|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: BCBS Trust/PPO |
$137.38
|
| Rate for Payer: BCN Commercial |
$130.06
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: Priority Health HMO/PPO |
$146.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.10
|
| Rate for Payer: UHC Core |
$140.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.22
|
|
|
HC AUDITORY FUNCTION 60 MIN
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
CPT 92620
|
| Hospital Charge Code |
76100495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.97 |
| Max. Negotiated Rate |
$151.47 |
| Rate for Payer: Aetna Commercial |
$143.06
|
| Rate for Payer: Aetna Medicare |
$43.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.59
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$42.08
|
| Rate for Payer: BCBS Trust/PPO |
$138.36
|
| Rate for Payer: BCN Commercial |
$130.85
|
| Rate for Payer: BCN Medicare Advantage |
$42.08
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$151.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.22
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.18
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: PACE Senior Care Partners |
$39.97
|
| Rate for Payer: PACE SWMI |
$42.08
|
| Rate for Payer: PHP Commercial |
$143.06
|
| Rate for Payer: PHP Medicare Advantage |
$42.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: Priority Health HMO/PPO |
$146.42
|
| Rate for Payer: Priority Health Medicare |
$42.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.76
|
| Rate for Payer: Railroad Medicare Medicare |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.10
|
| Rate for Payer: UHC Core |
$140.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.08
|
| Rate for Payer: UHC Exchange |
$42.08
|
| Rate for Payer: UHC Medicare Advantage |
$42.08
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.22
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
OP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$14.24 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$50.97
|
| Rate for Payer: Aetna Medicare |
$15.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.74
|
| Rate for Payer: BCBS Complete |
$23.99
|
| Rate for Payer: BCBS MAPPO |
$14.99
|
| Rate for Payer: BCBS Trust/PPO |
$49.30
|
| Rate for Payer: BCN Commercial |
$46.63
|
| Rate for Payer: BCN Medicare Advantage |
$14.99
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$53.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: Nomi Health Commercial |
$49.18
|
| Rate for Payer: PACE Senior Care Partners |
$14.24
|
| Rate for Payer: PACE SWMI |
$14.99
|
| Rate for Payer: PHP Commercial |
$50.97
|
| Rate for Payer: PHP Medicare Advantage |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: Priority Health HMO/PPO |
$52.17
|
| Rate for Payer: Priority Health Medicare |
$15.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.18
|
| Rate for Payer: Railroad Medicare Medicare |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.77
|
| Rate for Payer: UHC Core |
$50.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.99
|
| Rate for Payer: UHC Exchange |
$14.99
|
| Rate for Payer: UHC Medicare Advantage |
$14.99
|
| Rate for Payer: VA VA |
$14.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.98
|
|
|
HC AUD SCREEN PURE TONE AIR ONLY
|
Facility
|
IP
|
$59.97
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
47100003
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$50.97
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCN Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$47.98
|
| Rate for Payer: Cofinity Commercial |
$51.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.98
|
| Rate for Payer: Healthscope Commercial |
$53.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.97
|
| Rate for Payer: Nomi Health Commercial |
$49.18
|
| Rate for Payer: PHP Commercial |
$50.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.98
|
| Rate for Payer: Priority Health HMO/PPO |
$52.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.77
|
| Rate for Payer: UHC Core |
$50.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.98
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
OP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Medicare |
$14.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.22
|
| Rate for Payer: BCBS Complete |
$22.04
|
| Rate for Payer: BCBS MAPPO |
$13.78
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$42.85
|
| Rate for Payer: BCN Medicare Advantage |
$13.78
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$49.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Nomi Health Commercial |
$45.19
|
| Rate for Payer: PACE Senior Care Partners |
$13.09
|
| Rate for Payer: PACE SWMI |
$13.78
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: PHP Medicare Advantage |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: Priority Health HMO/PPO |
$47.95
|
| Rate for Payer: Priority Health Medicare |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.50
|
| Rate for Payer: UHC Core |
$46.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.78
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: VA VA |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
|
|
HC AUD VERTICAL ELECTRODE USE
|
Facility
|
IP
|
$55.11
|
|
|
Service Code
|
CPT 92547
|
| Hospital Charge Code |
47100004
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$49.60 |
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: BCBS Trust/PPO |
