|
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
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
IP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCN Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$65.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Healthscope Commercial |
$68.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: PHP Commercial |
$64.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.18
|
| Rate for Payer: UHC Core |
$63.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.26
|
|
|
HC DNA PROBES CMPT2
|
Facility
|
OP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000043
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: Aetna Medicare |
$19.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.86
|
| Rate for Payer: BCBS Complete |
$39.67
|
| Rate for Payer: BCBS MAPPO |
$19.08
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$59.35
|
| Rate for Payer: BCN Medicare Advantage |
$19.08
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$65.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.08
|
| Rate for Payer: Healthscope Commercial |
$68.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.26
|
| Rate for Payer: Mclaren Medicaid |
$37.78
|
| Rate for Payer: Meridian Medicaid |
$39.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: PACE Senior Care Partners |
$18.13
|
| Rate for Payer: PACE SWMI |
$19.08
|
| Rate for Payer: PHP Commercial |
$64.89
|
| Rate for Payer: PHP Medicare Advantage |
$19.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.42
|
| Rate for Payer: Priority Health Medicare |
$19.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.56
|
| Rate for Payer: Railroad Medicare Medicare |
$19.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.18
|
| Rate for Payer: UHC Core |
$63.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.08
|
| Rate for Payer: UHC Medicare Advantage |
$19.66
|
| Rate for Payer: VA VA |
$19.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.26
|
|
|
HC DOG IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC DOG IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200038
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
OP
|
$431.96
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$102.59 |
| Max. Negotiated Rate |
$388.76 |
| Rate for Payer: Aetna Commercial |
$367.17
|
| Rate for Payer: Aetna Medicare |
$112.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.99
|
| Rate for Payer: BCBS Complete |
$172.78
|
| Rate for Payer: BCBS MAPPO |
$107.99
|
| Rate for Payer: BCBS Trust/PPO |
$335.85
|
| Rate for Payer: BCN Commercial |
$335.85
|
| Rate for Payer: BCN Medicare Advantage |
$107.99
|
| Rate for Payer: Cash Price |
$345.57
|
| Rate for Payer: Cofinity Commercial |
$371.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.99
|
| Rate for Payer: Healthscope Commercial |
$388.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.17
|
| Rate for Payer: PACE Senior Care Partners |
$102.59
|
| Rate for Payer: PACE SWMI |
$107.99
|
| Rate for Payer: PHP Commercial |
$367.17
|
| Rate for Payer: PHP Medicare Advantage |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.81
|
| Rate for Payer: Priority Health Medicare |
$107.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.45
|
| Rate for Payer: Railroad Medicare Medicare |
$107.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.12
|
| Rate for Payer: UHC Core |
$360.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.99
|
| Rate for Payer: UHC Medicare Advantage |
$111.23
|
| Rate for Payer: VA VA |
$107.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.97
|
|
|
HC DOPPLER COLOR FLOW
|
Facility
|
IP
|
$431.96
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
48000007
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$388.76 |
| Rate for Payer: Aetna Commercial |
$367.17
|
| Rate for Payer: BCBS Trust/PPO |
$333.82
|
| Rate for Payer: BCN Commercial |
$333.82
|
| Rate for Payer: Cash Price |
$345.57
|
| Rate for Payer: Cofinity Commercial |
$371.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.57
|
| Rate for Payer: Healthscope Commercial |
$388.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.17
|
| Rate for Payer: PHP Commercial |
$367.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.12
|
| Rate for Payer: UHC Core |
$360.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.97
|
|
|
HC DOXYCYCLINE HYCLATE 100 MG
|
Facility
|
IP
|
$221.29
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: BCBS Trust/PPO |
$171.01
|
| Rate for Payer: BCN Commercial |
$171.01
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.10
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.74
|
| Rate for Payer: UHC Core |
$184.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.97
|
|
|
HC DOXYCYCLINE HYCLATE 100 MG
|
Facility
|
OP
|
$221.29
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600189
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.56 |
| Max. Negotiated Rate |
$199.16 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Medicare |
$57.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.15
|
| Rate for Payer: BCBS Complete |
$88.52
|
| Rate for Payer: BCBS MAPPO |
$55.32
|
| Rate for Payer: BCBS Trust/PPO |
$172.05
|
| Rate for Payer: BCN Commercial |
$172.05
|
| Rate for Payer: BCN Medicare Advantage |
$55.32
|
| Rate for Payer: Cash Price |
$177.03
|
| Rate for Payer: Cofinity Commercial |
$190.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.32
|
| Rate for Payer: Healthscope Commercial |
$199.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$188.10
|
| Rate for Payer: PACE Senior Care Partners |
$52.56
|
| Rate for Payer: PACE SWMI |
$55.32
|
| Rate for Payer: PHP Commercial |
$188.10
|
| Rate for Payer: PHP Medicare Advantage |
$55.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.52
|
| Rate for Payer: Priority Health Medicare |
$55.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.96
|
| Rate for Payer: Railroad Medicare Medicare |
$55.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.74
|
| Rate for Payer: UHC Core |
$184.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.32
|
| Rate for Payer: UHC Medicare Advantage |
$56.98
|
| Rate for Payer: VA VA |
