|
HC TCU OBSERVATION PER HOUR
|
Facility
|
OP
|
$145.08
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
76200015
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$130.57 |
| Rate for Payer: Aetna Commercial |
$123.32
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.34
|
| Rate for Payer: BCBS Complete |
$58.03
|
| Rate for Payer: BCBS MAPPO |
$36.27
|
| Rate for Payer: BCBS Trust/PPO |
$119.27
|
| Rate for Payer: BCN Commercial |
$112.80
|
| Rate for Payer: BCN Medicare Advantage |
$36.27
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.27
|
| Rate for Payer: Healthscope Commercial |
$130.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.32
|
| Rate for Payer: Nomi Health Commercial |
$118.97
|
| Rate for Payer: PACE Senior Care Partners |
$34.46
|
| Rate for Payer: PACE SWMI |
$36.27
|
| Rate for Payer: PHP Commercial |
$123.32
|
| Rate for Payer: PHP Medicare Advantage |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.30
|
| Rate for Payer: Priority Health HMO/PPO |
$126.22
|
| Rate for Payer: Priority Health Medicare |
$36.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.20
|
| Rate for Payer: Railroad Medicare Medicare |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.67
|
| Rate for Payer: UHC Core |
$121.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.27
|
| Rate for Payer: UHC Exchange |
$36.27
|
| Rate for Payer: UHC Medicare Advantage |
$36.27
|
| Rate for Payer: VA VA |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.81
|
|
|
HC TCU OR NCCU R&B
|
Facility
|
IP
|
$5,069.49
|
|
| Hospital Charge Code |
20800001
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$1,776.50 |
| Max. Negotiated Rate |
$4,562.54 |
| Rate for Payer: Aetna Commercial |
$4,309.07
|
| Rate for Payer: Aetna Medicare |
$1,944.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,337.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,337.50
|
| Rate for Payer: BCBS MAPPO |
$1,870.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,138.22
|
| Rate for Payer: BCN Commercial |
$3,917.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,870.00
|
| Rate for Payer: Cash Price |
$4,055.59
|
| Rate for Payer: Cash Price |
$4,055.59
|
| Rate for Payer: Cofinity Commercial |
$4,359.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,055.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,870.00
|
| Rate for Payer: Healthscope Commercial |
$4,562.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,802.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,963.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,150.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,309.07
|
| Rate for Payer: Nomi Health Commercial |
$4,156.98
|
| Rate for Payer: PACE Senior Care Partners |
$1,776.50
|
| Rate for Payer: PACE SWMI |
$1,870.00
|
| Rate for Payer: PHP Commercial |
$4,309.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,870.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,295.17
|
| Rate for Payer: Priority Health HMO/PPO |
$4,410.46
|
| Rate for Payer: Priority Health Medicare |
$1,888.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,396.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,870.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,461.15
|
| Rate for Payer: UHC Core |
$4,233.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,870.00
|
| Rate for Payer: UHC Exchange |
$1,870.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,870.00
|
| Rate for Payer: VA VA |
$1,870.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,802.12
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
OP
|
$1,888.91
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$388.40 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna Medicare |
$491.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.28
|
| Rate for Payer: BCBS Complete |
$407.85
|
| Rate for Payer: BCBS MAPPO |
$472.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.87
|
| Rate for Payer: BCN Commercial |
$1,468.63
|
| Rate for Payer: BCN Medicare Advantage |
$472.23
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.23
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Mclaren Medicaid |
$388.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.84
|
| Rate for Payer: Meridian Medicaid |
$407.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: PACE Senior Care Partners |
$448.62
|
| Rate for Payer: PACE SWMI |
$472.23
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: PHP Medicare Advantage |
$472.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,643.35
|
| Rate for Payer: Priority Health Medicare |
$476.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.57
|
| Rate for Payer: Railroad Medicare Medicare |
$472.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.24
|
| Rate for Payer: UHC Core |
$1,577.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.23