$44.99
|
| Rate for Payer: BCN Commercial |
$42.59
|
| Rate for Payer: Cash Price |
$44.09
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.09
|
| Rate for Payer: Healthscope Commercial |
$49.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Nomi Health Commercial |
$45.19
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.82
|
| Rate for Payer: Priority Health HMO/PPO |
$47.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.50
|
| Rate for Payer: UHC Core |
$46.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
OP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: Aetna Medicare |
$120.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.83
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$381.00
|
| Rate for Payer: BCN Commercial |
$360.33
|
| Rate for Payer: BCN Medicare Advantage |
$115.86
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.86
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.59
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.66
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: PACE Senior Care Partners |
$110.07
|
| Rate for Payer: PACE SWMI |
$115.86
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: PHP Medicare Advantage |
$115.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO |
$403.20
|
| Rate for Payer: Priority Health Medicare |
$117.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.51
|
| Rate for Payer: Railroad Medicare Medicare |
$115.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.84
|
| Rate for Payer: UHC Core |
$386.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.86
|
| Rate for Payer: UHC Exchange |
$115.86
|
| Rate for Payer: UHC Medicare Advantage |
$115.86
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$115.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.59
|
|
|
HC AUD VESTIBULAR EVAL BASIC
|
Facility
|
IP
|
$463.45
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
47100005
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$301.24 |
| Max. Negotiated Rate |
$417.10 |
| Rate for Payer: Aetna Commercial |
$393.93
|
| Rate for Payer: BCBS Trust/PPO |
$378.31
|
| Rate for Payer: BCN Commercial |
$358.15
|
| Rate for Payer: Cash Price |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$398.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.76
|
| Rate for Payer: Healthscope Commercial |
$417.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.93
|
| Rate for Payer: Nomi Health Commercial |
$380.03
|
| Rate for Payer: PHP Commercial |
$393.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.24
|
| Rate for Payer: Priority Health HMO/PPO |
$403.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.84
|
| Rate for Payer: UHC Core |
$386.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.59
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
IP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$536.43 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: BCBS Trust/PPO |
$673.68
|
| Rate for Payer: BCN Commercial |
$637.78
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health HMO/PPO |
$717.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.25
|
| Rate for Payer: UHC Core |
$689.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.96
|
|
|
HC AUTOLOGOUS UNIT
|
Facility
|
OP
|
$825.28
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
39000040
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$102.23 |
| Max. Negotiated Rate |
$742.75 |
| Rate for Payer: Aetna Commercial |
$701.49
|
| Rate for Payer: Aetna Medicare |
$214.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$257.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$257.90
|
| Rate for Payer: BCBS Complete |
$107.35
|
| Rate for Payer: BCBS MAPPO |
$206.32
|
| Rate for Payer: BCBS Trust/PPO |
$678.46
|
| Rate for Payer: BCN Commercial |
$641.66
|
| Rate for Payer: BCN Medicare Advantage |
$206.32
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cash Price |
$660.22
|
| Rate for Payer: Cofinity Commercial |
$709.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$660.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.32
|
| Rate for Payer: Healthscope Commercial |
$742.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$618.96
|
| Rate for Payer: Mclaren Medicaid |
$102.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.64
|
| Rate for Payer: Meridian Medicaid |
$107.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.49
|
| Rate for Payer: Nomi Health Commercial |
$676.73
|
| Rate for Payer: PACE Senior Care Partners |
$196.00
|
| Rate for Payer: PACE SWMI |
$206.32
|
| Rate for Payer: PHP Commercial |
$701.49
|
| Rate for Payer: PHP Medicare Advantage |
$206.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.43
|
| Rate for Payer: Priority Health HMO/PPO |
$717.99
|
| Rate for Payer: Priority Health Medicare |
$208.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.94
|
| Rate for Payer: Railroad Medicare Medicare |
$206.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.25
|
| Rate for Payer: UHC Core |
$689.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.32
|
| Rate for Payer: UHC Exchange |
$206.32
|
| Rate for Payer: UHC Medicare Advantage |
$206.32
|
| Rate for Payer: UHCCP Medicaid |
$102.23
|
| Rate for Payer: VA VA |
$206.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$618.96
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
OP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.11 |
| Max. Negotiated Rate |
$163.38 |
