|
HC THERAPEUTIC EX EACH 15 MIN
|
Facility
|
IP
|
$114.44
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
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 THERAPEUTIC EX EACH 15 MIN
|
Facility
|
OP
|
$114.44
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
42000020
|
|
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 THERAPEUTIC PHLEBOTOMY
|
Facility
|
IP
|
$863.24
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$561.11 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna Commercial |
$733.75
|
| Rate for Payer: BCBS Trust/PPO |
$704.66
|
| Rate for Payer: BCN Commercial |
$667.11
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cofinity Commercial |
$742.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.59
|
| Rate for Payer: Healthscope Commercial |
$776.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.75
|
| Rate for Payer: Nomi Health Commercial |
$707.86
|
| Rate for Payer: PHP Commercial |
$733.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.11
|
| Rate for Payer: Priority Health HMO/PPO |
$751.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.65
|
| Rate for Payer: UHC Core |
$720.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.43
|
|
|
HC THERAPEUTIC PHLEBOTOMY
|
Facility
|
OP
|
$863.24
|
|
|
Service Code
|
CPT 99195
|
| Hospital Charge Code |
76100010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.19 |
| Max. Negotiated Rate |
$776.92 |
| Rate for Payer: Aetna Commercial |
$733.75
|
| Rate for Payer: Aetna Medicare |
$224.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.76
|
| Rate for Payer: BCBS Complete |
$97.86
|
| Rate for Payer: BCBS MAPPO |
$215.81
|
| Rate for Payer: BCBS Trust/PPO |
$709.67
|
| Rate for Payer: BCN Commercial |
$671.17
|
| Rate for Payer: BCN Medicare Advantage |
$215.81
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cash Price |
$690.59
|
| Rate for Payer: Cofinity Commercial |
$742.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.81
|
| Rate for Payer: Healthscope Commercial |
$776.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.43
|
| Rate for Payer: Mclaren Medicaid |
$93.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.60
|
| Rate for Payer: Meridian Medicaid |
$97.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.75
|
| Rate for Payer: Nomi Health Commercial |
$707.86
|
| Rate for Payer: PACE Senior Care Partners |
$205.02
|
| Rate for Payer: PACE SWMI |
$215.81
|
| Rate for Payer: PHP Commercial |
$733.75
|
| Rate for Payer: PHP Medicare Advantage |
$215.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.11
|
| Rate for Payer: Priority Health HMO/PPO |
$751.02
|
| Rate for Payer: Priority Health Medicare |
$217.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.37
|
| Rate for Payer: Railroad Medicare Medicare |
$215.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.65
|
| Rate for Payer: UHC Core |
$720.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.81
|
| Rate for Payer: UHC Exchange |
$215.81
|
| Rate for Payer: UHC Medicare Advantage |
$215.81
|
| Rate for Payer: UHCCP Medicaid |
$93.19
|
| Rate for Payer: VA VA |
$215.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.43
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
OP
|
$59.43
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$53.49 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: Aetna Medicare |
$15.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.57
|
| Rate for Payer: BCBS Complete |
$23.77
|
| Rate for Payer: BCBS MAPPO |
$14.86
|
| Rate for Payer: BCBS Trust/PPO |
$48.86
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: BCN Medicare Advantage |
$14.86
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$51.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$53.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: Nomi Health Commercial |
$48.73
|
| Rate for Payer: PACE Senior Care Partners |
$14.11
|
| Rate for Payer: PACE SWMI |
$14.86
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: PHP Medicare Advantage |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.63
|
| Rate for Payer: Priority Health HMO/PPO |
$51.70
|
| Rate for Payer: Priority Health Medicare |
$15.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.30
|
| Rate for Payer: UHC Core |
$49.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.86
|
| Rate for Payer: UHC Exchange |
$14.86
|
| Rate for Payer: UHC Medicare Advantage |
$14.86
|
| Rate for Payer: VA VA |
$14.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.57
|
|
|
HC THERASKIN PER SQ CM (116 SQ CM)
|
Facility
|
IP
|
$59.43
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600219
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.63 |
| Max. Negotiated Rate |
$53.49 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: BCBS Trust/PPO |
$48.51
|
| Rate for Payer: BCN Commercial |
$45.93
|
| Rate for Payer: Cash Price |
$47.54
|
| Rate for Payer: Cofinity Commercial |
$51.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$53.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.52