|
| Rate for Payer: UHC Exchange |
$472.23
|
| Rate for Payer: UHC Medicare Advantage |
$472.23
|
| Rate for Payer: UHCCP Medicaid |
$388.40
|
| Rate for Payer: VA VA |
$472.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE ECHOCARDIOGRAM W/DOPPLER
|
Facility
|
IP
|
$1,888.91
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
48000012
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,227.79 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,541.92
|
| Rate for Payer: BCN Commercial |
$1,459.75
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,643.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.24
|
| Rate for Payer: UHC Core |
$1,577.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
OP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$448.62 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: Aetna Medicare |
$491.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.28
|
| Rate for Payer: BCBS Complete |
$587.68
|
| Rate for Payer: BCBS MAPPO |
$472.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.87
|
| Rate for Payer: BCN Commercial |
$1,468.63
|
| Rate for Payer: BCN Medicare Advantage |
$472.23
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.23
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Mclaren Medicaid |
$559.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.84
|
| Rate for Payer: Meridian Medicaid |
$587.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: PACE Senior Care Partners |
$448.62
|
| Rate for Payer: PACE SWMI |
$472.23
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: PHP Medicare Advantage |
$472.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,643.35
|
| Rate for Payer: Priority Health Medicare |
$476.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.57
|
| Rate for Payer: Railroad Medicare Medicare |
$472.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.24
|
| Rate for Payer: UHC Core |
$1,577.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.23
|
| Rate for Payer: UHC Exchange |
$472.23
|
| Rate for Payer: UHC Medicare Advantage |
$472.23
|
| Rate for Payer: UHCCP Medicaid |
$559.66
|
| Rate for Payer: VA VA |
$472.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEE W/DEFINITY
|
Facility
|
IP
|
$1,888.91
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300010
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,227.79 |
| Max. Negotiated Rate |
$1,700.02 |
| Rate for Payer: Aetna Commercial |
$1,605.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,541.92
|
| Rate for Payer: BCN Commercial |
$1,459.75
|
| Rate for Payer: Cash Price |
$1,511.13
|
| Rate for Payer: Cofinity Commercial |
$1,624.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,511.13
|
| Rate for Payer: Healthscope Commercial |
$1,700.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,605.57
|
| Rate for Payer: Nomi Health Commercial |
$1,548.91
|
| Rate for Payer: PHP Commercial |
$1,605.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,643.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,265.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,662.24
|
| Rate for Payer: UHC Core |
$1,577.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.68
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC TEG COAGULATION TIME ACTIVATED
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
30500100
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$53.29
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TEG FIBRINOGEN ACTIVITY
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
30500101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$7.38
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$7.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: Meridian Medicaid |
$7.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Exchange |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.32
|
| Rate for Payer: UHCCP Medicaid |
$7.03
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
IP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna Commercial |
$106.12
|
| Rate for Payer: BCBS Trust/PPO |
$101.92
|
| Rate for Payer: BCN Commercial |
$96.48
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$112.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: Nomi Health Commercial |
$102.38
|
| Rate for Payer: PHP Commercial |
$106.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health HMO/PPO |
$108.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.87
|
| Rate for Payer: UHC Core |
$104.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.64
|
|
|
HC TEG PLATELET AGGREGATION IN VITRO EACH
|
Facility
|
OP
|
$124.85
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
30500102
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna Commercial |
$106.12
|
| Rate for Payer: Aetna Medicare |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.02