| Rate for Payer: Aetna Commercial |
$154.30
|
| Rate for Payer: Aetna Medicare |
$47.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.73
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$45.38
|
| Rate for Payer: BCBS Trust/PPO |
$149.24
|
| Rate for Payer: BCN Commercial |
$141.14
|
| Rate for Payer: BCN Medicare Advantage |
$45.38
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.38
|
| Rate for Payer: Healthscope Commercial |
$163.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.15
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.65
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: Nomi Health Commercial |
$148.85
|
| Rate for Payer: PACE Senior Care Partners |
$43.11
|
| Rate for Payer: PACE SWMI |
$45.38
|
| Rate for Payer: PHP Commercial |
$154.30
|
| Rate for Payer: PHP Medicare Advantage |
$45.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: Priority Health HMO/PPO |
$157.93
|
| Rate for Payer: Priority Health Medicare |
$45.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.63
|
| Rate for Payer: Railroad Medicare Medicare |
$45.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.75
|
| Rate for Payer: UHC Core |
$151.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.38
|
| Rate for Payer: UHC Exchange |
$45.38
|
| Rate for Payer: UHC Medicare Advantage |
$45.38
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$45.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.15
|
|
|
HC AUTONOMIC FUNC ADRENERGIC
|
Facility
|
IP
|
$181.53
|
|
|
Service Code
|
CPT 95922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$117.99 |
| Max. Negotiated Rate |
$163.38 |
| Rate for Payer: Aetna Commercial |
$154.30
|
| Rate for Payer: BCBS Trust/PPO |
$148.18
|
| Rate for Payer: BCN Commercial |
$140.29
|
| Rate for Payer: Cash Price |
$145.22
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.22
|
| Rate for Payer: Healthscope Commercial |
$163.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.30
|
| Rate for Payer: Nomi Health Commercial |
$148.85
|
| Rate for Payer: PHP Commercial |
$154.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.99
|
| Rate for Payer: Priority Health HMO/PPO |
$157.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.75
|
| Rate for Payer: UHC Core |
$151.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.15
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$326.74 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: BCBS Trust/PPO |
$296.36
|
| Rate for Payer: BCN Commercial |
$280.57
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO |
$315.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.48
|
| Rate for Payer: UHC Core |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.29
|
|
|
HC AUTONOMIC FUNC CARDIO INNERVAT
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95921
|
| Hospital Charge Code |
92000006
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$86.22 |
| Max. Negotiated Rate |
$326.74 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$94.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.45
|
| Rate for Payer: BCBS Complete |
$116.39
|
| Rate for Payer: BCBS MAPPO |
$90.76
|
| Rate for Payer: BCBS Trust/PPO |
$298.46
|
| Rate for Payer: BCN Commercial |
$282.27
|
| Rate for Payer: BCN Medicare Advantage |
$90.76
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.76
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.29
|
| Rate for Payer: Mclaren Medicaid |
$110.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.30
|
| Rate for Payer: Meridian Medicaid |
$116.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PACE Senior Care Partners |
$86.22
|
| Rate for Payer: PACE SWMI |
$90.76
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: PHP Medicare Advantage |
$90.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO |
$315.85
|
| Rate for Payer: Priority Health Medicare |
$91.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.24
|
| Rate for Payer: Railroad Medicare Medicare |
$90.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.48
|
| Rate for Payer: UHC Core |
$303.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.76
|
| Rate for Payer: UHC Exchange |
$90.76
|
| Rate for Payer: UHC Medicare Advantage |
$90.76
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$90.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.29
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
IP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$235.98 |
| Max. Negotiated Rate |
$326.74 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: BCBS Trust/PPO |
$296.36
|
| Rate for Payer: BCN Commercial |
$280.57
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO |
$315.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.48
|
| Rate for Payer: UHC Core |
$303.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.29
|
|
|
HC AUTONOMIC FUNC QSART
|
Facility
|
OP
|
$363.05
|
|
|
Service Code
|
CPT 95923
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$86.22 |
| Max. Negotiated Rate |
$326.74 |
| Rate for Payer: Aetna Commercial |
$308.59
|
| Rate for Payer: Aetna Medicare |
$94.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.45
|
| Rate for Payer: BCBS Complete |
$95.88
|
| Rate for Payer: BCBS MAPPO |
$90.76
|
| Rate for Payer: BCBS Trust/PPO |
$298.46
|
| Rate for Payer: BCN Commercial |
$282.27
|
| Rate for Payer: BCN Medicare Advantage |
$90.76
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cash Price |
$290.44
|
| Rate for Payer: Cofinity Commercial |
