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health HMO/PPO |
$373.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.13
|
| Rate for Payer: UHC Core |
$358.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.27
|
|
|
HC RADIATION PROCEDURE
|
Facility
|
OP
|
$429.69
|
|
|
Service Code
|
CPT 77399
|
| Hospital Charge Code |
33300034
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.06 |
| Max. Negotiated Rate |
$386.72 |
| Rate for Payer: Aetna Commercial |
$365.24
|
| Rate for Payer: Aetna Medicare |
$111.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.28
|
| Rate for Payer: BCBS Complete |
$98.76
|
| Rate for Payer: BCBS MAPPO |
$107.42
|
| Rate for Payer: BCBS Trust/PPO |
$353.25
|
| Rate for Payer: BCN Commercial |
$334.08
|
| Rate for Payer: BCN Medicare Advantage |
$107.42
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cash Price |
$343.75
|
| Rate for Payer: Cofinity Commercial |
$369.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.42
|
| Rate for Payer: Healthscope Commercial |
$386.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.27
|
| Rate for Payer: Mclaren Medicaid |
$94.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.79
|
| Rate for Payer: Meridian Medicaid |
$98.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.24
|
| Rate for Payer: Nomi Health Commercial |
$352.35
|
| Rate for Payer: PACE Senior Care Partners |
$102.05
|
| Rate for Payer: PACE SWMI |
$107.42
|
| Rate for Payer: PHP Commercial |
$365.24
|
| Rate for Payer: PHP Medicare Advantage |
$107.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.30
|
| Rate for Payer: Priority Health HMO/PPO |
$373.83
|
| Rate for Payer: Priority Health Medicare |
$108.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$107.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.13
|
| Rate for Payer: UHC Core |
$358.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.42
|
| Rate for Payer: UHC Exchange |
$107.42
|
| Rate for Payer: UHC Medicare Advantage |
$107.42
|
| Rate for Payer: UHCCP Medicaid |
$94.06
|
| Rate for Payer: VA VA |
$107.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.27
|
|