|
| Rate for Payer: BCBS Complete |
$18.91
|
| Rate for Payer: BCBS MAPPO |
$31.21
|
| Rate for Payer: BCBS Trust/PPO |
$102.64
|
| Rate for Payer: BCN Commercial |
$97.07
|
| Rate for Payer: BCN Medicare Advantage |
$31.21
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.21
|
| Rate for Payer: Healthscope Commercial |
$112.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.64
|
| Rate for Payer: Mclaren Medicaid |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.77
|
| Rate for Payer: Meridian Medicaid |
$18.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.12
|
| Rate for Payer: Nomi Health Commercial |
$102.38
|
| Rate for Payer: PACE Senior Care Partners |
$29.65
|
| Rate for Payer: PACE SWMI |
$31.21
|
| Rate for Payer: PHP Commercial |
$106.12
|
| Rate for Payer: PHP Medicare Advantage |
$31.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.15
|
| Rate for Payer: Priority Health HMO/PPO |
$108.62
|
| Rate for Payer: Priority Health Medicare |
$31.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.65
|
| Rate for Payer: Railroad Medicare Medicare |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.87
|
| Rate for Payer: UHC Core |
$104.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.21
|
| Rate for Payer: UHC Exchange |
$31.21
|
| Rate for Payer: UHC Medicare Advantage |
$31.21
|
| Rate for Payer: UHCCP Medicaid |
$18.01
|
| Rate for Payer: VA VA |
$31.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.64
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
IP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.88 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: BCBS Trust/PPO |
$87.76
|
| Rate for Payer: BCN Commercial |
$83.08
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TEGRETOL CARBAMAZEPINE LVL
|
Facility
|
OP
|
$107.51
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$96.76 |
| Rate for Payer: Aetna Commercial |
$91.38
|
| Rate for Payer: Aetna Medicare |
$27.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.60
|
| Rate for Payer: BCBS Complete |
$11.06
|
| Rate for Payer: BCBS MAPPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$88.38
|
| Rate for Payer: BCN Commercial |
$83.59
|
| Rate for Payer: BCN Medicare Advantage |
$26.88
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cash Price |
$86.01
|
| Rate for Payer: Cofinity Commercial |
$92.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.88
|
| Rate for Payer: Healthscope Commercial |
$96.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.63
|
| Rate for Payer: Mclaren Medicaid |
$10.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.22
|
| Rate for Payer: Meridian Medicaid |
$11.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.38
|
| Rate for Payer: Nomi Health Commercial |
$88.16
|
| Rate for Payer: PACE Senior Care Partners |
$25.53
|
| Rate for Payer: PACE SWMI |
$26.88
|
| Rate for Payer: PHP Commercial |
$91.38
|
| Rate for Payer: PHP Medicare Advantage |
$26.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.88
|
| Rate for Payer: Priority Health HMO/PPO |
$93.53
|
| Rate for Payer: Priority Health Medicare |
$27.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.03
|
| Rate for Payer: Railroad Medicare Medicare |
$26.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.61
|
| Rate for Payer: UHC Core |
$89.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.88
|
| Rate for Payer: UHC Exchange |
$26.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.88
|
| Rate for Payer: UHCCP Medicaid |
$10.53
|
| Rate for Payer: VA VA |
$26.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.63
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$11.06
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$10.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$11.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Exchange |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$11.70
|
| Rate for Payer: UHCCP Medicaid |
$10.53
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TEGRETOL FREE AND TOTAL CMPT
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
30100023
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.22
|
| Rate for Payer: BCN Commercial |
$36.18
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
IP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.97
|
| Rate for Payer: BCN Commercial |
$32.16
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC TEGRETOL FREE AND TOTAL LEVEL
|
Facility
|
OP
|
$41.62
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
30100024
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$35.38
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.01
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$34.22
|
| Rate for Payer: BCN Commercial |
$32.36
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.22
|
