|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$33.89
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: BCBS Trust/PPO |
$26.19
|
| Rate for Payer: BCN Commercial |
$26.19
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.11
|
| Rate for Payer: Healthscope Commercial |
$30.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.81
|
| Rate for Payer: PHP Commercial |
$28.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.82
|
| Rate for Payer: UHC Core |
$28.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.42
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$33.89
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Aetna Commercial |
$28.81
|
| Rate for Payer: Aetna Medicare |
$8.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.59
|
| Rate for Payer: BCBS Complete |
$13.56
|
| Rate for Payer: BCBS MAPPO |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$26.35
|
| Rate for Payer: BCN Commercial |
$26.35
|
| Rate for Payer: BCN Medicare Advantage |
$8.47
|
| Rate for Payer: Cash Price |
$27.11
|
| Rate for Payer: Cofinity Commercial |
$29.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.47
|
| Rate for Payer: Healthscope Commercial |
$30.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.81
|
| Rate for Payer: PACE Senior Care Partners |
$8.05
|
| Rate for Payer: PACE SWMI |
$8.47
|
| Rate for Payer: PHP Commercial |
$28.81
|
| Rate for Payer: PHP Medicare Advantage |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.48
|
| Rate for Payer: Priority Health Medicare |
$8.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.67
|
| Rate for Payer: Railroad Medicare Medicare |
$8.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.82
|
| Rate for Payer: UHC Core |
$28.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.47
|
| Rate for Payer: UHC Medicare Advantage |
$8.73
|
| Rate for Payer: VA VA |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.42
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$24.80
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.75
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCN Commercial |
$19.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.20
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.89
|
| Rate for Payer: PACE SWMI |
$6.20
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: PHP Medicare Advantage |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.58
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.20
|
| Rate for Payer: UHC Medicare Advantage |
$6.39
|
| Rate for Payer: VA VA |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$24.80
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.17
|
| Rate for Payer: BCN Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$24.80
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.75
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCN Commercial |
$19.28
|
| Rate for Payer: BCN Medicare Advantage |
$6.20
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.20
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.89
|
| Rate for Payer: PACE SWMI |
$6.20
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: PHP Medicare Advantage |
$6.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.58
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.20
|
| Rate for Payer: UHC Medicare Advantage |
$6.39
|
| Rate for Payer: VA VA |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$24.80
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna Commercial |
$21.08
|
| Rate for Payer: BCBS Trust/PPO |
$19.17
|
| Rate for Payer: BCN Commercial |
$19.17
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$21.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$22.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.08
|
| Rate for Payer: PHP Commercial |
$21.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.82
|
| Rate for Payer: UHC Core |
$20.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.60
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,477.80
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,063.48 |
| Max. Negotiated Rate |
$4,030.02 |
| Rate for Payer: Aetna Commercial |
$3,806.13
|
| Rate for Payer: Aetna Medicare |
$1,164.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,399.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,399.31
|
| Rate for Payer: BCBS Complete |
$2,401.24
|
| Rate for Payer: BCBS MAPPO |
$1,119.45
|
| Rate for Payer: BCBS Trust/PPO |
$3,481.49
|
| Rate for Payer: BCN Commercial |
$3,481.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.45
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cofinity Commercial |
$3,850.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,582.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.45
|
| Rate for Payer: Healthscope Commercial |
$4,030.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,358.35
|
| Rate for Payer: Mclaren Medicaid |
$2,286.89
|
| Rate for Payer: Meridian Medicaid |
$2,401.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,175.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,287.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,806.13
|
| Rate for Payer: PACE Senior Care Partners |
$1,063.48
|
| Rate for Payer: PACE SWMI |
$1,119.45
|
| Rate for Payer: PHP Commercial |
$3,806.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,286.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,134.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,895.69
|
| Rate for Payer: Priority Health Medicare |
$1,119.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,731.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,119.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,940.46
|
| Rate for Payer: UHC Core |
$3,738.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,119.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,153.03
|
| Rate for Payer: VA VA |
$1,119.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,358.35
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,477.80
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,731.01 |
| Max. Negotiated Rate |
$4,030.02 |
| Rate for Payer: Aetna Commercial |
$3,806.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,460.44
|
| Rate for Payer: BCN Commercial |
$3,460.44
|
| Rate for Payer: Cash Price |
$3,582.24
|
| Rate for Payer: Cofinity Commercial |