$312.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.76
|
| Rate for Payer: Healthscope Commercial |
$326.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.29
|
| Rate for Payer: Mclaren Medicaid |
$91.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.30
|
| Rate for Payer: Meridian Medicaid |
$95.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.59
|
| Rate for Payer: Nomi Health Commercial |
$297.70
|
| Rate for Payer: PACE Senior Care Partners |
$86.22
|
| Rate for Payer: PACE SWMI |
$90.76
|
| Rate for Payer: PHP Commercial |
$308.59
|
| Rate for Payer: PHP Medicare Advantage |
$90.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.98
|
| Rate for Payer: Priority Health HMO/PPO |
$315.85
|
| Rate for Payer: Priority Health Medicare |
$91.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.24
|
| Rate for Payer: Railroad Medicare Medicare |
$90.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.48
|
| Rate for Payer: UHC Core |
$303.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.76
|
| Rate for Payer: UHC Exchange |
$90.76
|
| Rate for Payer: UHC Medicare Advantage |
$90.76
|
| Rate for Payer: UHCCP Medicaid |
$91.31
|
| Rate for Payer: VA VA |
$90.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.29
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
IP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$337.12 |
| Max. Negotiated Rate |
$466.78 |
| Rate for Payer: Aetna Commercial |
$440.84
|
| Rate for Payer: BCBS Trust/PPO |
$423.37
|
| Rate for Payer: BCN Commercial |
$400.80
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$446.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Healthscope Commercial |
$466.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: Nomi Health Commercial |
$425.28
|
| Rate for Payer: PHP Commercial |
$440.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health HMO/PPO |
$451.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$347.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.40
|
| Rate for Payer: UHC Core |
$433.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.98
|
|
|
HC AUTONOMIC W/O QSART
|
Facility
|
OP
|
$518.64
|
|
|
Service Code
|
CPT 95924
|
| Hospital Charge Code |
92000012
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$123.18 |
| Max. Negotiated Rate |
$466.78 |
| Rate for Payer: Aetna Commercial |
$440.84
|
| Rate for Payer: Aetna Medicare |
$134.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$162.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$162.08
|
| Rate for Payer: BCBS Complete |
$231.63
|
| Rate for Payer: BCBS MAPPO |
$129.66
|
| Rate for Payer: BCBS Trust/PPO |
$426.37
|
| Rate for Payer: BCN Commercial |
$403.24
|
| Rate for Payer: BCN Medicare Advantage |
$129.66
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cash Price |
$414.91
|
| Rate for Payer: Cofinity Commercial |
$446.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.66
|
| Rate for Payer: Healthscope Commercial |
$466.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.98
|
| Rate for Payer: Mclaren Medicaid |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.14
|
| Rate for Payer: Meridian Medicaid |
$231.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.84
|
| Rate for Payer: Nomi Health Commercial |
$425.28
|
| Rate for Payer: PACE Senior Care Partners |
$123.18
|
| Rate for Payer: PACE SWMI |
$129.66
|
| Rate for Payer: PHP Commercial |
$440.84
|
| Rate for Payer: PHP Medicare Advantage |
$129.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.12
|
| Rate for Payer: Priority Health HMO/PPO |
$451.22
|
| Rate for Payer: Priority Health Medicare |
$130.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$347.49
|
| Rate for Payer: Railroad Medicare Medicare |
$129.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.40
|
| Rate for Payer: UHC Core |
$433.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.66
|
| Rate for Payer: UHC Exchange |
$129.66
|
| Rate for Payer: UHC Medicare Advantage |
$129.66
|
| Rate for Payer: UHCCP Medicaid |
$220.59
|
| Rate for Payer: VA VA |
$129.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.98
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
IP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.96 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: BCBS Trust/PPO |
$261.17
|
| Rate for Payer: BCN Commercial |
$247.25
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$275.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Healthscope Commercial |
$287.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: Nomi Health Commercial |
$262.35
|
| Rate for Payer: PHP Commercial |
$271.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health HMO/PPO |
$278.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.55
|
| Rate for Payer: UHC Core |
$267.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.96
|
|
|
HC AVULSION OF NAIL PLATE
|
Facility
|
OP
|
$319.94
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
76100045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$271.95
|
| Rate for Payer: Aetna Medicare |
$83.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.98
|
| Rate for Payer: BCBS Complete |
$147.80
|
| Rate for Payer: BCBS MAPPO |
$79.98
|
| Rate for Payer: BCBS Trust/PPO |
$263.02
|
| Rate for Payer: BCN Commercial |
$248.75
|
| Rate for Payer: BCN Medicare Advantage |
$79.98
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cash Price |
$255.95
|
