|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
OP
|
$91.80
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$23.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.69
|
| Rate for Payer: BCBS Complete |
$16.99
|
| Rate for Payer: BCBS MAPPO |
$22.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.47
|
| Rate for Payer: BCN Commercial |
$75.47
|
| Rate for Payer: BCN Medicare Advantage |
$22.95
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.95
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Mclaren Medicaid |
$16.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.10
|
| Rate for Payer: Meridian Medicaid |
$16.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PACE Senior Care Partners |
$21.80
|
| Rate for Payer: PACE SWMI |
$22.95
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Medicare Advantage |
$22.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Medicare |
$23.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: Railroad Medicare Medicare |
$22.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: UHC Exchange |
$22.95
|
| Rate for Payer: UHC Medicaid |
$16.18
|
| Rate for Payer: UHC Medicare Advantage |
$22.95
|
| Rate for Payer: UHCCP Medicaid |
$16.18
|
| Rate for Payer: VA VA |
$22.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TESTOSTERONE UNLISTED CHEMISTRY
|
Facility
|
IP
|
$91.80
|
|
|
Service Code
|
CPT 84410
|
| Hospital Charge Code |
30100642
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$63.89 |
| Max. Negotiated Rate |
$82.62 |
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: BCBS Trust/PPO |
$75.82
|
| Rate for Payer: BCN Commercial |
$75.82
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Nomi Health Commercial |
$75.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.78
|
| Rate for Payer: UHC Core |
$76.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.60
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$33.16
|
| Rate for Payer: BCN Commercial |
$33.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.08
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Mclaren Medicaid |
$7.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Senior Care Partners |
$9.58
|
| Rate for Payer: PACE SWMI |
$10.08
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: UHC Exchange |
$10.08
|
| Rate for Payer: UHC Medicaid |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$10.08
|
| Rate for Payer: UHCCP Medicaid |
$7.11
|
| Rate for Payer: VA VA |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC TETANUS AND DIPTHERIA TOXOIDS ADSORDED (TD), PF, 7 YRS OR OLDER IM
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
63600083
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$51.32
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$11.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$11.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicaid |
$11.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$11.00
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC TETANUS ANTIBODIES
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
30200320
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$51.55
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.81
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
OP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$108.04
|
| Rate for Payer: Aetna Medicare |
$33.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.72
|
| Rate for Payer: BCBS Complete |
$23.53
|
| Rate for Payer: BCBS MAPPO |
$31.78
|
| Rate for Payer: BCBS Trust/PPO |
$104.50
|
| Rate for Payer: BCN Commercial |
$104.50
|
| Rate for Payer: BCN Medicare Advantage |
$31.78
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Commercial |
$109.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.33
|
| Rate for Payer: Mclaren Medicaid |
$22.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.37
|
| Rate for Payer: Meridian Medicaid |
$23.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Nomi Health Commercial |
$104.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: PACE Senior Care Partners |
$30.19
|
| Rate for Payer: PACE SWMI |
$31.78
|
| Rate for Payer: PHP Commercial |
$108.04
|
| Rate for Payer: PHP Medicare Advantage |
$31.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.59
|
| Rate for Payer: Priority Health Medicare |
$32.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.47
|
| Rate for Payer: Railroad Medicare Medicare |
$31.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.86
|
| Rate for Payer: UHC Core |
$106.14
|
| Rate for Payer: UHC Exchange |
$31.78
|
| Rate for Payer: UHC Medicaid |
$22.41
|
| Rate for Payer: UHC Medicare Advantage |
$31.78
|
| Rate for Payer: UHCCP Medicaid |
$22.41
|
| Rate for Payer: VA VA |
$31.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.33
|
|
|
HC TETANUS/DIPHTHERIA/PERTUSIS VACCINE
|
Facility
|
IP
|
$127.11
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
63600022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.47 |
| Max. Negotiated Rate |
$114.40 |
| Rate for Payer: Aetna Commercial |
$108.04
|
| Rate for Payer: BCBS Trust/PPO |
$104.98
|
| Rate for Payer: BCN Commercial |
$104.98
|
| Rate for Payer: Cash Price |
$101.69
|
| Rate for Payer: Cofinity Commercial |
$109.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.69
|
| Rate for Payer: Healthscope Commercial |
$114.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.04