$3,850.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,582.24
|
| Rate for Payer: Healthscope Commercial |
$4,030.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,358.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,806.13
|
| Rate for Payer: PHP Commercial |
$3,806.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,134.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,895.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,731.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,940.46
|
| Rate for Payer: UHC Core |
$3,738.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,358.35
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$44.50
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: BCBS Trust/PPO |
$34.39
|
| Rate for Payer: BCN Commercial |
$34.39
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.16
|
| Rate for Payer: UHC Core |
$37.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$44.50
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.91
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$34.60
|
| Rate for Payer: BCN Commercial |
$34.60
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.38
|
| Rate for Payer: Mclaren Medicaid |
$11.06
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: PACE Senior Care Partners |
$10.57
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.72
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: Railroad Medicare Medicare |
$11.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.16
|
| Rate for Payer: UHC Core |
$37.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.46
|
| Rate for Payer: VA VA |
$11.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.38
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$121.18
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$109.06 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: BCBS Trust/PPO |
$93.65
|
| Rate for Payer: BCN Commercial |
$93.65
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cofinity Commercial |
$104.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.94
|
| Rate for Payer: Healthscope Commercial |
$109.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.00
|
| Rate for Payer: PHP Commercial |
$103.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.64
|
| Rate for Payer: UHC Core |
$101.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.88
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$121.18
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$109.06 |
| Rate for Payer: Aetna Commercial |
$103.00
|
| Rate for Payer: Aetna Medicare |
$31.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.87
|
| Rate for Payer: BCBS Complete |
$48.47
|
| Rate for Payer: BCBS MAPPO |
$30.30
|
| Rate for Payer: BCBS Trust/PPO |
$94.22
|
| Rate for Payer: BCN Commercial |
$94.22
|
| Rate for Payer: BCN Medicare Advantage |
$30.30
|
| Rate for Payer: Cash Price |
$96.94
|
| Rate for Payer: Cofinity Commercial |
$104.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.30
|
| Rate for Payer: Healthscope Commercial |
$109.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.00
|
| Rate for Payer: PACE Senior Care Partners |
$28.78
|
| Rate for Payer: PACE SWMI |
$30.30
|
| Rate for Payer: PHP Commercial |
$103.00
|
| Rate for Payer: PHP Medicare Advantage |
$30.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.43
|
| Rate for Payer: Priority Health Medicare |
$30.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.91
|
| Rate for Payer: Railroad Medicare Medicare |
$30.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.64
|
| Rate for Payer: UHC Core |
$101.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.30
|
| Rate for Payer: UHC Medicare Advantage |
$31.20
|
| Rate for Payer: VA VA |
$30.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.88
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$52.73
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.48
|
| Rate for Payer: BCBS Complete |
$21.09
|
| Rate for Payer: BCBS MAPPO |
$13.18
|
| Rate for Payer: BCBS Trust/PPO |
$41.00
|
| Rate for Payer: BCN Commercial |
$41.00
|
| Rate for Payer: BCN Medicare Advantage |
$13.18
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PACE Senior Care Partners |
$12.52
|
| Rate for Payer: PACE SWMI |
$13.18
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.88
|
| Rate for Payer: Priority Health Medicare |
$13.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.16
|
| Rate for Payer: Railroad Medicare Medicare |
$13.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.40
|
| Rate for Payer: UHC Core |
$44.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.18
|
| Rate for Payer: UHC Medicare Advantage |
$13.58
|
| Rate for Payer: VA VA |
$13.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.55
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$52.73
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$47.46 |
| Rate for Payer: Aetna Commercial |
$44.82
|
| Rate for Payer: BCBS Trust/PPO |
$40.75
|
| Rate for Payer: BCN Commercial |
$40.75
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.18
|
| Rate for Payer: Healthscope Commercial |
$47.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.82
|
| Rate for Payer: PHP Commercial |
$44.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.40
|
| Rate for Payer: UHC Core |
$44.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.55
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$151.79
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$442.42 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: Aetna Medicare |
$39.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.43
|
| Rate for Payer: BCBS Complete |
$442.42
|
| Rate for Payer: BCBS MAPPO |
$37.95
|
| Rate for Payer: BCBS Trust/PPO |
$118.02
|
| Rate for Payer: BCN Commercial |
$118.02
|
| Rate for Payer: BCN Medicare Advantage |
$37.95
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.95
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Mclaren Medicaid |
$421.35
|
| Rate for Payer: Meridian Medicaid |
$442.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PACE Senior Care Partners |
$36.05
|
| Rate for Payer: PACE SWMI |
$37.95
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: PHP Medicare Advantage |
$37.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.06
|
| Rate for Payer: Priority Health Medicare |