| Rate for Payer: Cofinity Commercial |
$275.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.98
|
| Rate for Payer: Healthscope Commercial |
$287.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.96
|
| Rate for Payer: Mclaren Medicaid |
$140.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.98
|
| Rate for Payer: Meridian Medicaid |
$147.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.95
|
| Rate for Payer: Nomi Health Commercial |
$262.35
|
| Rate for Payer: PACE Senior Care Partners |
$75.99
|
| Rate for Payer: PACE SWMI |
$79.98
|
| Rate for Payer: PHP Commercial |
$271.95
|
| Rate for Payer: PHP Medicare Advantage |
$79.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.96
|
| Rate for Payer: Priority Health HMO/PPO |
$278.35
|
| Rate for Payer: Priority Health Medicare |
$80.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.36
|
| Rate for Payer: Railroad Medicare Medicare |
$79.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.55
|
| Rate for Payer: UHC Core |
$267.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.98
|
| Rate for Payer: UHC Exchange |
$79.98
|
| Rate for Payer: UHC Medicare Advantage |
$79.98
|
| Rate for Payer: UHCCP Medicaid |
$140.75
|
| Rate for Payer: VA VA |
$79.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.96
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
IP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: BCBS Trust/PPO |
$6.64
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: Nomi Health Commercial |
$6.67
|
| Rate for Payer: PHP Commercial |
$6.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: Priority Health HMO/PPO |
$7.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.15
|
| Rate for Payer: UHC Core |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.10
|
|
|
HC BACITRACIN 1 OZ
|
Facility
|
OP
|
$8.13
|
|
| Hospital Charge Code |
27100006
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.91
|
| Rate for Payer: Aetna Medicare |
$2.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.54
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS MAPPO |
$2.03
|
| Rate for Payer: BCBS Trust/PPO |
$6.68
|
| Rate for Payer: BCN Commercial |
$6.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.03
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$7.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.91
|
| Rate for Payer: Nomi Health Commercial |
$6.67
|
| Rate for Payer: PACE Senior Care Partners |
$1.93
|
| Rate for Payer: PACE SWMI |
$2.03
|
| Rate for Payer: PHP Commercial |
$6.91
|
| Rate for Payer: PHP Medicare Advantage |
$2.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.28
|
| Rate for Payer: Priority Health HMO/PPO |
$7.07
|
| Rate for Payer: Priority Health Medicare |
$2.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.45
|
| Rate for Payer: Railroad Medicare Medicare |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.15
|
| Rate for Payer: UHC Core |
$6.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.03
|
| Rate for Payer: UHC Exchange |
$2.03
|
| Rate for Payer: UHC Medicare Advantage |
$2.03
|
| Rate for Payer: VA VA |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.10
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
OP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: Aetna Medicare |
$8.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.68
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: BCBS MAPPO |
$7.74
|
| Rate for Payer: BCBS Trust/PPO |
$25.47
|
| Rate for Payer: BCN Commercial |
$24.09
|
| Rate for Payer: BCN Medicare Advantage |
$7.74
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.74
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$25.40
|
| Rate for Payer: PACE Senior Care Partners |
$7.36
|
| Rate for Payer: PACE SWMI |
$7.74
|
| Rate for Payer: PHP Commercial |
$26.33
|
| Rate for Payer: PHP Medicare Advantage |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health HMO/PPO |
$26.95
|
| Rate for Payer: Priority Health Medicare |
$7.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.76
|
| Rate for Payer: Railroad Medicare Medicare |
$7.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.26
|
| Rate for Payer: UHC Core |
$25.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.74
|
| Rate for Payer: UHC Exchange |
$7.74
|
| Rate for Payer: UHC Medicare Advantage |
$7.74
|
| Rate for Payer: VA VA |
$7.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.24
|
|
|
HC BACITRACIN 4 OZ
|
Facility
|
IP
|
$30.98
|
|
| Hospital Charge Code |
27100007
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: BCBS Trust/PPO |
$25.29
|
| Rate for Payer: BCN Commercial |
$23.94
|
| Rate for Payer: Cash Price |
$24.78
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$27.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$25.40
|
| Rate for Payer: PHP Commercial |
$26.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.14
|
| Rate for Payer: Priority Health HMO/PPO |
$26.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.26
|
| Rate for Payer: UHC Core |
$25.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.24
|
|
|
HC BACK SCREEN
|
Facility
|
OP
|
$52.02
|
|
| Hospital Charge Code |
42000047
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS MAPPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.00
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.00
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.00
|
| Rate for Payer: VA VA |
$13.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