|
| Rate for Payer: Nomi Health Commercial |
$48.73
|
| Rate for Payer: PHP Commercial |
$50.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.63
|
| Rate for Payer: Priority Health HMO/PPO |
$51.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.30
|
| Rate for Payer: UHC Core |
$49.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.57
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
IP
|
$184.13
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$165.72 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: BCBS Trust/PPO |
$150.31
|
| Rate for Payer: BCN Commercial |
$142.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cofinity Commercial |
$158.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.30
|
| Rate for Payer: Healthscope Commercial |
$165.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.51
|
| Rate for Payer: Nomi Health Commercial |
$150.99
|
| Rate for Payer: PHP Commercial |
$156.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.68
|
| Rate for Payer: Priority Health HMO/PPO |
$160.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.03
|
| Rate for Payer: UHC Core |
$153.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.10
|
|
|
HC THERASKIN PER SQ CM (13 SQ CM)
|
Facility
|
OP
|
$184.13
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.73 |
| Max. Negotiated Rate |
$165.72 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$47.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.54
|
| Rate for Payer: BCBS Complete |
$73.65
|
| Rate for Payer: BCBS MAPPO |
$46.03
|
| Rate for Payer: BCBS Trust/PPO |
$151.37
|
| Rate for Payer: BCN Commercial |
$143.16
|
| Rate for Payer: BCN Medicare Advantage |
$46.03
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cofinity Commercial |
$158.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.03
|
| Rate for Payer: Healthscope Commercial |
$165.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.51
|
| Rate for Payer: Nomi Health Commercial |
$150.99
|
| Rate for Payer: PACE Senior Care Partners |
$43.73
|
| Rate for Payer: PACE SWMI |
$46.03
|
| Rate for Payer: PHP Commercial |
$156.51
|
| Rate for Payer: PHP Medicare Advantage |
$46.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.68
|
| Rate for Payer: Priority Health HMO/PPO |
$160.19
|
| Rate for Payer: Priority Health Medicare |
$46.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.37
|
| Rate for Payer: Railroad Medicare Medicare |
$46.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.03
|
| Rate for Payer: UHC Core |
$153.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.03
|
| Rate for Payer: UHC Exchange |
$46.03
|
| Rate for Payer: UHC Medicare Advantage |
$46.03
|
| Rate for Payer: VA VA |
$46.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.10
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
OP
|
$84.55
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: Aetna Medicare |
$21.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.42
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: BCBS MAPPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$69.51
|
| Rate for Payer: BCN Commercial |
$65.74
|
| Rate for Payer: BCN Medicare Advantage |
$21.14
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PACE Senior Care Partners |
$20.08
|
| Rate for Payer: PACE SWMI |
$21.14
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: PHP Medicare Advantage |
$21.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Medicare |
$21.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: Railroad Medicare Medicare |
$21.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.14
|
| Rate for Payer: UHC Exchange |
$21.14
|
| Rate for Payer: UHC Medicare Advantage |
$21.14
|
| Rate for Payer: VA VA |
$21.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
HC THERASKIN PER SQ CM (39 SQ CM)
|
Facility
|
IP
|
$84.55
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
63600065
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Aetna Commercial |
$71.87
|
| Rate for Payer: BCBS Trust/PPO |
$69.02
|
| Rate for Payer: BCN Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$67.64
|
| Rate for Payer: Cofinity Commercial |
$72.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.64
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.87
|
| Rate for Payer: Nomi Health Commercial |
$69.33
|
| Rate for Payer: PHP Commercial |
$71.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.96
|
| Rate for Payer: Priority Health HMO/PPO |
$73.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.40
|
| Rate for Payer: UHC Core |
$70.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.41
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$273.68 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: BCBS Trust/PPO |
$343.69
|
| Rate for Payer: BCN Commercial |
$325.38
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO |
$366.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.52
|
| Rate for Payer: UHC Core |
$351.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC THERASKIN PER SQ CM (6 SQ CM)