|
| Rate for Payer: Nomi Health Commercial |
$104.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.33
|
| Rate for Payer: PHP Commercial |
$108.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$110.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.86
|
| Rate for Payer: UHC Core |
$106.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.33
|
|
|
HC THC URINE CONFIRM
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: Aetna Medicare |
$16.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.16
|
| Rate for Payer: BCBS Complete |
$11.94
|
| Rate for Payer: BCBS MAPPO |
$16.12
|
| Rate for Payer: BCBS Trust/PPO |
$53.03
|
| Rate for Payer: BCN Commercial |
$53.03
|
| Rate for Payer: BCN Medicare Advantage |
$16.12
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.12
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Mclaren Medicaid |
$11.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.93
|
| Rate for Payer: Meridian Medicaid |
$11.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PACE Senior Care Partners |
$15.32
|
| Rate for Payer: PACE SWMI |
$16.12
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: PHP Medicare Advantage |
$16.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.12
|
| Rate for Payer: Priority Health Medicare |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.89
|
| Rate for Payer: Railroad Medicare Medicare |
$16.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.76
|
| Rate for Payer: UHC Core |
$53.86
|
| Rate for Payer: UHC Exchange |
$16.12
|
| Rate for Payer: UHC Medicaid |
$11.37
|
| Rate for Payer: UHC Medicare Advantage |
$16.12
|
| Rate for Payer: UHCCP Medicaid |
$11.37
|
| Rate for Payer: VA VA |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC THC URINE CONFIRM
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
CPT 80349
|
| Hospital Charge Code |
30100568
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$58.05 |
| Rate for Payer: Aetna Commercial |
$54.83
|
| Rate for Payer: BCBS Trust/PPO |
$53.27
|
| Rate for Payer: BCN Commercial |
$53.27
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cofinity Commercial |
$55.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.60
|
| Rate for Payer: Healthscope Commercial |
$58.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.83
|
| Rate for Payer: Nomi Health Commercial |
$52.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.38
|
| Rate for Payer: PHP Commercial |
$54.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.76
|
| Rate for Payer: UHC Core |
$53.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.38
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
IP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.46 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: BCBS Trust/PPO |
$77.68
|
| Rate for Payer: BCN Commercial |
$77.68
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC THEOPHYLLINE LEVEL
|
Facility
|
OP
|
$94.05
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
30100048
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$79.94
|
| Rate for Payer: Aetna Medicare |
$24.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.39
|
| Rate for Payer: BCBS Complete |
$17.41
|
| Rate for Payer: BCBS MAPPO |
$23.51
|
| Rate for Payer: BCBS Trust/PPO |
$77.32
|
| Rate for Payer: BCN Commercial |
$77.32
|
| Rate for Payer: BCN Medicare Advantage |
$23.51
|
| Rate for Payer: Cash Price |
$75.24
|
| Rate for Payer: Cofinity Commercial |
$80.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.51
|
| Rate for Payer: Healthscope Commercial |
$84.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.54
|
| Rate for Payer: Mclaren Medicaid |
$16.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.69
|
| Rate for Payer: Meridian Medicaid |
$17.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.94
|
| Rate for Payer: Nomi Health Commercial |
$77.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.54
|
| Rate for Payer: PACE Senior Care Partners |
$22.34
|
| Rate for Payer: PACE SWMI |
$23.51
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$23.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.82
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.46
|
| Rate for Payer: Railroad Medicare Medicare |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.76
|
| Rate for Payer: UHC Core |
$78.53
|
| Rate for Payer: UHC Exchange |
$23.51
|
| Rate for Payer: UHC Medicaid |
$16.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.51
|
| Rate for Payer: UHCCP Medicaid |
$16.58
|
| Rate for Payer: VA VA |
$23.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.54
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
IP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: BCBS Trust/PPO |
$83.27
|
| Rate for Payer: BCN Commercial |
$83.27
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.72
|
| Rate for Payer: UHC Core |
$84.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
HC THERAPEUTIC ACTIVITIES EA 15 MIN
|
Facility
|
OP
|
$100.82
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$90.74 |
| Rate for Payer: Aetna Commercial |
$85.70
|
| Rate for Payer: Aetna Medicare |
$26.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.51
|
| Rate for Payer: BCBS Complete |
$18.66
|
| Rate for Payer: BCBS MAPPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$82.88
|
| Rate for Payer: BCN Commercial |
$82.88
|
