|
HC TOPIRAMATE LEVEL
|
Facility
|
IP
|
$58.62
|
|
|
Service Code
|
CPT 80201
|
| Hospital Charge Code |
30100050
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.10 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$49.83
|
| Rate for Payer: BCBS Trust/PPO |
$47.85
|
| Rate for Payer: BCN Commercial |
$45.30
|
| Rate for Payer: Cash Price |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.90
|
| Rate for Payer: Healthscope Commercial |
$52.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.83
|
| Rate for Payer: Nomi Health Commercial |
$48.07
|
| Rate for Payer: PHP Commercial |
$49.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.10
|
| Rate for Payer: Priority Health HMO/PPO |
$51.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.59
|
| Rate for Payer: UHC Core |
$48.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.96
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
30200251
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$10.01
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$10.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG CMPT 1
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
30200354
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$13.99
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC TORCH PROFILE IGG CMPT 2
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
30200285
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
OP
|
$14.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.64
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGG CMPT 4
|
Facility
|
IP
|
$14.57
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
30200322
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$11.89
|
| Rate for Payer: BCN Commercial |
$11.26
|
| Rate for Payer: Cash Price |
$11.66
|
| Rate for Payer: Cofinity Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$13.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Nomi Health Commercial |
$11.95
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.82
|
| Rate for Payer: UHC Core |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.93
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$56.06
|
| Rate for Payer: BCN Commercial |
$53.07
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO |
$59.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.43
|
| Rate for Payer: UHC Core |
$57.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.50
|
|
|
HC TORCH PROFILE IGM CMPT 1
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
30200280
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna Medicare |
$17.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.46
|
| Rate for Payer: BCBS Complete |
$10.92
|
| Rate for Payer: BCBS MAPPO |
$17.17
|
| Rate for Payer: BCBS Trust/PPO |
$56.45
|
| Rate for Payer: BCN Commercial |
$53.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.17
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.50
|
| Rate for Payer: Mclaren Medicaid |
$10.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.03
|
| Rate for Payer: Meridian Medicaid |
$10.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: PACE Senior Care Partners |
$16.31
|
| Rate for Payer: PACE SWMI |
$17.17
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO |
$59.74
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.43
|
| Rate for Payer: UHC Core |
$57.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.17
|
| Rate for Payer: UHC Exchange |
$17.17
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: UHCCP Medicaid |
$10.40
|
| Rate for Payer: VA VA |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.50
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
OP
|
$68.67
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: Aetna Medicare |
$17.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.46
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$17.17
|
| Rate for Payer: BCBS Trust/PPO |
$56.45
|
| Rate for Payer: BCN Commercial |
$53.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.17
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.50
|
| Rate for Payer: Mclaren Medicaid |
$10.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.03
|
| Rate for Payer: Meridian Medicaid |
$10.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: PACE Senior Care Partners |
$16.31
|
| Rate for Payer: PACE SWMI |
$17.17
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO |
$59.74
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.01
|
| Rate for Payer: Railroad Medicare Medicare |
$17.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.43
|
| Rate for Payer: UHC Core |
$57.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.17
|
| Rate for Payer: UHC Exchange |
$17.17
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: UHCCP Medicaid |
$10.42
|
| Rate for Payer: VA VA |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.50
|
|
|
HC TORCH PROFILE IGM CMPT 2
|
Facility
|
IP
|
$68.67
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
30200324
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$61.80 |
| Rate for Payer: Aetna Commercial |
$58.37
|
| Rate for Payer: BCBS Trust/PPO |
$56.06
|
| Rate for Payer: BCN Commercial |
$53.07
|
| Rate for Payer: Cash Price |
$54.94
|
| Rate for Payer: Cofinity Commercial |
$59.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.94
|
| Rate for Payer: Healthscope Commercial |
$61.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.37
|
| Rate for Payer: Nomi Health Commercial |
$56.31
|
| Rate for Payer: PHP Commercial |
$58.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.64
|
| Rate for Payer: Priority Health HMO/PPO |
$59.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.43
|
| Rate for Payer: UHC Core |
$57.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.50
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
IP
|
$2,333.11
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,516.52 |
| Max. Negotiated Rate |
$2,099.80 |
| Rate for Payer: Aetna Commercial |
$1,983.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,904.52
|
| Rate for Payer: BCN Commercial |
$1,803.03
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cofinity Commercial |
$2,006.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.49
|
| Rate for Payer: Healthscope Commercial |
$2,099.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,749.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.14
|
| Rate for Payer: Nomi Health Commercial |
$1,913.15
|
| Rate for Payer: PHP Commercial |
$1,983.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,029.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,563.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,053.14
|
| Rate for Payer: UHC Core |
$1,948.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,749.83
|
|
|
HC TOTAL BODY TUMOR SCAN 2 OR MORE DAYS
|
Facility
|
OP
|
$2,333.11
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
34100057
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$554.11 |