|
Facility
|
OP
|
$421.04
|
|
|
Service Code
|
HCPCS Q4121
|
| Hospital Charge Code |
63600127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna Medicare |
$109.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.57
|
| Rate for Payer: BCBS Complete |
$168.42
|
| Rate for Payer: BCBS MAPPO |
$105.26
|
| Rate for Payer: BCBS Trust/PPO |
$346.14
|
| Rate for Payer: BCN Commercial |
$327.36
|
| Rate for Payer: BCN Medicare Advantage |
$105.26
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.26
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.88
|
| Rate for Payer: Nomi Health Commercial |
$345.25
|
| Rate for Payer: PACE Senior Care Partners |
$100.00
|
| Rate for Payer: PACE SWMI |
$105.26
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: PHP Medicare Advantage |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.68
|
| Rate for Payer: Priority Health HMO/PPO |
$366.30
|
| Rate for Payer: Priority Health Medicare |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.10
|
| Rate for Payer: Railroad Medicare Medicare |
$105.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.52
|
| Rate for Payer: UHC Core |
$351.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.26
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UHC Medicare Advantage |
$105.26
|
| Rate for Payer: VA VA |
$105.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
OP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: Aetna Medicare |
$22.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.40
|
| Rate for Payer: BCBS Complete |
$18.59
|
| Rate for Payer: BCBS MAPPO |
$21.92
|
| Rate for Payer: BCBS Trust/PPO |
$72.08
|
| Rate for Payer: BCN Commercial |
$68.17
|
| Rate for Payer: BCN Medicare Advantage |
$21.92
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Mclaren Medicaid |
$17.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.02
|
| Rate for Payer: Meridian Medicaid |
$18.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PACE Senior Care Partners |
$20.82
|
| Rate for Payer: PACE SWMI |
$21.92
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: PHP Medicare Advantage |
$21.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.75
|
| Rate for Payer: Railroad Medicare Medicare |
$21.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.92
|
| Rate for Payer: UHC Exchange |
$21.92
|
| Rate for Payer: UHC Medicare Advantage |
$21.92
|
| Rate for Payer: UHCCP Medicaid |
$17.71
|
| Rate for Payer: VA VA |
$21.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC THER PROC STRGTH/END RESP 15M
|
Facility
|
IP
|
$87.68
|
|
|
Service Code
|
HCPCS G0237
|
| Hospital Charge Code |
41000047
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$56.99 |
| Max. Negotiated Rate |
$78.91 |
| Rate for Payer: Aetna Commercial |
$74.53
|
| Rate for Payer: BCBS Trust/PPO |
$71.57
|
| Rate for Payer: BCN Commercial |
$67.76
|
| Rate for Payer: Cash Price |
$70.14
|
| Rate for Payer: Cofinity Commercial |
$75.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.14
|
| Rate for Payer: Healthscope Commercial |
$78.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.53
|
| Rate for Payer: Nomi Health Commercial |
$71.90
|
| Rate for Payer: PHP Commercial |
$74.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.99
|
| Rate for Payer: Priority Health HMO/PPO |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.16
|
| Rate for Payer: UHC Core |
$73.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.76
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
OP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.18
|
| Rate for Payer: BCBS Complete |
$16.12
|
| Rate for Payer: BCBS MAPPO |
$15.35
|
| Rate for Payer: BCBS Trust/PPO |
$50.46
|
| Rate for Payer: BCN Commercial |
$47.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.35
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.03
|
| Rate for Payer: Mclaren Medicaid |
$15.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.11
|
| Rate for Payer: Meridian Medicaid |
$16.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: PACE Senior Care Partners |
$14.58
|
| Rate for Payer: PACE SWMI |
$15.35
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: PHP Medicare Advantage |
$15.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO |
$53.40
|
| Rate for Payer: Priority Health Medicare |
$15.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.01
|
| Rate for Payer: UHC Core |
$51.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.35
|
| Rate for Payer: UHC Exchange |
$15.35
|
| Rate for Payer: UHC Medicare Advantage |
$15.35
|
| Rate for Payer: UHCCP Medicaid |
$15.35
|
| Rate for Payer: VA VA |
$15.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.03
|
|
|
HC THIAMINE LEVEL VITAMIN B1
|
Facility
|
IP
|
$61.38
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
30100432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$55.24 |
| Rate for Payer: Aetna Commercial |
$52.17
|
| Rate for Payer: BCBS Trust/PPO |
$50.10
|
| Rate for Payer: BCN Commercial |
$47.43
