|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
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 DUCK FEATHERS IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
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 DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,630.80 |
| Max. Negotiated Rate |
$3,882.15 |
| Rate for Payer: Aetna Commercial |
$3,666.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,333.47
|
| Rate for Payer: BCN Commercial |
$3,333.47
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$3,709.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Healthscope Commercial |
$3,882.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: PHP Commercial |
$3,666.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,752.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,630.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,795.88
|
| Rate for Payer: UHC Core |
$3,601.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,235.12
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,313.50
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,024.46 |
| Max. Negotiated Rate |
$3,882.15 |
| Rate for Payer: Aetna Commercial |
$3,666.48
|
| Rate for Payer: Aetna Medicare |
$1,121.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,347.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,347.97
|
| Rate for Payer: BCBS Complete |
$1,725.40
|
| Rate for Payer: BCBS MAPPO |
$1,078.38
|
| Rate for Payer: BCBS Trust/PPO |
$3,353.75
|
| Rate for Payer: BCN Commercial |
$3,353.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,078.38
|
| Rate for Payer: Cash Price |
$3,450.80
|
| Rate for Payer: Cofinity Commercial |
$3,709.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,450.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,078.38
|
| Rate for Payer: Healthscope Commercial |
$3,882.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,235.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,132.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,240.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,666.48
|
| Rate for Payer: PACE Senior Care Partners |
$1,024.46
|
| Rate for Payer: PACE SWMI |
$1,078.38
|
| Rate for Payer: PHP Commercial |
$3,666.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,078.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,019.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,752.74
|
| Rate for Payer: Priority Health Medicare |
$1,078.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,630.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1,078.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,795.88
|
| Rate for Payer: UHC Core |
$3,601.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,078.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,110.73
|
| Rate for Payer: VA VA |
$1,078.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,235.12
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$510.76 |
| Max. Negotiated Rate |
$1,935.51 |
| Rate for Payer: Aetna Commercial |
$1,827.98
|
| Rate for Payer: Aetna Medicare |
$559.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$672.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$672.05
|
| Rate for Payer: BCBS Complete |
$860.23
|
| Rate for Payer: BCBS MAPPO |
$537.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.07
|
| Rate for Payer: BCN Commercial |
$1,672.07
|
| Rate for Payer: BCN Medicare Advantage |
$537.64
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$1,849.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.64
|
| Rate for Payer: Healthscope Commercial |
$1,935.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,612.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$564.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: PACE Senior Care Partners |
$510.76
|
| Rate for Payer: PACE SWMI |
$537.64
|
| Rate for Payer: PHP Commercial |
$1,827.98
|
| Rate for Payer: PHP Medicare Advantage |
$537.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,871.00
|
| Rate for Payer: Priority Health Medicare |
$537.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,311.63
|
| Rate for Payer: Railroad Medicare Medicare |
$537.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,892.50
|
| Rate for Payer: UHC Core |
$1,795.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.64
|
| Rate for Payer: UHC Medicare Advantage |
$553.77
|
| Rate for Payer: VA VA |
$537.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,612.93
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,150.57
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,311.63 |
| Max. Negotiated Rate |
$1,935.51 |
| Rate for Payer: Aetna Commercial |
$1,827.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,661.96
|
| Rate for Payer: BCN Commercial |
$1,661.96
|
| Rate for Payer: Cash Price |
$1,720.46
|
| Rate for Payer: Cofinity Commercial |
$1,849.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,720.46
|
| Rate for Payer: Healthscope Commercial |
$1,935.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,612.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,827.98
|
| Rate for Payer: PHP Commercial |
$1,827.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,871.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,311.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,892.50
