|
HC TANGENTIAL BIOPSY SKIN ADDL LESION
|
Facility
|
OP
|
$83.55
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
76100149
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$75.20 |
| Rate for Payer: Aetna Commercial |
$71.02
|
| Rate for Payer: Aetna Medicare |
$21.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.11
|
| Rate for Payer: BCBS Complete |
$33.42
|
| Rate for Payer: BCBS MAPPO |
$20.89
|
| Rate for Payer: BCBS Trust/PPO |
$68.69
|
| Rate for Payer: BCN Commercial |
$64.96
|
| Rate for Payer: BCN Medicare Advantage |
$20.89
|
| Rate for Payer: Cash Price |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$71.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.89
|
| Rate for Payer: Healthscope Commercial |
$75.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.02
|
| Rate for Payer: Nomi Health Commercial |
$68.51
|
| Rate for Payer: PACE Senior Care Partners |
$19.84
|
| Rate for Payer: PACE SWMI |
$20.89
|
| Rate for Payer: PHP Commercial |
$71.02
|
| Rate for Payer: PHP Medicare Advantage |
$20.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health HMO/PPO |
$72.69
|
| Rate for Payer: Priority Health Medicare |
$21.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.98
|
| Rate for Payer: Railroad Medicare Medicare |
$20.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.52
|
| Rate for Payer: UHC Core |
$69.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.89
|
| Rate for Payer: UHC Exchange |
$20.89
|
| Rate for Payer: UHC Medicare Advantage |
$20.89
|
| Rate for Payer: VA VA |
$20.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.66
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
OP
|
$275.71
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.48 |
| Max. Negotiated Rate |
$248.14 |
| Rate for Payer: Aetna Commercial |
$234.35
|
| Rate for Payer: Aetna Medicare |
$71.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.16
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$68.93
|
| Rate for Payer: BCBS Trust/PPO |
$226.66
|
| Rate for Payer: BCN Commercial |
$214.36
|
| Rate for Payer: BCN Medicare Advantage |
$68.93
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$237.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.78
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.37
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: PACE Senior Care Partners |
$65.48
|
| Rate for Payer: PACE SWMI |
$68.93
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: PHP Medicare Advantage |
$68.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health HMO/PPO |
$239.87
|
| Rate for Payer: Priority Health Medicare |
$69.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.73
|
| Rate for Payer: Railroad Medicare Medicare |
$68.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.62
|
| Rate for Payer: UHC Core |
$230.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.93
|
| Rate for Payer: UHC Exchange |
$68.93
|
| Rate for Payer: UHC Medicare Advantage |
$68.93
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$68.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.78
|
|
|
HC TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Facility
|
IP
|
$275.71
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
76100148
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$248.14 |
| Rate for Payer: Aetna Commercial |
$234.35
|
| Rate for Payer: BCBS Trust/PPO |
$225.06
|
| Rate for Payer: BCN Commercial |
$213.07
|
| Rate for Payer: Cash Price |
$220.57
|
| Rate for Payer: Cofinity Commercial |
$237.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.57
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.35
|
| Rate for Payer: Nomi Health Commercial |
$226.08
|
| Rate for Payer: PHP Commercial |
$234.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.21
|
| Rate for Payer: Priority Health HMO/PPO |
$239.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.62
|
| Rate for Payer: UHC Core |
$230.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.78
|
|
|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
IP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4,241.69 |
| Max. Negotiated Rate |
$5,873.11 |
| Rate for Payer: Aetna Commercial |
$5,546.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,326.91
|
| Rate for Payer: BCN Commercial |
$5,043.05
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$5,612.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Healthscope Commercial |
$5,873.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,894.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: Nomi Health Commercial |
$5,351.06
|
| Rate for Payer: PHP Commercial |
$5,546.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health HMO/PPO |
$5,677.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,372.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,742.60
|
| Rate for Payer: UHC Core |
$5,448.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,894.26
|
|
|
HC TAVR CONVERTED TO ON-PUMP
|
Facility
|
OP
|
$6,525.68
|
|
| Hospital Charge Code |
27000703
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,549.85 |
| Max. Negotiated Rate |
$5,873.11 |
| Rate for Payer: Aetna Commercial |
$5,546.83
|
| Rate for Payer: Aetna Medicare |
$1,696.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,039.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,039.28
|
| Rate for Payer: BCBS Complete |
$2,610.27
|
| Rate for Payer: BCBS MAPPO |
$1,631.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,364.76
