|
HC VERTEBROPLASTY SACRUM UNI W WO BONE BX AND IMAGING
|
Facility
|
OP
|
$5,010.27
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
36100299
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,189.94 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$4,258.73
|
| Rate for Payer: Aetna Medicare |
$1,302.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,565.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,565.71
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$1,252.57
|
| Rate for Payer: BCBS Trust/PPO |
$4,118.94
|
| Rate for Payer: BCN Commercial |
$3,895.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,252.57
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cash Price |
$4,008.22
|
| Rate for Payer: Cofinity Commercial |
$4,308.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,008.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,252.57
|
| Rate for Payer: Healthscope Commercial |
$4,509.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,757.70
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.20
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,440.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,258.73
|
| Rate for Payer: Nomi Health Commercial |
$4,108.42
|
| Rate for Payer: PACE Senior Care Partners |
$1,189.94
|
| Rate for Payer: PACE SWMI |
$1,252.57
|
| Rate for Payer: PHP Commercial |
$4,258.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,252.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,256.68
|
| Rate for Payer: Priority Health HMO/PPO |
$4,358.93
|
| Rate for Payer: Priority Health Medicare |
$1,265.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,356.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,252.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,409.04
|
| Rate for Payer: UHC Core |
$4,183.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,252.57
|
| Rate for Payer: UHC Exchange |
$1,252.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,252.57
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$1,252.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,757.70
|
|
|
HC VEST SUPPLY
|
Facility
|
OP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$418.24 |
| Rate for Payer: Aetna Commercial |
$395.00
|
| Rate for Payer: Aetna Medicare |
$120.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.22
|
| Rate for Payer: BCBS Complete |
$185.88
|
| Rate for Payer: BCBS MAPPO |
$116.18
|
| Rate for Payer: BCBS Trust/PPO |
$382.04
|
| Rate for Payer: BCN Commercial |
$361.31
|
| Rate for Payer: BCN Medicare Advantage |
$116.18
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$399.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.18
|
| Rate for Payer: Healthscope Commercial |
$418.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: Nomi Health Commercial |
$381.06
|
| Rate for Payer: PACE Senior Care Partners |
$110.37
|
| Rate for Payer: PACE SWMI |
$116.18
|
| Rate for Payer: PHP Commercial |
$395.00
|
| Rate for Payer: PHP Medicare Advantage |
$116.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: Priority Health HMO/PPO |
$404.30
|
| Rate for Payer: Priority Health Medicare |
$117.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.36
|
| Rate for Payer: Railroad Medicare Medicare |
$116.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.94
|
| Rate for Payer: UHC Core |
$388.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.18
|
| Rate for Payer: UHC Exchange |
$116.18
|
| Rate for Payer: UHC Medicare Advantage |
$116.18
|
| Rate for Payer: VA VA |
$116.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.53
|
|
|
HC VEST SUPPLY
|
Facility
|
IP
|
$464.71
|
|
| Hospital Charge Code |
27000169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$302.06 |
| Max. Negotiated Rate |
$418.24 |
| Rate for Payer: Aetna Commercial |
$395.00
|
| Rate for Payer: BCBS Trust/PPO |
$379.34
|
| Rate for Payer: BCN Commercial |
$359.13
|
| Rate for Payer: Cash Price |
$371.77
|
| Rate for Payer: Cofinity Commercial |
$399.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.77
|
| Rate for Payer: Healthscope Commercial |
$418.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.00
|
| Rate for Payer: Nomi Health Commercial |
$381.06
|
| Rate for Payer: PHP Commercial |
$395.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.06
|
| Rate for Payer: Priority Health HMO/PPO |
$404.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.94
|
| Rate for Payer: UHC Core |
$388.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.53
|
|
|
HC VIABAHN 2
|
Facility
|
OP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.08 |
| Max. Negotiated Rate |
$7,302.60 |
| Rate for Payer: Aetna Commercial |
$6,896.90
|
| Rate for Payer: Aetna Medicare |
$2,109.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,535.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,535.62
|
| Rate for Payer: BCBS Complete |
$3,245.60
|
| Rate for Payer: BCBS MAPPO |
$2,028.50
|
| Rate for Payer: BCBS Trust/PPO |
$6,670.52
|