|
| Rate for Payer: UHC Core |
$1,795.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,612.93
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$398.90 |
| Max. Negotiated Rate |
$1,511.60 |
| Rate for Payer: Aetna Commercial |
$1,427.63
|
| Rate for Payer: Aetna Medicare |
$436.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$524.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$524.86
|
| Rate for Payer: BCBS Complete |
$671.82
|
| Rate for Payer: BCBS MAPPO |
$419.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.86
|
| Rate for Payer: BCN Commercial |
$1,305.86
|
| Rate for Payer: BCN Medicare Advantage |
$419.89
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,444.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.89
|
| Rate for Payer: Healthscope Commercial |
$1,511.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$440.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$482.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: PACE Senior Care Partners |
$398.90
|
| Rate for Payer: PACE SWMI |
$419.89
|
| Rate for Payer: PHP Commercial |
$1,427.63
|
| Rate for Payer: PHP Medicare Advantage |
$419.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,461.22
|
| Rate for Payer: Priority Health Medicare |
$419.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,024.36
|
| Rate for Payer: Railroad Medicare Medicare |
$419.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.01
|
| Rate for Payer: UHC Core |
$1,402.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$419.89
|
| Rate for Payer: UHC Medicare Advantage |
$432.49
|
| Rate for Payer: VA VA |
$419.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.67
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$1,679.56
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,024.36 |
| Max. Negotiated Rate |
$1,511.60 |
| Rate for Payer: Aetna Commercial |
$1,427.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,297.96
|
| Rate for Payer: BCN Commercial |
$1,297.96
|
| Rate for Payer: Cash Price |
$1,343.65
|
| Rate for Payer: Cofinity Commercial |
$1,444.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,343.65
|
| Rate for Payer: Healthscope Commercial |
$1,511.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,259.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,427.63
|
| Rate for Payer: PHP Commercial |
$1,427.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,175.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,461.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,024.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,478.01
|
| Rate for Payer: UHC Core |
$1,402.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,259.67
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: BCBS Trust/PPO |
$36.16
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Healthscope Commercial |
$42.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: PHP Commercial |
$39.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.18
|
| Rate for Payer: UHC Core |
$39.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.09
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$46.79
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$42.11 |
| Rate for Payer: Aetna Commercial |
$39.77
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.62
|
| Rate for Payer: BCBS Complete |
$18.72
|
| Rate for Payer: BCBS MAPPO |
$11.70
|
| Rate for Payer: BCBS Trust/PPO |
$36.38
|
| Rate for Payer: BCN Commercial |
$36.38
|
| Rate for Payer: BCN Medicare Advantage |
$11.70
|
| Rate for Payer: Cash Price |
$37.43
|
| Rate for Payer: Cofinity Commercial |
$40.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$42.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.77
|
| Rate for Payer: PACE Senior Care Partners |
$11.11
|
| Rate for Payer: PACE SWMI |
$11.70
|
| Rate for Payer: PHP Commercial |
$39.77
|
| Rate for Payer: PHP Medicare Advantage |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.71
|
| Rate for Payer: Priority Health Medicare |
$11.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.54
|
| Rate for Payer: Railroad Medicare Medicare |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.18
|
| Rate for Payer: UHC Core |
$39.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: VA VA |
$11.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.09
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$74.12
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$66.71 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Medicare |
$19.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.16
|
| Rate for Payer: BCBS Complete |
$29.65
|
| Rate for Payer: BCBS MAPPO |
$18.53
|
| Rate for Payer: BCBS Trust/PPO |
$57.63
|
| Rate for Payer: BCN Commercial |
$57.63
|
| Rate for Payer: BCN Medicare Advantage |
$18.53
|
| Rate for Payer: Cash Price |
$59.30
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.53
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.00
|
| Rate for Payer: PACE Senior Care Partners |
$17.60
|
| Rate for Payer: PACE SWMI |
$18.53
|
| Rate for Payer: PHP Commercial |
$63.00
|
| Rate for Payer: PHP Medicare Advantage |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.48
|
| Rate for Payer: Priority Health Medicare |
$18.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.21
|
| Rate for Payer: Railroad Medicare Medicare |
