|
HC RADXF UNL NM H R L 78199
|
Facility
|
OP
|
$750.34
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$675.31 |
| Rate for Payer: Aetna Commercial |
$637.79
|
| Rate for Payer: Aetna Medicare |
$195.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$234.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$234.48
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$187.59
|
| Rate for Payer: BCBS Trust/PPO |
$616.85
|
| Rate for Payer: BCN Commercial |
$583.39
|
| Rate for Payer: BCN Medicare Advantage |
$187.59
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cofinity Commercial |
$645.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.59
|
| Rate for Payer: Healthscope Commercial |
$675.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.75
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.96
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.79
|
| Rate for Payer: Nomi Health Commercial |
$615.28
|
| Rate for Payer: PACE Senior Care Partners |
$178.21
|
| Rate for Payer: PACE SWMI |
$187.59
|
| Rate for Payer: PHP Commercial |
$637.79
|
| Rate for Payer: PHP Medicare Advantage |
$187.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.72
|
| Rate for Payer: Priority Health HMO/PPO |
$652.80
|
| Rate for Payer: Priority Health Medicare |
$189.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$502.73
|
| Rate for Payer: Railroad Medicare Medicare |
$187.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.30
|
| Rate for Payer: UHC Core |
$626.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.59
|
| Rate for Payer: UHC Exchange |
$187.59
|
| Rate for Payer: UHC Medicare Advantage |
$187.59
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$187.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.75
|
|
|
HC RADXF UNL NM H R L 78199
|
Facility
|
IP
|
$750.34
|
|
|
Service Code
|
CPT 78199
|
| Hospital Charge Code |
34100013
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$487.72 |
| Max. Negotiated Rate |
$675.31 |
| Rate for Payer: Aetna Commercial |
$637.79
|
| Rate for Payer: BCBS Trust/PPO |
$612.50
|
| Rate for Payer: BCN Commercial |
$579.86
|
| Rate for Payer: Cash Price |
$600.27
|
| Rate for Payer: Cofinity Commercial |
$645.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$600.27
|
| Rate for Payer: Healthscope Commercial |
$675.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$562.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$637.79
|
| Rate for Payer: Nomi Health Commercial |
$615.28
|
| Rate for Payer: PHP Commercial |
$637.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.72
|
| Rate for Payer: Priority Health HMO/PPO |
$652.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$502.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.30
|
| Rate for Payer: UHC Core |
$626.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$562.75
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
IP
|
$1,923.10
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,250.02 |
| Max. Negotiated Rate |
$1,730.79 |
| Rate for Payer: Aetna Commercial |
$1,634.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.83
|
| Rate for Payer: BCN Commercial |
$1,486.17
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cofinity Commercial |
$1,653.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.48
|
| Rate for Payer: Healthscope Commercial |
$1,730.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.63
|
| Rate for Payer: Nomi Health Commercial |
$1,576.94
|
| Rate for Payer: PHP Commercial |
$1,634.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,673.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,288.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,692.33
|
| Rate for Payer: UHC Core |
$1,605.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.33
|
|
|
HC RADXF UNL NM MUSCSKL 78399
|
Facility
|
OP
|
$1,923.10
|
|
|
Service Code
|
CPT 78399
|
| Hospital Charge Code |
34100028
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$290.52 |
| Max. Negotiated Rate |
$1,730.79 |
| Rate for Payer: Aetna Commercial |
$1,634.63
|
| Rate for Payer: Aetna Medicare |
$500.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$600.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$600.97
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$480.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.98
|
| Rate for Payer: BCN Commercial |
$1,495.21
|
| Rate for Payer: BCN Medicare Advantage |
$480.77
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cash Price |
$1,538.48
|
| Rate for Payer: Cofinity Commercial |
$1,653.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.77
|
| Rate for Payer: Healthscope Commercial |
$1,730.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.33
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.81
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.63
|
| Rate for Payer: Nomi Health Commercial |
$1,576.94
|
| Rate for Payer: PACE Senior Care Partners |
$456.74
|
| Rate for Payer: PACE SWMI |
$480.77
|
| Rate for Payer: PHP Commercial |
$1,634.63
|
| Rate for Payer: PHP Medicare Advantage |
$480.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,673.10
|
| Rate for Payer: Priority Health Medicare |
$485.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,288.48
|
| Rate for Payer: Railroad Medicare Medicare |
$480.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,692.33