| Rate for Payer: Mclaren Medicaid |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Medicaid |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.38
|
| Rate for Payer: Nomi Health Commercial |
$34.13
|
| Rate for Payer: PACE Senior Care Partners |
$9.88
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Commercial |
$35.38
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.05
|
| Rate for Payer: Priority Health HMO/PPO |
$36.21
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.89
|
| Rate for Payer: Railroad Medicare Medicare |
$10.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.63
|
| Rate for Payer: UHC Core |
$34.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
| Rate for Payer: UHCCP Medicaid |
$9.58
|
| Rate for Payer: VA VA |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.22
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
OP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: Aetna Commercial |
$76.31
|
| Rate for Payer: Aetna Medicare |
$23.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.06
|
| Rate for Payer: BCBS Complete |
$35.91
|
| Rate for Payer: BCBS MAPPO |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$73.81
|
| Rate for Payer: BCN Commercial |
$69.80
|
| Rate for Payer: BCN Medicare Advantage |
$22.44
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$77.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.44
|
| Rate for Payer: Healthscope Commercial |
$80.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: PACE Senior Care Partners |
$21.32
|
| Rate for Payer: PACE SWMI |
$22.44
|
| Rate for Payer: PHP Commercial |
$76.31
|
| Rate for Payer: PHP Medicare Advantage |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: Priority Health HMO/PPO |
$78.11
|
| Rate for Payer: Priority Health Medicare |
$22.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.15
|
| Rate for Payer: Railroad Medicare Medicare |
$22.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.01
|
| Rate for Payer: UHC Core |
$74.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.44
|
| Rate for Payer: UHC Exchange |
$22.44
|
| Rate for Payer: UHC Medicare Advantage |
$22.44
|
| Rate for Payer: VA VA |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.34
|
|
|
HC TELEHEALTH ORG SITE FACILITY
|
Facility
|
IP
|
$89.78
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
78000001
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: Aetna Commercial |
$76.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.29
|
| Rate for Payer: BCN Commercial |
$69.38
|
| Rate for Payer: Cash Price |
$71.82
|
| Rate for Payer: Cofinity Commercial |
$77.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.82
|
| Rate for Payer: Healthscope Commercial |
$80.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.31
|
| Rate for Payer: Nomi Health Commercial |
$73.62
|
| Rate for Payer: PHP Commercial |
$76.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.36
|
| Rate for Payer: Priority Health HMO/PPO |
$78.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.01
|
| Rate for Payer: UHC Core |
$74.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.34
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: BCBS Trust/PPO |
$93.42
|
| Rate for Payer: BCN Commercial |
$88.44
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health HMO/PPO |
$99.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.71
|
| Rate for Payer: UHC Core |
$95.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.83
|
|
|
HC TE MANUAL TX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$97.27
|
| Rate for Payer: Aetna Medicare |
$29.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.76
|
| Rate for Payer: BCBS Complete |
$45.78
|
| Rate for Payer: BCBS MAPPO |
$28.61
|
| Rate for Payer: BCBS Trust/PPO |
$94.08
|
| Rate for Payer: BCN Commercial |
$88.98
|
| Rate for Payer: BCN Medicare Advantage |
$28.61
|
| Rate for Payer: Cash Price |
$91.55
|
| Rate for Payer: Cofinity Commercial |
$98.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.61
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.27
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: PACE Senior Care Partners |
$27.18
|
| Rate for Payer: PACE SWMI |
$28.61
|
| Rate for Payer: PHP Commercial |
$97.27
|
| Rate for Payer: PHP Medicare Advantage |
$28.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.39
|
| Rate for Payer: Priority Health HMO/PPO |
$99.56
|
| Rate for Payer: Priority Health Medicare |
$28.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.67
|
| Rate for Payer: Railroad Medicare Medicare |
$28.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.71
|
| Rate for Payer: UHC Core |
$95.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.61
|
| Rate for Payer: UHC Exchange |
$28.61
|
| Rate for Payer: UHC Medicare Advantage |
$28.61
|