$55.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.97
|
|
|
HC DPPX AB CBA, S
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.12
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.38
|
| Rate for Payer: BCN Commercial |
$194.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.50
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.50
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PACE Senior Care Partners |
$59.38
|
| Rate for Payer: PACE SWMI |
$62.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: PHP Medicare Advantage |
$62.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Medicare |
$62.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: Railroad Medicare Medicare |
$62.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.50
|
| Rate for Payer: UHC Medicare Advantage |
$64.38
|
| Rate for Payer: VA VA |
$62.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC DPPX AB CBA, S
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200462
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$152.48 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$212.50
|
| Rate for Payer: BCBS Trust/PPO |
$193.20
|
| Rate for Payer: BCN Commercial |
$193.20
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$215.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.00
|
| Rate for Payer: Healthscope Commercial |
$225.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.50
|
| Rate for Payer: PHP Commercial |
$212.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.00
|
| Rate for Payer: UHC Core |
$208.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.50
|
|
|
HC DPPX AB IFA, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DPPX AB IFA, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200463
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
OP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.91
|
| Rate for Payer: BCBS Complete |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$59.48
|
| Rate for Payer: BCN Medicare Advantage |
$19.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Mclaren Medicaid |
$8.89
|
| Rate for Payer: Meridian Medicaid |
$9.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PACE Senior Care Partners |
$18.17
|
| Rate for Payer: PACE SWMI |
$19.12
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: PHP Medicare Advantage |
$19.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Medicare |
$19.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.12
|
| Rate for Payer: UHC Medicare Advantage |
$19.70
|
| Rate for Payer: VA VA |
$19.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DPPX AB IFA TITER, S
|
Facility
|
IP
|
$76.50
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
30200461
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.66 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: BCBS Trust/PPO |
$59.12
|
| Rate for Payer: BCN Commercial |
$59.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.20
|
| Rate for Payer: Healthscope Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.02
|
| Rate for Payer: PHP Commercial |
$65.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.32
|
| Rate for Payer: UHC Core |
$63.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.38
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$16.23
|
| Rate for Payer: BCN Commercial |
$16.23
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.85
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.48
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
|
|
HC DRAINAGE CATHETER LVL 1
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$5.25
|
| Rate for Payer: BCBS Trust/PPO |
$16.33
|
| Rate for Payer: BCN Commercial |
$16.33
|
| Rate for Payer: BCN Medicare Advantage |
$5.25
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.25
|
| Rate for Payer: Healthscope Commercial |
$18.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.85
|
| Rate for Payer: PACE Senior Care Partners |
$4.99
|
| Rate for Payer: PACE SWMI |
$5.25
|
| Rate for Payer: PHP Commercial |
$17.85
|
| Rate for Payer: PHP Medicare Advantage |
$5.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.27
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.81
|
| Rate for Payer: Railroad Medicare Medicare |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.48
|
| Rate for Payer: UHC Core |
$17.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$5.41
|
| Rate for Payer: VA VA |
$5.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.75
|
|
|
HC DRAINAGE CATHETER LVL 15
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$377.62 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Aetna Commercial |
$1,351.50
|
| Rate for Payer: Aetna Medicare |
$413.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$496.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$496.88
|
| Rate for Payer: BCBS Complete |
$636.00
|
| Rate for Payer: BCBS MAPPO |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.22
|
| Rate for Payer: BCN Commercial |
$1,236.22
|
| Rate for Payer: BCN Medicare Advantage |
$397.50
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,367.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.50
|
| Rate for Payer: Healthscope Commercial |
$1,431.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,192.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$417.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$457.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,351.50
|
| Rate for Payer: PACE Senior Care Partners |
$377.62
|
| Rate for Payer: PACE SWMI |
$397.50
|
| Rate for Payer: PHP Commercial |
$1,351.50
|
| Rate for Payer: PHP Medicare Advantage |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,383.30
|
| Rate for Payer: Priority Health Medicare |
$397.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$969.74
|
| Rate for Payer: Railroad Medicare Medicare |
$397.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,399.20
|
| Rate for Payer: UHC Core |
$1,327.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.50
|
| Rate for Payer: UHC Medicare Advantage |
$409.42
|
| Rate for Payer: VA VA |
$397.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.50
|
|
|
HC DRAINAGE CATHETER LVL 15
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$969.74 |
| Max. Negotiated Rate |