|
| Rate for Payer: UHC Core |
$1,605.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.77
|
| Rate for Payer: UHC Exchange |
$480.77
|
| Rate for Payer: UHC Medicare Advantage |
$480.77
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$480.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.33
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Aetna Medicare |
$208.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.10
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$200.88
|
| Rate for Payer: BCBS Trust/PPO |
$660.57
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$200.88
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.92
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Senior Care Partners |
$190.84
|
| Rate for Payer: PACE SWMI |
$200.88
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: PHP Medicare Advantage |
$200.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Medicare |
$202.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: Railroad Medicare Medicare |
$200.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.88
|
| Rate for Payer: UHC Exchange |
$200.88
|
| Rate for Payer: UHC Medicare Advantage |
$200.88
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$200.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL NM PROC MISC 78999
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78999
|
| Hospital Charge Code |
34100061
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: BCBS Trust/PPO |
$655.91
|
| Rate for Payer: BCN Commercial |
$620.96
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL NM RADPHARM THER 799
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: BCBS Trust/PPO |
$655.91
|
| Rate for Payer: BCN Commercial |
$620.96
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL NM RADPHARM THER 799
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 79999
|
| Hospital Charge Code |
34100066
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Aetna Medicare |
$208.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.10
|
| Rate for Payer: BCBS Complete |
$170.16
|
| Rate for Payer: BCBS MAPPO |
$200.88
|
| Rate for Payer: BCBS Trust/PPO |
$660.57
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$200.88
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Mclaren Medicaid |
$162.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.92
|
| Rate for Payer: Meridian Medicaid |
$170.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Senior Care Partners |
$190.84
|
| Rate for Payer: PACE SWMI |
$200.88
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: PHP Medicare Advantage |
$200.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Medicare |
$202.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: Railroad Medicare Medicare |
$200.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.88
|
| Rate for Payer: UHC Exchange |
$200.88
|
| Rate for Payer: UHC Medicare Advantage |
$200.88
|
| Rate for Payer: UHCCP Medicaid |
$162.05
|
| Rate for Payer: VA VA |
$200.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL NM RESP 78599
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Aetna Medicare |
$208.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.10
|
| Rate for Payer: BCBS Complete |
$305.07
|
| Rate for Payer: BCBS MAPPO |
$200.88
|
| Rate for Payer: BCBS Trust/PPO |
$660.57
|
| Rate for Payer: BCN Commercial |
$624.74
|
| Rate for Payer: BCN Medicare Advantage |
$200.88
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.88
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Mclaren Medicaid |
$290.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.92
|
| Rate for Payer: Meridian Medicaid |
$305.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PACE Senior Care Partners |
$190.84
|
| Rate for Payer: PACE SWMI |
$200.88
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: PHP Medicare Advantage |
$200.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Medicare |
$202.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: Railroad Medicare Medicare |
$200.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.88
|
| Rate for Payer: UHC Exchange |
$200.88
|
| Rate for Payer: UHC Medicare Advantage |
$200.88
|
| Rate for Payer: UHCCP Medicaid |
$290.52
|
| Rate for Payer: VA VA |
$200.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL NM RESP 78599
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
CPT 78599
|
| Hospital Charge Code |
34100036
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$522.29 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: BCBS Trust/PPO |
$655.91
|
| Rate for Payer: BCN Commercial |
$620.96
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Nomi Health Commercial |
$658.89
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.29
|
| Rate for Payer: Priority Health HMO/PPO |
$699.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.10
|
| Rate for Payer: UHC Core |
$670.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
OP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$195.53 |
| Rate for Payer: Aetna Commercial |
$184.67
|
| Rate for Payer: Aetna Medicare |
$56.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.89
|
| Rate for Payer: BCBS Complete |
$66.85
|
| Rate for Payer: BCBS MAPPO |
$54.31
|
| Rate for Payer: BCBS Trust/PPO |
$178.61
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: BCN Medicare Advantage |