| Rate for Payer: BCN Medicare Advantage |
$25.20
|
| Rate for Payer: Cash Price |
$80.66
|
| Rate for Payer: Cofinity Commercial |
$86.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.20
|
| Rate for Payer: Healthscope Commercial |
$90.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.61
|
| Rate for Payer: Mclaren Medicaid |
$17.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.47
|
| Rate for Payer: Meridian Medicaid |
$18.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.70
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.61
|
| Rate for Payer: PACE Senior Care Partners |
$23.94
|
| Rate for Payer: PACE SWMI |
$25.20
|
| Rate for Payer: PHP Commercial |
$85.70
|
| Rate for Payer: PHP Medicare Advantage |
$25.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$87.71
|
| Rate for Payer: Priority Health Medicare |
$25.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.17
|
| Rate for Payer: Railroad Medicare Medicare |
$25.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.72
|
| Rate for Payer: UHC Core |
$84.18
|
| Rate for Payer: UHC Exchange |
$25.20
|
| Rate for Payer: UHC Medicaid |
$17.77
|
| Rate for Payer: UHC Medicare Advantage |
$25.20
|
| Rate for Payer: UHCCP Medicaid |
$17.77
|
| Rate for Payer: VA VA |
$25.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.61
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
OP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$459.54 |
| Max. Negotiated Rate |
$2,345.94 |
| Rate for Payer: Aetna Commercial |
$2,215.61
|
| Rate for Payer: Aetna Medicare |
$677.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$814.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$814.56
|
| Rate for Payer: BCBS Complete |
$482.48
|
| Rate for Payer: BCBS MAPPO |
$651.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,142.89
|
| Rate for Payer: BCN Commercial |
$2,142.89
|
| Rate for Payer: BCN Medicare Advantage |
$651.65
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Commercial |
$2,241.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$651.65
|
| Rate for Payer: Healthscope Commercial |
$2,345.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.95
|
| Rate for Payer: Mclaren Medicaid |
$459.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.23
|
| Rate for Payer: Meridian Medicaid |
$482.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$749.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$716.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$2,137.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: PACE Senior Care Partners |
$619.07
|
| Rate for Payer: PACE SWMI |
$651.65
|
| Rate for Payer: PHP Commercial |
$2,215.61
|
| Rate for Payer: PHP Medicare Advantage |
$651.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,267.74
|
| Rate for Payer: Priority Health Medicare |
$658.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,814.19
|
| Rate for Payer: Railroad Medicare Medicare |
$651.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,293.81
|
| Rate for Payer: UHC Core |
$2,176.51
|
| Rate for Payer: UHC Exchange |
$651.65
|
| Rate for Payer: UHC Medicaid |
$459.54
|
| Rate for Payer: UHC Medicare Advantage |
$651.65
|
| Rate for Payer: UHCCP Medicaid |
$459.54
|
| Rate for Payer: VA VA |
$651.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.95
|
|
|
HC THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Facility
|
IP
|
$2,606.60
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
36100520
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,814.19 |
| Max. Negotiated Rate |
$2,345.94 |
| Rate for Payer: Aetna Commercial |
$2,215.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,152.79
|
| Rate for Payer: BCN Commercial |
$2,152.79
|
| Rate for Payer: Cash Price |
$2,085.28
|
| Rate for Payer: Cofinity Commercial |
$2,241.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,085.28
|
| Rate for Payer: Healthscope Commercial |
$2,345.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,954.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,215.61
|
| Rate for Payer: Nomi Health Commercial |
$2,137.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,954.95
|
| Rate for Payer: PHP Commercial |
$2,215.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,267.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,814.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,293.81
|
| Rate for Payer: UHC Core |
$2,176.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,954.95
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,761.35 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.08
|
| Rate for Payer: BCN Commercial |
$2,090.08
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,898.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,201.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,761.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.99
|
| Rate for Payer: UHC Core |
$2,113.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,898.00
|
|
|
HC THERAPEUTIC APHERESIS RED BLOOD CELLS
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
76100326
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna Medicare |
$657.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$790.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$790.83
|
| Rate for Payer: BCBS Complete |
$468.43
|
| Rate for Payer: BCBS MAPPO |
$632.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,080.46