| Rate for Payer: VA VA |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.83
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
OP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$665.92 |
| Max. Negotiated Rate |
$6,156.08 |
| Rate for Payer: Aetna Commercial |
$2,383.30
|
| Rate for Payer: Aetna Medicare |
$729.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$876.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$876.21
|
| Rate for Payer: BCBS Complete |
$6,156.08
|
| Rate for Payer: BCBS MAPPO |
$700.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,305.07
|
| Rate for Payer: BCN Commercial |
$2,180.02
|
| Rate for Payer: BCN Medicare Advantage |
$700.97
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,411.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.97
|
| Rate for Payer: Healthscope Commercial |
$2,523.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.91
|
| Rate for Payer: Mclaren Medicaid |
$5,862.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.02
|
| Rate for Payer: Meridian Medicaid |
$6,156.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$806.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: PACE Senior Care Partners |
$665.92
|
| Rate for Payer: PACE SWMI |
$700.97
|
| Rate for Payer: PHP Commercial |
$2,383.30
|
| Rate for Payer: PHP Medicare Advantage |
$700.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,862.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,439.38
|
| Rate for Payer: Priority Health Medicare |
$707.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,878.60
|
| Rate for Payer: Railroad Medicare Medicare |
$700.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,467.41
|
| Rate for Payer: UHC Core |
$2,341.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.97
|
| Rate for Payer: UHC Exchange |
$700.97
|
| Rate for Payer: UHC Medicare Advantage |
$700.97
|
| Rate for Payer: UHCCP Medicaid |
$5,862.55
|
| Rate for Payer: VA VA |
$700.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.91
|
|
|
HC TEMPORARY PACEMAKER
|
Facility
|
IP
|
$2,803.88
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
36100060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,822.52 |
| Max. Negotiated Rate |
$2,523.49 |
| Rate for Payer: Aetna Commercial |
$2,383.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,288.81
|
| Rate for Payer: BCN Commercial |
$2,166.84
|
| Rate for Payer: Cash Price |
$2,243.10
|
| Rate for Payer: Cofinity Commercial |
$2,411.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,243.10
|
| Rate for Payer: Healthscope Commercial |
$2,523.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,102.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.30
|
| Rate for Payer: Nomi Health Commercial |
$2,299.18
|
| Rate for Payer: PHP Commercial |
$2,383.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,439.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,878.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,467.41
|
| Rate for Payer: UHC Core |
$2,341.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,102.91
|
|
|
HC TEMPORARY PACING WIRE
|
Facility
|
OP
|
$688.29
|
|
|
Service Code
|
HCPCS C1756
|
| Hospital Charge Code |
27200074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$619.46 |
| Rate for Payer: Aetna Commercial |
$585.05
|
| Rate for Payer: Aetna Medicare |
$178.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$215.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$215.09
|
| Rate for Payer: BCBS Complete |
$275.32
|
| Rate for Payer: BCBS MAPPO |
$172.07
|
| Rate for Payer: BCBS Trust/PPO |
$565.84
|
| Rate for Payer: BCN Commercial |
$535.15
|
| Rate for Payer: BCN Medicare Advantage |
$172.07
|
| Rate for Payer: Cash Price |
$550.63
|
| Rate for Payer: Cofinity Commercial |
$591.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$550.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.07
|
| Rate for Payer: Healthscope Commercial |
$619.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.05
|
| Rate for Payer: Nomi Health Commercial |
$564.40
|
| Rate for Payer: PACE Senior Care Partners |
$163.47
|
| Rate for Payer: PACE SWMI |
$172.07
|
| Rate for Payer: PHP Commercial |
$585.05
|
| Rate for Payer: PHP Medicare Advantage |
$172.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.39
|
| Rate for Payer: Priority Health HMO/PPO |
$598.81
|
| Rate for Payer: Priority Health Medicare |
$173.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$461.15
|
| Rate for Payer: Railroad Medicare Medicare |
$172.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$605.70
|
| Rate for Payer: UHC Core |
$574.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.07
|
| Rate for Payer: UHC Exchange |
$172.07
|
| Rate for Payer: UHC Medicare Advantage |
$172.07
|
| Rate for Payer: VA VA |
$172.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.22
|
|