| Rate for Payer: BCN Commercial |
$6,308.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,028.50
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$6,978.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,028.50
|
| Rate for Payer: Healthscope Commercial |
$7,302.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,085.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,129.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,332.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: Nomi Health Commercial |
$6,653.48
|
| Rate for Payer: PACE Senior Care Partners |
$1,927.08
|
| Rate for Payer: PACE SWMI |
$2,028.50
|
| Rate for Payer: PHP Commercial |
$6,896.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,028.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: Priority Health HMO/PPO |
$7,059.18
|
| Rate for Payer: Priority Health Medicare |
$2,048.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,436.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,028.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,140.32
|
| Rate for Payer: UHC Core |
$6,775.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,028.50
|
| Rate for Payer: UHC Exchange |
$2,028.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,028.50
|
| Rate for Payer: VA VA |
$2,028.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,085.50
|
|
|
HC VIABAHN 2
|
Facility
|
IP
|
$8,114.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27800034
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,274.10 |
| Max. Negotiated Rate |
$7,302.60 |
| Rate for Payer: Aetna Commercial |
$6,896.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,623.46
|
| Rate for Payer: BCN Commercial |
$6,270.50
|
| Rate for Payer: Cash Price |
$6,491.20
|
| Rate for Payer: Cofinity Commercial |
$6,978.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,491.20
|
| Rate for Payer: Healthscope Commercial |
$7,302.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,085.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,896.90
|
| Rate for Payer: Nomi Health Commercial |
$6,653.48
|
| Rate for Payer: PHP Commercial |
$6,896.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,274.10
|
| Rate for Payer: Priority Health HMO/PPO |
$7,059.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,436.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,140.32
|
| Rate for Payer: UHC Core |
$6,775.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,085.50
|
|
|
HC VISCOSITY
|
Facility
|
OP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.11
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.16
|
| Rate for Payer: BCN Commercial |
$55.01
|
| Rate for Payer: BCN Medicare Advantage |
$17.69
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.57
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: PACE Senior Care Partners |
$16.80
|
| Rate for Payer: PACE SWMI |
$17.69
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Medicare |
$17.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.69
|
| Rate for Payer: UHC Exchange |
$17.69
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC VISCOSITY
|
Facility
|
IP
|
$70.75
|
|
|
Service Code
|
CPT 85810
|
| Hospital Charge Code |
30500065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$57.75
|
| Rate for Payer: BCN Commercial |
$54.68
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.99
|
| Rate for Payer: Priority Health HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
IP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.19
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.50
|
| Rate for Payer: UHC Core |
$2.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.13
|
|
|
HC VISIPAQUE 320 PER ML
|
Facility
|
OP
|
$2.84
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.33
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$2.33
|
| Rate for Payer: PACE Senior Care Partners |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.47
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.50
|
| Rate for Payer: UHC Core |
$2.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.13
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
OP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Aetna Commercial |
$33.77
|
| Rate for Payer: Aetna Medicare |
$10.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.42
|
| Rate for Payer: BCBS Complete |
$15.89
|
| Rate for Payer: BCBS MAPPO |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$32.66
|
| Rate for Payer: BCN Commercial |
$30.89
|
| Rate for Payer: BCN Medicare Advantage |
$9.93
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$32.58
|
| Rate for Payer: PACE Senior Care Partners |
$9.44
|
| Rate for Payer: PACE SWMI |
$9.93
|
| Rate for Payer: PHP Commercial |
$33.77
|
| Rate for Payer: PHP Medicare Advantage |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: Priority Health HMO/PPO |
$34.57
|
| Rate for Payer: Priority Health Medicare |
$10.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.62
|