| Max. Negotiated Rate |
$2,099.80 |
| Rate for Payer: Aetna Commercial |
$1,983.14
|
| Rate for Payer: Aetna Medicare |
$606.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$729.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$729.10
|
| Rate for Payer: BCBS Complete |
$971.08
|
| Rate for Payer: BCBS MAPPO |
$583.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,918.05
|
| Rate for Payer: BCN Commercial |
$1,813.99
|
| Rate for Payer: BCN Medicare Advantage |
$583.28
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cash Price |
$1,866.49
|
| Rate for Payer: Cofinity Commercial |
$2,006.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,866.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.28
|
| Rate for Payer: Healthscope Commercial |
$2,099.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,749.83
|
| Rate for Payer: Mclaren Medicaid |
$924.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.44
|
| Rate for Payer: Meridian Medicaid |
$971.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$670.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,983.14
|
| Rate for Payer: Nomi Health Commercial |
$1,913.15
|
| Rate for Payer: PACE Senior Care Partners |
$554.11
|
| Rate for Payer: PACE SWMI |
$583.28
|
| Rate for Payer: PHP Commercial |
$1,983.14
|
| Rate for Payer: PHP Medicare Advantage |
$583.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$924.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,029.81
|
| Rate for Payer: Priority Health Medicare |
$589.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,563.18
|
| Rate for Payer: Railroad Medicare Medicare |
$583.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,053.14
|
| Rate for Payer: UHC Core |
$1,948.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$583.28
|
| Rate for Payer: UHC Exchange |
$583.28
|
| Rate for Payer: UHC Medicare Advantage |
$583.28
|
| Rate for Payer: UHCCP Medicaid |
$924.77
|
| Rate for Payer: VA VA |
$583.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,749.83
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC TOTAL IRON BIND CALC & TRANSFE
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
30100483
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Mclaren Medicaid |
$9.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: Meridian Medicaid |
$9.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: UHCCP Medicaid |
$9.23
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC TOTAL PROTEIN
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.95
|
| Rate for Payer: BCN Commercial |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PACE Senior Care Partners |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL PROTEIN
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
30100406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$30.03
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$30.03
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL PROTEIN FLUID
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
30100408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$3.04
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.95
|
| Rate for Payer: BCN Commercial |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Mclaren Medicaid |
$2.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PACE Senior Care Partners |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$2.89
|
| Rate for Payer: VA VA |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.95
|
| Rate for Payer: BCN Commercial |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Mclaren Medicaid |
$2.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PACE Senior Care Partners |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Medicare |
$9.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.72
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$2.65
|
| Rate for Payer: VA VA |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL PROTEIN URINE
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
30100407
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.26 |
| Max. Negotiated Rate |
$34.97 |
| Rate for Payer: Aetna Commercial |
$33.03
|
| Rate for Payer: BCBS Trust/PPO |
$31.72
|
| Rate for Payer: BCN Commercial |
$30.03
|
| Rate for Payer: Cash Price |
$31.09
|
| Rate for Payer: Cofinity Commercial |
$33.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$34.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.03
|
| Rate for Payer: Nomi Health Commercial |
$31.87
|
| Rate for Payer: PHP Commercial |
$33.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.26
|
| Rate for Payer: Priority Health HMO/PPO |
$33.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.20
|
| Rate for Payer: UHC Core |
$32.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.14
|
|
|
HC TOTAL T3
|
Facility
|
IP
|
$47.76
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.04 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: BCBS Trust/PPO |
$38.99
|
| Rate for Payer: BCN Commercial |
$36.91
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health HMO/PPO |
$41.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.03
|
| Rate for Payer: UHC Core |
$39.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
|
HC TOTAL T3
|
Facility
|
OP
|
$47.76
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
30100447
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$42.98 |
| Rate for Payer: Aetna Commercial |
$40.60
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.92
|
| Rate for Payer: BCBS Complete |
$10.77
|
| Rate for Payer: BCBS MAPPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$39.26
|
| Rate for Payer: BCN Commercial |
$37.13
|
| Rate for Payer: BCN Medicare Advantage |
$11.94
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cash Price |
$38.21
|
| Rate for Payer: Cofinity Commercial |
$41.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$42.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.82
|
| Rate for Payer: Mclaren Medicaid |
$10.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.54
|
| Rate for Payer: Meridian Medicaid |
$10.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$39.16
|
| Rate for Payer: PACE Senior Care Partners |
$11.34
|
| Rate for Payer: PACE SWMI |
$11.94
|
| Rate for Payer: PHP Commercial |
$40.60
|
| Rate for Payer: PHP Medicare Advantage |
$11.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.04
|
| Rate for Payer: Priority Health HMO/PPO |
$41.55
|
| Rate for Payer: Priority Health Medicare |
$12.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.00
|
| Rate for Payer: Railroad Medicare Medicare |
$11.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.03
|
| Rate for Payer: UHC Core |
$39.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.94
|
| Rate for Payer: UHC Exchange |
$11.94
|
| Rate for Payer: UHC Medicare Advantage |
$11.94
|
| Rate for Payer: UHCCP Medicaid |
$10.25
|
| Rate for Payer: VA VA |
$11.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.82
|
|