$54.31
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.31
|
| Rate for Payer: Healthscope Commercial |
$195.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.94
|
| Rate for Payer: Mclaren Medicaid |
$63.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.03
|
| Rate for Payer: Meridian Medicaid |
$66.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: PACE Senior Care Partners |
$51.60
|
| Rate for Payer: PACE SWMI |
$54.31
|
| Rate for Payer: PHP Commercial |
$184.67
|
| Rate for Payer: PHP Medicare Advantage |
$54.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: Priority Health HMO/PPO |
$189.02
|
| Rate for Payer: Priority Health Medicare |
$54.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.56
|
| Rate for Payer: Railroad Medicare Medicare |
$54.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.19
|
| Rate for Payer: UHC Core |
$181.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.31
|
| Rate for Payer: UHC Exchange |
$54.31
|
| Rate for Payer: UHC Medicare Advantage |
$54.31
|
| Rate for Payer: UHCCP Medicaid |
$63.66
|
| Rate for Payer: VA VA |
$54.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.94
|
|
|
HC RADXF UNL ULTRASOUND 76999
|
Facility
|
IP
|
$217.26
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
40200051
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$195.53 |
| Rate for Payer: Aetna Commercial |
$184.67
|
| Rate for Payer: BCBS Trust/PPO |
$177.35
|
| Rate for Payer: BCN Commercial |
$167.90
|
| Rate for Payer: Cash Price |
$173.81
|
| Rate for Payer: Cofinity Commercial |
$186.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.81
|
| Rate for Payer: Healthscope Commercial |
$195.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.67
|
| Rate for Payer: Nomi Health Commercial |
$178.15
|
| Rate for Payer: PHP Commercial |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.22
|
| Rate for Payer: Priority Health HMO/PPO |
$189.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.19
|
| Rate for Payer: UHC Core |
$181.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.94
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC RAGWEED SHORT IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200056
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
IP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.12 |
| Max. Negotiated Rate |
$135.86 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: BCBS Trust/PPO |
$123.23
|
| Rate for Payer: BCN Commercial |
$116.66
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Healthscope Commercial |
$135.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: PHP Commercial |
$128.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health HMO/PPO |
$131.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.84
|
| Rate for Payer: UHC Core |
$126.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.22
|
|
|
HC RAJI CELL ASSAY
|
Facility
|
OP
|
$150.96
|
|
|
Service Code
|
CPT 86332
|
| Hospital Charge Code |
30200192
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$135.86 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna Medicare |
$39.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.17
|
| Rate for Payer: BCBS Complete |
$18.50
|
| Rate for Payer: BCBS MAPPO |
$37.74
|
| Rate for Payer: BCBS Trust/PPO |
$124.10
|
| Rate for Payer: BCN Commercial |
$117.37
|
| Rate for Payer: BCN Medicare Advantage |
$37.74
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cash Price |
$120.77
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$135.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.22
|
| Rate for Payer: Mclaren Medicaid |
$17.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.63
|
| Rate for Payer: Meridian Medicaid |
$18.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.32
|
| Rate for Payer: Nomi Health Commercial |
$123.79
|
| Rate for Payer: PACE Senior Care Partners |
$35.85
|
| Rate for Payer: PACE SWMI |
$37.74
|
| Rate for Payer: PHP Commercial |
$128.32
|
| Rate for Payer: PHP Medicare Advantage |
$37.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.12
|
| Rate for Payer: Priority Health HMO/PPO |
$131.34
|
| Rate for Payer: Priority Health Medicare |
$38.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.14
|
| Rate for Payer: Railroad Medicare Medicare |
$37.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.84
|
| Rate for Payer: UHC Core |
$126.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.74
|
| Rate for Payer: UHC Exchange |
$37.74
|
| Rate for Payer: UHC Medicare Advantage |
$37.74
|
| Rate for Payer: UHCCP Medicaid |
$17.62
|
| Rate for Payer: VA VA |
$37.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.22
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
IP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.49 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$459.64
|
| Rate for Payer: BCBS Trust/PPO |
$441.41
|
| Rate for Payer: BCN Commercial |
$417.89
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$465.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Healthscope Commercial |
$486.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: PHP Commercial |
$459.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: Priority Health HMO/PPO |
$470.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.86
|
| Rate for Payer: UHC Core |