|
| Rate for Payer: BCN Commercial |
$2,080.46
|
| Rate for Payer: BCN Medicare Advantage |
$632.67
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.67
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,898.00
|
| Rate for Payer: Mclaren Medicaid |
$446.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.30
|
| Rate for Payer: Meridian Medicaid |
$468.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$727.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$695.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Senior Care Partners |
$601.03
|
| Rate for Payer: PACE SWMI |
$632.67
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: PHP Medicare Advantage |
$632.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,201.68
|
| Rate for Payer: Priority Health Medicare |
$638.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,761.35
|
| Rate for Payer: Railroad Medicare Medicare |
$632.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.99
|
| Rate for Payer: UHC Core |
$2,113.11
|
| Rate for Payer: UHC Exchange |
$632.67
|
| Rate for Payer: UHC Medicaid |
$446.16
|
| Rate for Payer: UHC Medicare Advantage |
$632.67
|
| Rate for Payer: UHCCP Medicaid |
$446.16
|
| Rate for Payer: VA VA |
$632.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,898.00
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
IP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,761.35 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,090.08
|
| Rate for Payer: BCN Commercial |
$2,090.08
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,898.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,201.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,761.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.99
|
| Rate for Payer: UHC Core |
$2,113.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,898.00
|
|
|
HC THERAPEUTIC APHERESIS WHITE BLOOD CELL
|
Facility
|
OP
|
$2,530.67
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
76100327
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$2,277.60 |
| Rate for Payer: Aetna Commercial |
$2,151.07
|
| Rate for Payer: Aetna Medicare |
$657.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$790.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$790.83
|
| Rate for Payer: BCBS Complete |
$468.43
|
| Rate for Payer: BCBS MAPPO |
$632.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,080.46
|
| Rate for Payer: BCN Commercial |
$2,080.46
|
| Rate for Payer: BCN Medicare Advantage |
$632.67
|
| Rate for Payer: Cash Price |
$2,024.54
|
| Rate for Payer: Cofinity Commercial |
$2,176.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,024.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.67
|
| Rate for Payer: Healthscope Commercial |
$2,277.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,898.00
|
| Rate for Payer: Mclaren Medicaid |
$446.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.30
|
| Rate for Payer: Meridian Medicaid |
$468.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$727.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$695.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,151.07
|
| Rate for Payer: Nomi Health Commercial |
$2,075.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,898.00
|
| Rate for Payer: PACE Senior Care Partners |
$601.03
|
| Rate for Payer: PACE SWMI |
$632.67
|
| Rate for Payer: PHP Commercial |
$2,151.07
|
| Rate for Payer: PHP Medicare Advantage |
$632.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,201.68
|
| Rate for Payer: Priority Health Medicare |
$638.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,761.35
|
| Rate for Payer: Railroad Medicare Medicare |
$632.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.99
|
| Rate for Payer: UHC Core |
$2,113.11
|
| Rate for Payer: UHC Exchange |
$632.67
|
| Rate for Payer: UHC Medicaid |
$446.16
|
| Rate for Payer: UHC Medicare Advantage |
$632.67
|
| Rate for Payer: UHCCP Medicaid |
$446.16
|
| Rate for Payer: VA VA |
$632.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,898.00
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.24 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: BCBS Trust/PPO |
$96.41
|
| Rate for Payer: BCN Commercial |
$96.41
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$101.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.72
|
| Rate for Payer: UHC Core |
$97.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.55
|
|
|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$105.06 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Medicare |
$30.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.48
|
| Rate for Payer: BCBS Complete |
$21.61
|
| Rate for Payer: BCBS MAPPO |
$29.18
|
| Rate for Payer: BCBS Trust/PPO |
$95.96
|
| Rate for Payer: BCN Commercial |
$95.96
|
| Rate for Payer: BCN Medicare Advantage |
$29.18
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$100.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.18
|
| Rate for Payer: Healthscope Commercial |
$105.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.55
|
| Rate for Payer: Mclaren Medicaid |
$20.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.64
|
| Rate for Payer: Meridian Medicaid |
$21.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: PACE Senior Care Partners |
$27.72
|
| Rate for Payer: PACE SWMI |
$29.18
|
| Rate for Payer: PHP Commercial |
$99.22