$1,431.00 |
| Rate for Payer: Aetna Commercial |
$1,351.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.75
|
| Rate for Payer: BCN Commercial |
$1,228.75
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,367.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,272.00
|
| Rate for Payer: Healthscope Commercial |
$1,431.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,192.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,351.50
|
| Rate for Payer: PHP Commercial |
$1,351.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,383.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$969.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,399.20
|
| Rate for Payer: UHC Core |
$1,327.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,192.50
|
|
|
HC DRAINAGE CATHETER LVL 2
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.06 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$176.20
|
| Rate for Payer: BCN Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
HC DRAINAGE CATHETER LVL 2
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$59.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.25
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$57.00
|
| Rate for Payer: BCBS Trust/PPO |
$177.27
|
| Rate for Payer: BCN Commercial |
$177.27
|
| Rate for Payer: BCN Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.00
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PACE Senior Care Partners |
$54.15
|
| Rate for Payer: PACE SWMI |
$57.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Medicare Advantage |
$57.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.36
|
| Rate for Payer: Priority Health Medicare |
$57.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.06
|
| Rate for Payer: Railroad Medicare Medicare |
$57.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.00
|
| Rate for Payer: UHC Medicare Advantage |
$58.71
|
| Rate for Payer: VA VA |
$57.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
HC DRAINAGE CATHETER LVL 3
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.54 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: BCBS Trust/PPO |
$292.12
|
| Rate for Payer: BCN Commercial |
$292.12
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$325.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.40
|
| Rate for Payer: Healthscope Commercial |
$340.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.30
|
| Rate for Payer: PHP Commercial |
$321.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.64
|
| Rate for Payer: UHC Core |
$315.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.50
|
|
|
HC DRAINAGE CATHETER LVL 3
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Medicare |
$98.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$118.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$118.12
|
| Rate for Payer: BCBS Complete |
$151.20
|
| Rate for Payer: BCBS MAPPO |
$94.50
|
| Rate for Payer: BCBS Trust/PPO |
$293.90
|
| Rate for Payer: BCN Commercial |
$293.90
|
| Rate for Payer: BCN Medicare Advantage |
$94.50
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$325.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$302.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.50
|
| Rate for Payer: Healthscope Commercial |
$340.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$283.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$321.30
|
| Rate for Payer: PACE Senior Care Partners |
$89.78
|
| Rate for Payer: PACE SWMI |
$94.50
|
| Rate for Payer: PHP Commercial |
$321.30
|
| Rate for Payer: PHP Medicare Advantage |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.86
|
| Rate for Payer: Priority Health Medicare |
$94.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.54
|
| Rate for Payer: Railroad Medicare Medicare |
$94.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.64
|
| Rate for Payer: UHC Core |
$315.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.50
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
| Rate for Payer: VA VA |
$94.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$283.50
|
|
|
HC DRAINAGE CATHETER LVL 4
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: Aetna Medicare |
$137.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.00
|
| Rate for Payer: BCBS Complete |
$211.20
|
| Rate for Payer: BCBS MAPPO |
$132.00
|
| Rate for Payer: BCBS Trust/PPO |
$410.52
|
| Rate for Payer: BCN Commercial |
$410.52
|
| Rate for Payer: BCN Medicare Advantage |
$132.00
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$138.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$151.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.80
|
| Rate for Payer: PACE Senior Care Partners |
$125.40
|
| Rate for Payer: PACE SWMI |
$132.00
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: PHP Medicare Advantage |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.36
|
| Rate for Payer: Priority Health Medicare |
$132.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.03
|
| Rate for Payer: Railroad Medicare Medicare |
$132.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.64
|
| Rate for Payer: UHC Core |
$440.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.00
|
| Rate for Payer: UHC Medicare Advantage |
$135.96
|
| Rate for Payer: VA VA |
$132.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
|
|
HC DRAINAGE CATHETER LVL 4
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200271
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.03 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$448.80
|
| Rate for Payer: BCBS Trust/PPO |
$408.04
|
| Rate for Payer: BCN Commercial |
$408.04
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$454.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$422.40
|
| Rate for Payer: Healthscope Commercial |
$475.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$396.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$448.80
|
| Rate for Payer: PHP Commercial |
$448.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$459.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$322.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.64
|
| Rate for Payer: UHC Core |
$440.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$396.00
|
|