$18.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.23
|
| Rate for Payer: UHC Core |
$61.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.53
|
| Rate for Payer: UHC Medicare Advantage |
$19.09
|
| Rate for Payer: VA VA |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.59
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
IP
|
$74.12
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$66.71 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.28
|
| Rate for Payer: BCN Commercial |
$57.28
|
| Rate for Payer: Cash Price |
$59.30
|
| Rate for Payer: Cofinity Commercial |
$63.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.30
|
| Rate for Payer: Healthscope Commercial |
$66.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.00
|
| Rate for Payer: PHP Commercial |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.23
|
| Rate for Payer: UHC Core |
$61.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.59
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
OP
|
$103.46
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: Aetna Commercial |
$87.94
|
| Rate for Payer: Aetna Medicare |
$26.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.33
|
| Rate for Payer: BCBS Complete |
$41.38
|
| Rate for Payer: BCBS MAPPO |
$25.86
|
| Rate for Payer: BCBS Trust/PPO |
$80.44
|
| Rate for Payer: BCN Commercial |
$80.44
|
| Rate for Payer: BCN Medicare Advantage |
$25.86
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.86
|
| Rate for Payer: Healthscope Commercial |
$93.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.94
|
| Rate for Payer: PACE Senior Care Partners |
$24.57
|
| Rate for Payer: PACE SWMI |
$25.86
|
| Rate for Payer: PHP Commercial |
$87.94
|
| Rate for Payer: PHP Medicare Advantage |
$25.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.01
|
| Rate for Payer: Priority Health Medicare |
$25.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.10
|
| Rate for Payer: Railroad Medicare Medicare |
$25.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.04
|
| Rate for Payer: UHC Core |
$86.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.86
|
| Rate for Payer: UHC Medicare Advantage |
$26.64
|
| Rate for Payer: VA VA |
$25.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
HC DUODERM CGF 8X8
|
Facility
|
IP
|
$103.46
|
|
| Hospital Charge Code |
27100012
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.10 |
| Max. Negotiated Rate |
$93.11 |
| Rate for Payer: Aetna Commercial |
$87.94
|
| Rate for Payer: BCBS Trust/PPO |
$79.95
|
| Rate for Payer: BCN Commercial |
$79.95
|
| Rate for Payer: Cash Price |
$82.77
|
| Rate for Payer: Cofinity Commercial |
$88.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$93.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.94
|
| Rate for Payer: PHP Commercial |
$87.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.04
|
| Rate for Payer: UHC Core |
$86.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.60
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
IP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.79 |
| Max. Negotiated Rate |
$573.72 |
| Rate for Payer: Aetna Commercial |
$541.85
|
| Rate for Payer: BCBS Trust/PPO |
$492.64
|
| Rate for Payer: BCN Commercial |
$492.64
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$548.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.98
|
| Rate for Payer: Healthscope Commercial |
$573.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: PHP Commercial |
$541.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.97
|
| Rate for Payer: UHC Core |
$532.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.10
|
|
|
HC DUOGLIDE CATHETER
|
Facility
|
OP
|
$637.47
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27200176
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$573.72 |
| Rate for Payer: Aetna Commercial |
$541.85
|
| Rate for Payer: Aetna Medicare |
$165.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.21
|
| Rate for Payer: BCBS Complete |
$254.99
|
| Rate for Payer: BCBS MAPPO |
$159.37
|
| Rate for Payer: BCBS Trust/PPO |
$495.63
|
| Rate for Payer: BCN Commercial |
$495.63
|
| Rate for Payer: BCN Medicare Advantage |
$159.37
|
| Rate for Payer: Cash Price |
$509.98
|
| Rate for Payer: Cofinity Commercial |
$548.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.37
|
| Rate for Payer: Healthscope Commercial |
$573.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$478.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$167.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.85
|
| Rate for Payer: PACE Senior Care Partners |
$151.40
|
| Rate for Payer: PACE SWMI |
$159.37
|
| Rate for Payer: PHP Commercial |
$541.85
|
| Rate for Payer: PHP Medicare Advantage |
$159.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$446.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.60
|
| Rate for Payer: Priority Health Medicare |
$159.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.79
|
| Rate for Payer: Railroad Medicare Medicare |
$159.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.97
|
| Rate for Payer: UHC Core |
$532.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.37
|
| Rate for Payer: UHC Medicare Advantage |
$164.15
|
| Rate for Payer: VA VA |
$159.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$478.10