$451.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.56
|
|
|
HC RAPID DESENSITIZATION PROC EA HOUR
|
Facility
|
OP
|
$540.75
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
76100075
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.43 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$459.64
|
| Rate for Payer: Aetna Medicare |
$140.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$168.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$168.98
|
| Rate for Payer: BCBS Complete |
$302.95
|
| Rate for Payer: BCBS MAPPO |
$135.19
|
| Rate for Payer: BCBS Trust/PPO |
$444.55
|
| Rate for Payer: BCN Commercial |
$420.43
|
| Rate for Payer: BCN Medicare Advantage |
$135.19
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cofinity Commercial |
$465.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$432.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.19
|
| Rate for Payer: Healthscope Commercial |
$486.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$405.56
|
| Rate for Payer: Mclaren Medicaid |
$288.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.95
|
| Rate for Payer: Meridian Medicaid |
$302.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.64
|
| Rate for Payer: Nomi Health Commercial |
$443.42
|
| Rate for Payer: PACE Senior Care Partners |
$128.43
|
| Rate for Payer: PACE SWMI |
$135.19
|
| Rate for Payer: PHP Commercial |
$459.64
|
| Rate for Payer: PHP Medicare Advantage |
$135.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.49
|
| Rate for Payer: Priority Health HMO/PPO |
$470.45
|
| Rate for Payer: Priority Health Medicare |
$136.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.30
|
| Rate for Payer: Railroad Medicare Medicare |
$135.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$475.86
|
| Rate for Payer: UHC Core |
$451.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.19
|
| Rate for Payer: UHC Exchange |
$135.19
|
| Rate for Payer: UHC Medicare Advantage |
$135.19
|
| Rate for Payer: UHCCP Medicaid |
$288.51
|
| Rate for Payer: VA VA |
$135.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$405.56
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
OP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$138.34 |
| Rate for Payer: Aetna Commercial |
$130.65
|
| Rate for Payer: Aetna Medicare |
$39.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.03
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: BCBS MAPPO |
$38.43
|
| Rate for Payer: BCBS Trust/PPO |
$126.36
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$38.43
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.43
|
| Rate for Payer: Healthscope Commercial |
$138.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.28
|
| Rate for Payer: Mclaren Medicaid |
$6.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.35
|
| Rate for Payer: Meridian Medicaid |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: PACE Senior Care Partners |
$36.51
|
| Rate for Payer: PACE SWMI |
$38.43
|
| Rate for Payer: PHP Commercial |
$130.65
|
| Rate for Payer: PHP Medicare Advantage |
$38.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: Priority Health HMO/PPO |
$133.73
|
| Rate for Payer: Priority Health Medicare |
$38.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.99
|
| Rate for Payer: Railroad Medicare Medicare |
$38.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.26
|
| Rate for Payer: UHC Core |
$128.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.43
|
| Rate for Payer: UHC Exchange |
$38.43
|
| Rate for Payer: UHC Medicare Advantage |
$38.43
|
| Rate for Payer: UHCCP Medicaid |
$6.43
|
| Rate for Payer: VA VA |
$38.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.28
|
|
|
HC RAPID HIV ANTIBODY
|
Facility
|
IP
|
$153.71
|
|
|
Service Code
|
CPT 86701
|
| Hospital Charge Code |
30200290
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$99.91 |
| Max. Negotiated Rate |
$138.34 |
| Rate for Payer: Aetna Commercial |
$130.65
|
| Rate for Payer: BCBS Trust/PPO |
$125.47
|
| Rate for Payer: BCN Commercial |
$118.79
|
| Rate for Payer: Cash Price |
$122.97
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.97
|
| Rate for Payer: Healthscope Commercial |
$138.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$126.04
|
| Rate for Payer: PHP Commercial |
$130.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.91
|
| Rate for Payer: Priority Health HMO/PPO |
$133.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.26
|
| Rate for Payer: UHC Core |
$128.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.28
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
IP
|
$77.93
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$50.65 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$66.24
|
| Rate for Payer: BCBS Trust/PPO |
$63.61
|
| Rate for Payer: BCN Commercial |
$60.22
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$67.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.34
|
| Rate for Payer: Healthscope Commercial |
$70.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$63.90
|
| Rate for Payer: PHP Commercial |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: Priority Health HMO/PPO |
$67.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.58
|
| Rate for Payer: UHC Core |
$65.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.45
|
|
|
HC RAPID INFLUENZA A & B SCREEN