$37.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.58
|
| Rate for Payer: Railroad Medicare Medicare |
$37.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.95
|
| Rate for Payer: UHC Medicare Advantage |
$39.09
|
| Rate for Payer: VA VA |
$37.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$151.79
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$92.58 |
| Max. Negotiated Rate |
$136.61 |
| Rate for Payer: Aetna Commercial |
$129.02
|
| Rate for Payer: BCBS Trust/PPO |
$117.30
|
| Rate for Payer: BCN Commercial |
$117.30
|
| Rate for Payer: Cash Price |
$121.43
|
| Rate for Payer: Cofinity Commercial |
$130.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.43
|
| Rate for Payer: Healthscope Commercial |
$136.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.02
|
| Rate for Payer: PHP Commercial |
$129.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.58
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.84
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$64.36
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$57.92 |
| Rate for Payer: Aetna Commercial |
$54.71
|
| Rate for Payer: Aetna Medicare |
$16.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.11
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$50.04
|
| Rate for Payer: BCN Commercial |
$50.04
|
| Rate for Payer: BCN Medicare Advantage |
$16.09
|
| Rate for Payer: Cash Price |
$51.49
|
| Rate for Payer: Cash Price |
$51.49
|
| Rate for Payer: Cofinity Commercial |
$55.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$57.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.27
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.71
|
| Rate for Payer: PACE Senior Care Partners |
$15.29
|
| Rate for Payer: PACE SWMI |
$16.09
|
| Rate for Payer: PHP Commercial |
$54.71
|
| Rate for Payer: PHP Medicare Advantage |
$16.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.99
|
| Rate for Payer: Priority Health Medicare |
$16.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| Rate for Payer: Railroad Medicare Medicare |
$16.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.64
|
| Rate for Payer: UHC Core |
$53.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.09
|
| Rate for Payer: UHC Medicare Advantage |
$16.57
|
| Rate for Payer: VA VA |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.27
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$64.36
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$57.92 |
| Rate for Payer: Aetna Commercial |
$54.71
|
| Rate for Payer: BCBS Trust/PPO |
$49.74
|
| Rate for Payer: BCN Commercial |
$49.74
|
| Rate for Payer: Cash Price |
$51.49
|
| Rate for Payer: Cofinity Commercial |
$55.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.49
|
| Rate for Payer: Healthscope Commercial |
$57.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.71
|
| Rate for Payer: PHP Commercial |
$54.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.64
|
| Rate for Payer: UHC Core |
$53.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.27
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.48 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$115.92
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.88
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS MAPPO |
$37.50
|
| Rate for Payer: BCBS Trust/PPO |
$116.62
|
| Rate for Payer: BCN Commercial |
$116.62
|
| Rate for Payer: BCN Medicare Advantage |
$37.50
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Mclaren Medicaid |
$16.36
|
| Rate for Payer: Meridian Medicaid |
$17.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.50
|
| Rate for Payer: PACE Senior Care Partners |
$35.62
|
| Rate for Payer: PACE SWMI |
$37.50
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Medicare Advantage |
$37.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.50
|
| Rate for Payer: Priority Health Medicare |
$37.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.48
|
| Rate for Payer: Railroad Medicare Medicare |
$37.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.00
|
| Rate for Payer: UHC Core |
$125.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.50
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$37.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.81 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.44
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$118.75
|
| Rate for Payer: BCBS Trust/PPO |
$369.31
|
| Rate for Payer: BCN Commercial |
$369.31
|
| Rate for Payer: BCN Medicare Advantage |
$118.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.75
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PACE Senior Care Partners |
$112.81
|
| Rate for Payer: PACE SWMI |
$118.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: PHP Medicare Advantage |
$118.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.25
|
| Rate for Payer: Priority Health Medicare |
$118.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.70
|
| Rate for Payer: Railroad Medicare Medicare |
$118.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.75
|
| Rate for Payer: UHC Medicare Advantage |
$122.31
|
| Rate for Payer: VA VA |
$118.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: BCBS Trust/PPO |
$367.08
|
| Rate for Payer: BCN Commercial |
$367.08
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.52
|
| Rate for Payer: BCN Commercial |
$212.52
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.31 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$213.81
|
| Rate for Payer: BCN Commercial |
$213.81
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PACE Senior Care Partners |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.75
|
| Rate for Payer: UHC Medicare Advantage |
$70.81
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
|
HC DNA DOUBLE STRANDED AB
|
Facility
|
IP
|
$27.85
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$23.67
|
| Rate for Payer: BCBS Trust/PPO |
$21.52
|
| Rate for Payer: BCN Commercial |
$21.52
|
| Rate for Payer: Cash Price |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$23.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.28
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.67
|
| Rate for Payer: PHP Commercial |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.51
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.89
|
|