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
OP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$806.18
|
| Rate for Payer: Aetna Medicare |
$246.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$296.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$296.39
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$237.11
|
| Rate for Payer: BCBS Trust/PPO |
$737.42
|
| Rate for Payer: BCN Commercial |
$737.42
|
| Rate for Payer: BCN Medicare Advantage |
$237.11
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$815.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.11
|
| Rate for Payer: Healthscope Commercial |
$853.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.34
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$248.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: PACE Senior Care Partners |
$225.26
|
| Rate for Payer: PACE SWMI |
$237.11
|
| Rate for Payer: PHP Commercial |
$806.18
|
| Rate for Payer: PHP Medicare Advantage |
$237.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.15
|
| Rate for Payer: Priority Health Medicare |
$237.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.46
|
| Rate for Payer: Railroad Medicare Medicare |
$237.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.64
|
| Rate for Payer: UHC Core |
$791.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.11
|
| Rate for Payer: UHC Medicare Advantage |
$244.23
|
| Rate for Payer: VA VA |
$237.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.34
|
|
|
HC DUPLX HEMODIALYSIS ACCESS
|
Facility
|
IP
|
$948.45
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$578.46 |
| Max. Negotiated Rate |
$853.60 |
| Rate for Payer: Aetna Commercial |
$806.18
|
| Rate for Payer: BCBS Trust/PPO |
$732.96
|
| Rate for Payer: BCN Commercial |
$732.96
|
| Rate for Payer: Cash Price |
$758.76
|
| Rate for Payer: Cofinity Commercial |
$815.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.76
|
| Rate for Payer: Healthscope Commercial |
$853.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$806.18
|
| Rate for Payer: PHP Commercial |
$806.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.64
|
| Rate for Payer: UHC Core |
$791.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.34
|
|
|
HC DUST MITE DF IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
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 DUST MITE DF IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200039
|
|
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 DUST MITE DP IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
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 DUST MITE DP IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200040
|
|
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 DXA BONE DENSITY W FX ASSESS
|
Facility
|
IP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$468.10 |
| Max. Negotiated Rate |
$690.76 |
| Rate for Payer: Aetna Commercial |
$652.38
|
| Rate for Payer: BCBS Trust/PPO |
$593.13
|
| Rate for Payer: BCN Commercial |
$593.13
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$660.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.01
|
| Rate for Payer: Healthscope Commercial |
$690.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: PHP Commercial |
$652.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$667.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$675.41
|
| Rate for Payer: UHC Core |
$640.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.63
|
|
|
HC DXA BONE DENSITY W FX ASSESS
|
Facility
|
OP
|
$767.51
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
32000304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$690.76 |
| Rate for Payer: Aetna Commercial |
$652.38
|
| Rate for Payer: Aetna Medicare |
$199.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$239.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$239.85
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$191.88
|
| Rate for Payer: BCBS Trust/PPO |
$596.74
|
| Rate for Payer: BCN Commercial |
$596.74
|
| Rate for Payer: BCN Medicare Advantage |
$191.88
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cash Price |
$614.01
|
| Rate for Payer: Cofinity Commercial |
$660.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.88
|
| Rate for Payer: Healthscope Commercial |
$690.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$575.63
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$201.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$652.38
|
| Rate for Payer: PACE Senior Care Partners |
$182.28
|
| Rate for Payer: PACE SWMI |
$191.88
|
| Rate for Payer: PHP Commercial |
$652.38
|
| Rate for Payer: PHP Medicare Advantage |
$191.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$667.73
|
| Rate for Payer: Priority Health Medicare |
$191.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.10
|
| Rate for Payer: Railroad Medicare Medicare |
$191.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$675.41
|
| Rate for Payer: UHC Core |
$640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.88
|
| Rate for Payer: UHC Medicare Advantage |
$197.63
|
| Rate for Payer: VA VA |
$191.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$575.63
|
|
|
HC E72 MOUSE URINE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200452
|
|
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
|
|