|
| Rate for Payer: BCN Commercial |
$5,073.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,631.42
|
| Rate for Payer: Cash Price |
$5,220.54
|
| Rate for Payer: Cofinity Commercial |
$5,612.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,220.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,631.42
|
| Rate for Payer: Healthscope Commercial |
$5,873.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,894.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,712.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,876.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,546.83
|
| Rate for Payer: Nomi Health Commercial |
$5,351.06
|
| Rate for Payer: PACE Senior Care Partners |
$1,549.85
|
| Rate for Payer: PACE SWMI |
$1,631.42
|
| Rate for Payer: PHP Commercial |
$5,546.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,631.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,241.69
|
| Rate for Payer: Priority Health HMO/PPO |
$5,677.34
|
| Rate for Payer: Priority Health Medicare |
$1,647.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,372.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,631.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,742.60
|
| Rate for Payer: UHC Core |
$5,448.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,631.42
|
| Rate for Payer: UHC Exchange |
$1,631.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,631.42
|
| Rate for Payer: VA VA |
$1,631.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,894.26
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
OP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,906.25 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: Aetna Medicare |
$9,750.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,718.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,718.75
|
| Rate for Payer: BCBS Complete |
$15,000.00
|
| Rate for Payer: BCBS MAPPO |
$9,375.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,828.75
|
| Rate for Payer: BCN Commercial |
$29,156.25
|
| Rate for Payer: BCN Medicare Advantage |
$9,375.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,375.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,843.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,781.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: Nomi Health Commercial |
$30,750.00
|
| Rate for Payer: PACE Senior Care Partners |
$8,906.25
|
| Rate for Payer: PACE SWMI |
$9,375.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: PHP Medicare Advantage |
$9,375.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32,625.00
|
| Rate for Payer: Priority Health Medicare |
$9,468.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25,125.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9,375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,000.00
|
| Rate for Payer: UHC Core |
$31,312.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,375.00
|
| Rate for Payer: UHC Exchange |
$9,375.00
|
| Rate for Payer: UHC Medicare Advantage |
$9,375.00
|
| Rate for Payer: VA VA |
$9,375.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 37
|
Facility
|
IP
|
$37,500.00
|
|
| Hospital Charge Code |
27800353
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,375.00 |
| Max. Negotiated Rate |
$33,750.00 |
| Rate for Payer: Aetna Commercial |
$31,875.00
|
| Rate for Payer: BCBS Trust/PPO |
$30,611.25
|
| Rate for Payer: BCN Commercial |
$28,980.00
|
| Rate for Payer: Cash Price |
$30,000.00
|
| Rate for Payer: Cofinity Commercial |
$32,250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30,000.00
|
| Rate for Payer: Healthscope Commercial |
$33,750.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28,125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31,875.00
|
| Rate for Payer: Nomi Health Commercial |
$30,750.00
|
| Rate for Payer: PHP Commercial |
$31,875.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24,375.00
|
| Rate for Payer: Priority Health HMO/PPO |
$32,625.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25,125.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,000.00
|
| Rate for Payer: UHC Core |
$31,312.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28,125.00
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
IP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,406.25 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: BCBS Trust/PPO |
$33,162.19
|
| Rate for Payer: BCN Commercial |
$31,395.00
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: Nomi Health Commercial |
$33,312.50
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health HMO/PPO |
$35,343.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27,218.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,750.00
|
| Rate for Payer: UHC Core |
$33,921.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TAVR VALVE LVL 40
|
Facility
|
OP
|
$40,625.00
|
|
| Hospital Charge Code |
27800354
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,648.44 |
| Max. Negotiated Rate |
$36,562.50 |
| Rate for Payer: Aetna Commercial |
$34,531.25
|
| Rate for Payer: Aetna Medicare |
$10,562.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,695.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,695.31
|
| Rate for Payer: BCBS Complete |
$16,250.00
|
| Rate for Payer: BCBS MAPPO |
$10,156.25
|
| Rate for Payer: BCBS Trust/PPO |
$33,397.81
|
| Rate for Payer: BCN Commercial |
$31,585.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,156.25
|
| Rate for Payer: Cash Price |
$32,500.00