|
Facility
|
OP
|
$77.93
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
30600174
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$70.14 |
| Rate for Payer: Aetna Commercial |
$66.24
|
| Rate for Payer: Aetna Medicare |
$20.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.35
|
| Rate for Payer: BCBS Complete |
$12.56
|
| Rate for Payer: BCBS MAPPO |
$19.48
|
| Rate for Payer: BCBS Trust/PPO |
$64.07
|
| Rate for Payer: BCN Commercial |
$60.59
|
| Rate for Payer: BCN Medicare Advantage |
$19.48
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cash Price |
$62.34
|
| Rate for Payer: Cofinity Commercial |
$67.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$70.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.45
|
| Rate for Payer: Mclaren Medicaid |
$11.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.46
|
| Rate for Payer: Meridian Medicaid |
$12.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.24
|
| Rate for Payer: Nomi Health Commercial |
$63.90
|
| Rate for Payer: PACE Senior Care Partners |
$18.51
|
| Rate for Payer: PACE SWMI |
$19.48
|
| Rate for Payer: PHP Commercial |
$66.24
|
| Rate for Payer: PHP Medicare Advantage |
$19.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.65
|
| Rate for Payer: Priority Health HMO/PPO |
$67.80
|
| Rate for Payer: Priority Health Medicare |
$19.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.21
|
| Rate for Payer: Railroad Medicare Medicare |
$19.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.58
|
| Rate for Payer: UHC Core |
$65.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.48
|
| Rate for Payer: UHC Exchange |
$19.48
|
| Rate for Payer: UHC Medicare Advantage |
$19.48
|
| Rate for Payer: UHCCP Medicaid |
$11.97
|
| Rate for Payer: VA VA |
$19.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.45
|
|
|
HC RAPID INFUSER
|
Facility
|
IP
|
$1,432.45
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$931.09 |
| Max. Negotiated Rate |
$1,289.20 |
| Rate for Payer: Aetna Commercial |
$1,217.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.31
|
| Rate for Payer: BCN Commercial |
$1,107.00
|
| Rate for Payer: Cash Price |
$1,145.96
|
| Rate for Payer: Cofinity Commercial |
$1,231.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.96
|
| Rate for Payer: Healthscope Commercial |
$1,289.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,074.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.58
|
| Rate for Payer: Nomi Health Commercial |
$1,174.61
|
| Rate for Payer: PHP Commercial |
$1,217.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$931.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1,246.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$959.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,260.56
|
| Rate for Payer: UHC Core |
$1,196.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,074.34
|
|
|
HC RAPID INFUSER
|
Facility
|
OP
|
$1,432.45
|
|
| Hospital Charge Code |
27000294
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$340.21 |
| Max. Negotiated Rate |
$1,289.20 |
| Rate for Payer: Aetna Commercial |
$1,217.58
|
| Rate for Payer: Aetna Medicare |
$372.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$447.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$447.64
|
| Rate for Payer: BCBS Complete |
$572.98
|
| Rate for Payer: BCBS MAPPO |
$358.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.62
|
| Rate for Payer: BCN Commercial |
$1,113.73
|
| Rate for Payer: BCN Medicare Advantage |
$358.11
|
| Rate for Payer: Cash Price |
$1,145.96
|
| Rate for Payer: Cofinity Commercial |
$1,231.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,145.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.11
|
| Rate for Payer: Healthscope Commercial |
$1,289.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,074.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$411.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,217.58
|
| Rate for Payer: Nomi Health Commercial |
$1,174.61
|
| Rate for Payer: PACE Senior Care Partners |
$340.21
|
| Rate for Payer: PACE SWMI |
$358.11
|
| Rate for Payer: PHP Commercial |
$1,217.58
|
| Rate for Payer: PHP Medicare Advantage |
$358.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$931.09
|
| Rate for Payer: Priority Health HMO/PPO |
$1,246.23
|
| Rate for Payer: Priority Health Medicare |
$361.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$959.74
|
| Rate for Payer: Railroad Medicare Medicare |
$358.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,260.56
|
| Rate for Payer: UHC Core |
$1,196.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$358.11
|
| Rate for Payer: UHC Exchange |
$358.11
|
| Rate for Payer: UHC Medicare Advantage |
$358.11
|
| Rate for Payer: VA VA |
$358.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,074.34
|
|
|
HC RAPID MALARIA ASSAY
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
30600298
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.62 |
| 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 |
$12.20
|
| 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 |
$11.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$12.20
|
| 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 |
$11.62
|
| 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 |
$11.62
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