| Rate for Payer: Railroad Medicare Medicare |
$9.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.96
|
| Rate for Payer: UHC Core |
$33.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.93
|
| Rate for Payer: UHC Exchange |
$9.93
|
| Rate for Payer: UHC Medicare Advantage |
$9.93
|
| Rate for Payer: VA VA |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
HC VISUAL ACUITY SCREEN
|
Facility
|
IP
|
$39.73
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000099
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.82 |
| Max. Negotiated Rate |
$35.76 |
| Rate for Payer: Aetna Commercial |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$32.43
|
| Rate for Payer: BCN Commercial |
$30.70
|
| Rate for Payer: Cash Price |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$34.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.78
|
| Rate for Payer: Healthscope Commercial |
$35.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$32.58
|
| Rate for Payer: PHP Commercial |
$33.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.82
|
| Rate for Payer: Priority Health HMO/PPO |
$34.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.96
|
| Rate for Payer: UHC Core |
$33.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
IP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$137.91 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: BCBS Trust/PPO |
$173.19
|
| Rate for Payer: BCN Commercial |
$163.96
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO |
$184.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.71
|
| Rate for Payer: UHC Core |
$177.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC VISUAL AUDIOMETRY VRA
|
Facility
|
OP
|
$212.17
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
47100013
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$180.34
|
| Rate for Payer: Aetna Medicare |
$55.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.30
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$53.04
|
| Rate for Payer: BCBS Trust/PPO |
$174.42
|
| Rate for Payer: BCN Commercial |
$164.96
|
| Rate for Payer: BCN Medicare Advantage |
$53.04
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cash Price |
$169.74
|
| Rate for Payer: Cofinity Commercial |
$182.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.13
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.69
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.34
|
| Rate for Payer: Nomi Health Commercial |
$173.98
|
| Rate for Payer: PACE Senior Care Partners |
$50.39
|
| Rate for Payer: PACE SWMI |
$53.04
|
| Rate for Payer: PHP Commercial |
$180.34
|
| Rate for Payer: PHP Medicare Advantage |
$53.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.91
|
| Rate for Payer: Priority Health HMO/PPO |
$184.59
|
| Rate for Payer: Priority Health Medicare |
$53.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.15
|
| Rate for Payer: Railroad Medicare Medicare |
$53.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.71
|
| Rate for Payer: UHC Core |
$177.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.04
|
| Rate for Payer: UHC Exchange |
$53.04
|
| Rate for Payer: UHC Medicare Advantage |
$53.04
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$53.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.13
|
|
|
HC VITAL CAPACITY
|
Facility
|
IP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$241.25 |
| Rate for Payer: Aetna Commercial |
$227.84
|
| Rate for Payer: BCBS Trust/PPO |
$218.81
|
| Rate for Payer: BCN Commercial |
$207.15
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$230.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Healthscope Commercial |
$241.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: Priority Health HMO/PPO |
$233.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.88
|
| Rate for Payer: UHC Core |
$223.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.04
|
|
|
HC VITAL CAPACITY
|
Facility
|
OP
|
$268.05
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$241.25 |
| Rate for Payer: Aetna Commercial |
$227.84
|
| Rate for Payer: Aetna Medicare |
$69.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.77
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$67.01
|
| Rate for Payer: BCBS Trust/PPO |
$220.36
|
| Rate for Payer: BCN Commercial |
$208.41
|
| Rate for Payer: BCN Medicare Advantage |
$67.01
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cash Price |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$230.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.01
|
| Rate for Payer: Healthscope Commercial |
$241.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.04
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.36
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.84
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE Senior Care Partners |
$63.66
|
| Rate for Payer: PACE SWMI |
$67.01
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: PHP Medicare Advantage |
$67.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: Priority Health HMO/PPO |