|
| Rate for Payer: Cofinity Commercial |
$34,937.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,500.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,156.25
|
| Rate for Payer: Healthscope Commercial |
$36,562.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,468.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,664.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,679.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,531.25
|
| Rate for Payer: Nomi Health Commercial |
$33,312.50
|
| Rate for Payer: PACE Senior Care Partners |
$9,648.44
|
| Rate for Payer: PACE SWMI |
$10,156.25
|
| Rate for Payer: PHP Commercial |
$34,531.25
|
| Rate for Payer: PHP Medicare Advantage |
$10,156.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,406.25
|
| Rate for Payer: Priority Health HMO/PPO |
$35,343.75
|
| Rate for Payer: Priority Health Medicare |
$10,257.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27,218.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10,156.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,750.00
|
| Rate for Payer: UHC Core |
$33,921.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,156.25
|
| Rate for Payer: UHC Exchange |
$10,156.25
|
| Rate for Payer: UHC Medicare Advantage |
$10,156.25
|
| Rate for Payer: VA VA |
$10,156.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,468.75
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
IP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: BCBS Trust/PPO |
$34.97
|
| Rate for Payer: BCN Commercial |
$33.11
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS DXA/OTHER IMG CALCULATION W/I&R FX RISK
|
Facility
|
OP
|
$42.84
|
|
|
Service Code
|
CPT 77089
|
| Hospital Charge Code |
32000343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$38.56 |
| Rate for Payer: Aetna Commercial |
$36.41
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.39
|
| Rate for Payer: BCBS Complete |
$17.14
|
| Rate for Payer: BCBS MAPPO |
$10.71
|
| Rate for Payer: BCBS Trust/PPO |
$35.22
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: BCN Medicare Advantage |
$10.71
|
| Rate for Payer: Cash Price |
$34.27
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.71
|
| Rate for Payer: Healthscope Commercial |
$38.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.41
|
| Rate for Payer: Nomi Health Commercial |
$35.13
|
| Rate for Payer: PACE Senior Care Partners |
$10.17
|
| Rate for Payer: PACE SWMI |
$10.71
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.85
|
| Rate for Payer: Priority Health HMO/PPO |
$37.27
|
| Rate for Payer: Priority Health Medicare |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.70
|
| Rate for Payer: UHC Core |
$35.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.71
|
| Rate for Payer: UHC Exchange |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.71
|
| Rate for Payer: VA VA |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.13
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
OP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.35 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: Aetna Medicare |
$64.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.09
|
| Rate for Payer: BCBS Complete |
$65.50
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$205.44
|
| Rate for Payer: BCN Commercial |
$194.30
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.42
|
| Rate for Payer: Mclaren Medicaid |
$62.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$65.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PACE Senior Care Partners |
$59.35
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Exchange |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$62.48
|
| Rate for Payer: UHCCP Medicaid |
$62.37
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.42
|
|
|
HC TBS TECHNICAL CALCULATION ONLY
|
Facility
|
IP
|
$249.90
|
|
|
Service Code
|
CPT 77091
|
| Hospital Charge Code |
32000335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.44 |
| Max. Negotiated Rate |
$224.91 |
| Rate for Payer: Aetna Commercial |
$212.42
|
| Rate for Payer: BCBS Trust/PPO |
$203.99
|
| Rate for Payer: BCN Commercial |
$193.12
|
| Rate for Payer: Cash Price |
$199.92
|
| Rate for Payer: Cofinity Commercial |
$214.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.92
|
| Rate for Payer: Healthscope Commercial |
$224.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.42
|
| Rate for Payer: Nomi Health Commercial |
$204.92
|
| Rate for Payer: PHP Commercial |
$212.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health HMO/PPO |
$217.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.91
|
| Rate for Payer: UHC Core |
$208.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.42
|
|
|
HC TB TEST
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Aetna Medicare |
$6.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: BCBS MAPPO |
$6.12
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$19.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.12
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.12
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Mclaren Medicaid |
$17.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.43
|
| Rate for Payer: Meridian Medicaid |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.81
|
| Rate for Payer: PACE SWMI |
$6.12
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Medicare |
$6.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.12
|
| Rate for Payer: UHC Exchange |
$6.12
|