|
| Rate for Payer: PHP Medicare Advantage |
$29.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$101.56
|
| Rate for Payer: Priority Health Medicare |
$29.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.24
|
| Rate for Payer: Railroad Medicare Medicare |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.72
|
| Rate for Payer: UHC Core |
$97.47
|
| Rate for Payer: UHC Exchange |
$29.18
|
| Rate for Payer: UHC Medicaid |
$20.58
|
| Rate for Payer: UHC Medicare Advantage |
$29.18
|
| Rate for Payer: UHCCP Medicaid |
$20.58
|
| Rate for Payer: VA VA |
$29.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.55
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$155.23 |
| Max. Negotiated Rate |
$792.45 |
| Rate for Payer: Aetna Commercial |
$748.42
|
| Rate for Payer: Aetna Medicare |
$228.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.16
|
| Rate for Payer: BCBS Complete |
$162.98
|
| Rate for Payer: BCBS MAPPO |
$220.12
|
| Rate for Payer: BCBS Trust/PPO |
$723.86
|
| Rate for Payer: BCN Commercial |
$723.86
|
| Rate for Payer: BCN Medicare Advantage |
$220.12
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Commercial |
$757.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.12
|
| Rate for Payer: Healthscope Commercial |
$792.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$660.38
|
| Rate for Payer: Mclaren Medicaid |
$155.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.13
|
| Rate for Payer: Meridian Medicaid |
$162.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$242.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.42
|
| Rate for Payer: Nomi Health Commercial |
$722.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| Rate for Payer: PACE Senior Care Partners |
$209.12
|
| Rate for Payer: PACE SWMI |
$220.12
|
| Rate for Payer: PHP Commercial |
$748.42
|
| Rate for Payer: PHP Medicare Advantage |
$220.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.03
|
| Rate for Payer: Priority Health Medicare |
$222.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.83
|
| Rate for Payer: Railroad Medicare Medicare |
$220.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.84
|
| Rate for Payer: UHC Core |
$735.22
|
| Rate for Payer: UHC Exchange |
$220.12
|
| Rate for Payer: UHC Medicaid |
$155.23
|
| Rate for Payer: UHC Medicare Advantage |
$220.12
|
| Rate for Payer: UHCCP Medicaid |
$155.23
|
| Rate for Payer: VA VA |
$220.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$660.38
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$880.50
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$612.83 |
| Max. Negotiated Rate |
$792.45 |
| Rate for Payer: Aetna Commercial |
$748.42
|
| Rate for Payer: BCBS Trust/PPO |
$727.20
|
| Rate for Payer: BCN Commercial |
$727.20
|
| Rate for Payer: Cash Price |
$704.40
|
| Rate for Payer: Cofinity Commercial |
$757.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$704.40
|
| Rate for Payer: Healthscope Commercial |
$792.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$660.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$748.42
|
| Rate for Payer: Nomi Health Commercial |
$722.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$660.38
|
| Rate for Payer: PHP Commercial |
$748.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$766.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.84
|
| Rate for Payer: UHC Core |
$735.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$660.38
|
|
|
HC THERASKIN 1.75X1.75 PER SQ CM
|
Facility
|
OP
|
$588.13
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.69 |
| Max. Negotiated Rate |
$529.32 |
| Rate for Payer: Aetna Commercial |
$499.91
|
| Rate for Payer: Aetna Medicare |
$152.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$183.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$183.79
|
| Rate for Payer: BCBS Complete |
$108.86
|
| Rate for Payer: BCBS MAPPO |
$147.03
|
| Rate for Payer: BCBS Trust/PPO |
$483.50
|
| Rate for Payer: BCN Commercial |
$483.50
|
| Rate for Payer: BCN Medicare Advantage |
$147.03
|
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Cofinity Commercial |
$505.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.03
|
| Rate for Payer: Healthscope Commercial |
$529.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$441.10
|
| Rate for Payer: Mclaren Medicaid |
$103.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.38
|
| Rate for Payer: Meridian Medicaid |
$108.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.91
|
| Rate for Payer: Nomi Health Commercial |
$482.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.10
|
| Rate for Payer: PACE Senior Care Partners |
$139.68
|
| Rate for Payer: PACE SWMI |
$147.03
|
| Rate for Payer: PHP Commercial |
$499.91
|
| Rate for Payer: PHP Medicare Advantage |
$147.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$511.67
|
| Rate for Payer: Priority Health Medicare |
$148.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.34
|
| Rate for Payer: Railroad Medicare Medicare |
$147.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.55
|
| Rate for Payer: UHC Core |
$491.09
|
| Rate for Payer: UHC Exchange |
$147.03
|
| Rate for Payer: UHC Medicaid |
$103.69
|
| Rate for Payer: UHC Medicare Advantage |
$147.03
|
| Rate for Payer: UHCCP Medicaid |
$103.69
|
| Rate for Payer: VA VA |
$147.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$441.10
|
|