$233.20
|
| Rate for Payer: Priority Health Medicare |
$67.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.59
|
| Rate for Payer: Railroad Medicare Medicare |
$67.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.88
|
| Rate for Payer: UHC Core |
$223.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.01
|
| Rate for Payer: UHC Exchange |
$67.01
|
| Rate for Payer: UHC Medicare Advantage |
$67.01
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$67.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.04
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.39 |
| 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 |
$8.81
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$36.40
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| 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 |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$8.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$8.81
|
| 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 |
$11.71
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.39
|
| 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 |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.71
|
| Rate for Payer: UHC Exchange |
$11.71
|
| Rate for Payer: UHC Medicare Advantage |
$11.71
|
| Rate for Payer: UHCCP Medicaid |
$8.39
|
| Rate for Payer: VA VA |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC VITAMIN A LEVEL
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
30100458
|
|
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 VITAMIN B12 LEVEL
|
Facility
|
OP
|
$62.42
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: Aetna Medicare |
$16.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.51
|
| Rate for Payer: BCBS Complete |
$11.45
|
| Rate for Payer: BCBS MAPPO |
$15.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$48.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.61
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Mclaren Medicaid |
$10.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.39
|
| Rate for Payer: Meridian Medicaid |
$11.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.82
|
| Rate for Payer: PACE SWMI |
$15.61
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Medicare |
$15.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.61
|
| Rate for Payer: UHC Exchange |
$15.61
|
| Rate for Payer: UHC Medicare Advantage |
$15.61
|
| Rate for Payer: UHCCP Medicaid |
$10.90
|
| Rate for Payer: VA VA |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC VITAMIN B12 LEVEL
|
Facility
|
IP
|
$62.42
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
30100185
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$56.18 |
| Rate for Payer: Aetna Commercial |
$53.06
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.94
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.94
|
| Rate for Payer: Healthscope Commercial |
$56.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.06
|
| Rate for Payer: Nomi Health Commercial |
$51.18
|
| Rate for Payer: PHP Commercial |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health HMO/PPO |
$54.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Core |
$52.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.81
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
OP
|
$188.45
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$169.60 |
| Rate for Payer: Aetna Commercial |
$160.18
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.89
|
| Rate for Payer: BCBS Complete |
$12.95
|
| Rate for Payer: BCBS MAPPO |
$47.11
|
| Rate for Payer: BCBS Trust/PPO |
$154.92
|
| Rate for Payer: BCN Commercial |
$146.52
|
| Rate for Payer: BCN Medicare Advantage |
$47.11
|
| Rate for Payer: Cash Price |
$150.76
|
| Rate for Payer: Cash Price |
$150.76
|
| Rate for Payer: Cofinity Commercial |
$162.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.11
|
| Rate for Payer: Healthscope Commercial |
$169.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.34
|
| Rate for Payer: Mclaren Medicaid |
$12.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.47
|
| Rate for Payer: Meridian Medicaid |
$12.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.18
|
| Rate for Payer: Nomi Health Commercial |
$154.53
|
| Rate for Payer: PACE Senior Care Partners |
$44.76
|
| Rate for Payer: PACE SWMI |
$47.11
|
| Rate for Payer: PHP Commercial |
$160.18
|
| Rate for Payer: PHP Medicare Advantage |
$47.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.49
|
| Rate for Payer: Priority Health HMO/PPO |
$163.95
|
| Rate for Payer: Priority Health Medicare |
$47.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.26
|
| Rate for Payer: Railroad Medicare Medicare |
$47.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.84
|
| Rate for Payer: UHC Core |
$157.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.11
|
| Rate for Payer: UHC Exchange |
$47.11
|
| Rate for Payer: UHC Medicare Advantage |
$47.11
|
| Rate for Payer: UHCCP Medicaid |
$12.33
|
| Rate for Payer: VA VA |