| Rate for Payer: UHC Medicare Advantage |
$6.12
|
| Rate for Payer: UHCCP Medicaid |
$17.34
|
| Rate for Payer: VA VA |
$6.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TB TEST
|
Facility
|
IP
|
$24.48
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
30000069
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$19.98
|
| Rate for Payer: BCN Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.81
|
| Rate for Payer: Nomi Health Commercial |
$20.07
|
| Rate for Payer: PHP Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.54
|
| Rate for Payer: UHC Core |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.36
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
OP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.22
|
| Rate for Payer: BCBS Complete |
$63.01
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$129.50
|
| Rate for Payer: BCN Commercial |
$122.47
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: PACE Senior Care Partners |
$37.41
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health HMO/PPO |
$137.04
|
| Rate for Payer: Priority Health Medicare |
$39.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.54
|
| Rate for Payer: Railroad Medicare Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.62
|
| Rate for Payer: UHC Core |
$131.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Exchange |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$39.38
|
| Rate for Payer: VA VA |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC 99M ABD PER STUDY
|
Facility
|
IP
|
$157.52
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
34300019
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$102.39 |
| Max. Negotiated Rate |
$141.77 |
| Rate for Payer: Aetna Commercial |
$133.89
|
| Rate for Payer: BCBS Trust/PPO |
$128.58
|
| Rate for Payer: BCN Commercial |
$121.73
|
| Rate for Payer: Cash Price |
$126.02
|
| Rate for Payer: Cofinity Commercial |
$135.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.02
|
| Rate for Payer: Healthscope Commercial |
$141.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.89
|
| Rate for Payer: Nomi Health Commercial |
$129.17
|
| Rate for Payer: PHP Commercial |
$133.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.39
|
| Rate for Payer: Priority Health HMO/PPO |
$137.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.62
|
| Rate for Payer: UHC Core |
$131.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.14
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
IP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,156.94 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,452.94
|
| Rate for Payer: BCN Commercial |
$1,375.51
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,548.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.32
|
| Rate for Payer: UHC Core |
$1,486.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC-99M AUTOL WBC DIAG PER DOSE
|
Facility
|
OP
|
$1,779.91
|
|
|
Service Code
|
HCPCS A9569
|
| Hospital Charge Code |
34300027
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$422.73 |
| Max. Negotiated Rate |
$1,601.92 |
| Rate for Payer: Aetna Commercial |
$1,512.92
|
| Rate for Payer: Aetna Medicare |
$462.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.22
|
| Rate for Payer: BCBS Complete |
$789.81
|
| Rate for Payer: BCBS MAPPO |
$444.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.26
|
| Rate for Payer: BCN Commercial |
$1,383.88
|
| Rate for Payer: BCN Medicare Advantage |
$444.98
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cash Price |
$1,423.93
|
| Rate for Payer: Cofinity Commercial |
$1,530.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,423.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.98
|
| Rate for Payer: Healthscope Commercial |
$1,601.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,334.93
|
| Rate for Payer: Mclaren Medicaid |
$752.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.23
|
| Rate for Payer: Meridian Medicaid |
$789.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,512.92
|
| Rate for Payer: Nomi Health Commercial |
$1,459.53
|
| Rate for Payer: PACE Senior Care Partners |
$422.73
|
| Rate for Payer: PACE SWMI |
$444.98
|
| Rate for Payer: PHP Commercial |
$1,512.92
|
| Rate for Payer: PHP Medicare Advantage |
$444.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$752.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,156.94
|
| Rate for Payer: Priority Health HMO/PPO |
$1,548.52
|
| Rate for Payer: Priority Health Medicare |
$449.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.54
|
| Rate for Payer: Railroad Medicare Medicare |
$444.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,566.32
|
| Rate for Payer: UHC Core |
$1,486.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.98
|
| Rate for Payer: UHC Exchange |
$444.98
|
| Rate for Payer: UHC Medicare Advantage |
$444.98
|
| Rate for Payer: UHCCP Medicaid |
$752.15
|
| Rate for Payer: VA VA |
$444.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,334.93
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
IP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$87.11 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: BCBS Trust/PPO |
$109.40
|
| Rate for Payer: BCN Commercial |
$103.57
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO |
$116.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.94
|
| Rate for Payer: UHC Core |
$111.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC99M DTPA AEROSOL <=75 MCI
|