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$52.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.10
|
| Rate for Payer: Healthscope Commercial |
$55.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.17
|
| Rate for Payer: Nomi Health Commercial |
$50.33
|
| Rate for Payer: PHP Commercial |
$52.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO |
$53.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.01
|
| Rate for Payer: UHC Core |
$51.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.03
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP DIAGNOSTIC
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
31100004
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$15.38
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$14.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$14.65
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$20.20
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$19.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$20.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$19.24
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP DIAGNOSTIC AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
31100031
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.65 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$15.38
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$14.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$14.65
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP SCREENING
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
31100028
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$20.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.38
|
| Rate for Payer: BCBS Complete |
$20.11
|
| Rate for Payer: BCBS MAPPO |
$19.51
|
| Rate for Payer: BCBS Trust/PPO |
$64.15
|
| Rate for Payer: BCN Commercial |
$60.67
|
| Rate for Payer: BCN Medicare Advantage |
$19.51
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Mclaren Medicaid |
$19.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.48
|
| Rate for Payer: Meridian Medicaid |
$20.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PACE Senior Care Partners |
$18.53
|
| Rate for Payer: PACE SWMI |
$19.51
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Medicare |
$19.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: Railroad Medicare Medicare |
$19.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.51
|
| Rate for Payer: UHC Exchange |
$19.51
|
| Rate for Payer: UHC Medicare Advantage |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$19.15
|
| Rate for Payer: VA VA |
$19.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIN PREP PAP SCREENING AUTO
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
HCPCS G0145
|
| Hospital Charge Code |
31100032
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$50.72 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCN Commercial |
$60.30
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$63.98
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.72
|
| Rate for Payer: Priority Health HMO/PPO |
$67.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.67
|
| Rate for Payer: UHC Core |
$65.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.52
|
|
|
HC THIOPURINE METABOLITES
|
Facility
|
OP
|
$295.80
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.48 |
| Max. Negotiated Rate |
$266.22 |
| Rate for Payer: Aetna Commercial |
$251.43
|
| Rate for Payer: Aetna Medicare |
$76.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.44
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS MAPPO |
$73.95
|
| Rate for Payer: BCBS Trust/PPO |
$243.18
|
| Rate for Payer: BCN Commercial |
$229.98
|
| Rate for Payer: BCN Medicare Advantage |
$73.95
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cash Price |
$236.64
|
| Rate for Payer: Cofinity Commercial |
$254.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.95
|
| Rate for Payer: Healthscope Commercial |
$266.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.85
|
| Rate for Payer: Mclaren Medicaid |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.65
|
| Rate for Payer: Meridian Medicaid |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.43
|
| Rate for Payer: Nomi Health Commercial |
$242.56
|
| Rate for Payer: PACE Senior Care Partners |
$70.25
|
| Rate for Payer: PACE SWMI |
$73.95
|
| Rate for Payer: PHP Commercial |
$251.43
|
| Rate for Payer: PHP Medicare Advantage |
$73.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.27
|
| Rate for Payer: Priority Health HMO/PPO |
$257.35
|
| Rate for Payer: Priority Health Medicare |
$74.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: Railroad Medicare Medicare |
$73.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.30
|
| Rate for Payer: UHC Core |
$246.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.95
|
| Rate for Payer: UHC Exchange |
$73.95
|
| Rate for Payer: UHC Medicare Advantage |
$73.95
|
| Rate for Payer: UHCCP Medicaid |
$13.48
|
| Rate for Payer: VA VA |
$73.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.85
|
|