$47.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.34
|
|
|
HC VITAMIN B3 AND METABOLITES, P
|
Facility
|
IP
|
$188.45
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
30100754
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$122.49 |
| Max. Negotiated Rate |
$169.60 |
| Rate for Payer: Aetna Commercial |
$160.18
|
| Rate for Payer: BCBS Trust/PPO |
$153.83
|
| Rate for Payer: BCN Commercial |
$145.63
|
| Rate for Payer: Cash Price |
$150.76
|
| Rate for Payer: Cofinity Commercial |
$162.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.76
|
| Rate for Payer: Healthscope Commercial |
$169.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.18
|
| Rate for Payer: Nomi Health Commercial |
$154.53
|
| Rate for Payer: PHP Commercial |
$160.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.49
|
| Rate for Payer: Priority Health HMO/PPO |
$163.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.84
|
| Rate for Payer: UHC Core |
$157.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.34
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
OP
|
$57.22
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.88
|
| Rate for Payer: BCBS Complete |
$21.33
|
| Rate for Payer: BCBS MAPPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$47.04
|
| Rate for Payer: BCN Commercial |
$44.49
|
| Rate for Payer: BCN Medicare Advantage |
$14.30
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.91
|
| Rate for Payer: Mclaren Medicaid |
$20.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.02
|
| Rate for Payer: Meridian Medicaid |
$21.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: PACE Senior Care Partners |
$13.59
|
| Rate for Payer: PACE SWMI |
$14.30
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$14.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO |
$49.78
|
| Rate for Payer: Priority Health Medicare |
$14.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.35
|
| Rate for Payer: UHC Core |
$47.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.30
|
| Rate for Payer: UHC Exchange |
$14.30
|
| Rate for Payer: UHC Medicare Advantage |
$14.30
|
| Rate for Payer: UHCCP Medicaid |
$20.32
|
| Rate for Payer: VA VA |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.91
|
|
|
HC VITAMIN B6 LEVEL
|
Facility
|
IP
|
$57.22
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
30100413
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: Aetna Commercial |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$46.71
|
| Rate for Payer: BCN Commercial |
$44.22
|
| Rate for Payer: Cash Price |
$45.78
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.78
|
| Rate for Payer: Healthscope Commercial |
$51.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.64
|
| Rate for Payer: Nomi Health Commercial |
$46.92
|
| Rate for Payer: PHP Commercial |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health HMO/PPO |
$49.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.35
|
| Rate for Payer: UHC Core |
$47.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.91
|
|
|
HC VITAMIN C LEVEL
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
30100112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: Aetna Medicare |
$17.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.72
|
| Rate for Payer: BCBS Complete |
$7.51
|
| Rate for Payer: BCBS MAPPO |
$16.57
|
| Rate for Payer: BCBS Trust/PPO |
$54.51
|
| Rate for Payer: BCN Commercial |
$51.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.57
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Mclaren Medicaid |
$7.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.40
|
| Rate for Payer: Meridian Medicaid |
$7.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Senior Care Partners |
$15.75
|
| Rate for Payer: PACE SWMI |
$16.57
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: PHP Medicare Advantage |
$16.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Medicare |
$16.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.57
|
| Rate for Payer: UHC Exchange |
$16.57
|
| Rate for Payer: UHC Medicare Advantage |
$16.57
|
| Rate for Payer: UHCCP Medicaid |
$7.15
|
| Rate for Payer: VA VA |
$16.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
|
HC VITAMIN C LEVEL
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
30100112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$59.67 |
| Rate for Payer: Aetna Commercial |
$56.35
|
| Rate for Payer: BCBS Trust/PPO |
$54.12
|
| Rate for Payer: BCN Commercial |
$51.24
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$57.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$59.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.35
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PHP Commercial |
$56.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.09
|
| Rate for Payer: Priority Health HMO/PPO |
$57.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.34
|
| Rate for Payer: UHC Core |
$55.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.73
|
|