Facility
|
OP
|
$134.02
|
|
|
Service Code
|
HCPCS A9567
|
| Hospital Charge Code |
34300030
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Aetna Commercial |
$113.92
|
| Rate for Payer: Aetna Medicare |
$34.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.88
|
| Rate for Payer: BCBS Complete |
$53.61
|
| Rate for Payer: BCBS MAPPO |
$33.50
|
| Rate for Payer: BCBS Trust/PPO |
$110.18
|
| Rate for Payer: BCN Commercial |
$104.20
|
| Rate for Payer: BCN Medicare Advantage |
$33.50
|
| Rate for Payer: Cash Price |
$107.22
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.50
|
| Rate for Payer: Healthscope Commercial |
$120.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.92
|
| Rate for Payer: Nomi Health Commercial |
$109.90
|
| Rate for Payer: PACE Senior Care Partners |
$31.83
|
| Rate for Payer: PACE SWMI |
$33.50
|
| Rate for Payer: PHP Commercial |
$113.92
|
| Rate for Payer: PHP Medicare Advantage |
$33.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.11
|
| Rate for Payer: Priority Health HMO/PPO |
$116.60
|
| Rate for Payer: Priority Health Medicare |
$33.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.79
|
| Rate for Payer: Railroad Medicare Medicare |
$33.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.94
|
| Rate for Payer: UHC Core |
$111.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.50
|
| Rate for Payer: UHC Exchange |
$33.50
|
| Rate for Payer: UHC Medicare Advantage |
$33.50
|
| Rate for Payer: VA VA |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.52
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
OP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: Aetna Medicare |
$35.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.01
|
| Rate for Payer: BCBS Complete |
$55.06
|
| Rate for Payer: BCBS MAPPO |
$34.41
|
| Rate for Payer: BCBS Trust/PPO |
$113.15
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$34.41
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: PACE Senior Care Partners |
$32.69
|
| Rate for Payer: PACE SWMI |
$34.41
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: PHP Medicare Advantage |
$34.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Medicare |
$34.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: Railroad Medicare Medicare |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.41
|
| Rate for Payer: UHC Exchange |
$34.41
|
| Rate for Payer: UHC Medicare Advantage |
$34.41
|
| Rate for Payer: VA VA |
$34.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MAA PER STUDY
|
Facility
|
IP
|
$137.64
|
|
|
Service Code
|
HCPCS A9540
|
| Hospital Charge Code |
34300017
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$123.88 |
| Rate for Payer: Aetna Commercial |
$116.99
|
| Rate for Payer: BCBS Trust/PPO |
$112.36
|
| Rate for Payer: BCN Commercial |
$106.37
|
| Rate for Payer: Cash Price |
$110.11
|
| Rate for Payer: Cofinity Commercial |
$118.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.11
|
| Rate for Payer: Healthscope Commercial |
$123.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.99
|
| Rate for Payer: Nomi Health Commercial |
$112.86
|
| Rate for Payer: PHP Commercial |
$116.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.47
|
| Rate for Payer: Priority Health HMO/PPO |
$119.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.12
|
| Rate for Payer: UHC Core |
$114.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.23
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
IP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: BCBS Trust/PPO |
$116.59
|
| Rate for Payer: BCN Commercial |
$110.38
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO |
$124.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.69
|
| Rate for Payer: UHC Core |
$119.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
|
HC TC 99M MDP PER STUDY
|
Facility
|
OP
|
$142.83
|
|
|
Service Code
|
HCPCS A9503
|
| Hospital Charge Code |
34300018
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$33.92 |
| Max. Negotiated Rate |
$128.55 |
| Rate for Payer: Aetna Commercial |
$121.41
|
| Rate for Payer: Aetna Medicare |
$37.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.63
|
| Rate for Payer: BCBS Complete |
$57.13
|
| Rate for Payer: BCBS MAPPO |
$35.71
|
| Rate for Payer: BCBS Trust/PPO |
$117.42
|
| Rate for Payer: BCN Commercial |
$111.05
|
| Rate for Payer: BCN Medicare Advantage |
$35.71
|
| Rate for Payer: Cash Price |
$114.26
|
| Rate for Payer: Cofinity Commercial |
$122.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.71
|
| Rate for Payer: Healthscope Commercial |
$128.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.41
|
| Rate for Payer: Nomi Health Commercial |
$117.12
|
| Rate for Payer: PACE Senior Care Partners |
$33.92
|
| Rate for Payer: PACE SWMI |
$35.71
|
| Rate for Payer: PHP Commercial |
$121.41
|
| Rate for Payer: PHP Medicare Advantage |
$35.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.84
|
| Rate for Payer: Priority Health HMO/PPO |
$124.26
|
| Rate for Payer: Priority Health Medicare |
$36.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.70
|
| Rate for Payer: Railroad Medicare Medicare |
$35.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.69
|
| Rate for Payer: UHC Core |
$119.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.71
|
| Rate for Payer: UHC Exchange |
$35.71
|
| Rate for Payer: UHC Medicare Advantage |
$35.71
|
| Rate for Payer: VA VA |
$35.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.12
|
|
