|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
IP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.36 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: BCBS Trust/PPO |
$599.49
|
| Rate for Payer: BCN Commercial |
$567.54
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health HMO/PPO |
$638.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.27
|
| Rate for Payer: UHC Core |
$613.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 7
|
Facility
|
OP
|
$734.40
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200044
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$660.96 |
| Rate for Payer: Aetna Commercial |
$624.24
|
| Rate for Payer: Aetna Medicare |
$190.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.50
|
| Rate for Payer: BCBS Complete |
$293.76
|
| Rate for Payer: BCBS MAPPO |
$183.60
|
| Rate for Payer: BCBS Trust/PPO |
$603.75
|
| Rate for Payer: BCN Commercial |
$571.00
|
| Rate for Payer: BCN Medicare Advantage |
$183.60
|
| Rate for Payer: Cash Price |
$587.52
|
| Rate for Payer: Cofinity Commercial |
$631.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$587.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$660.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$550.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.24
|
| Rate for Payer: Nomi Health Commercial |
$602.21
|
| Rate for Payer: PACE Senior Care Partners |
$174.42
|
| Rate for Payer: PACE SWMI |
$183.60
|
| Rate for Payer: PHP Commercial |
$624.24
|
| Rate for Payer: PHP Medicare Advantage |
$183.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.36
|
| Rate for Payer: Priority Health HMO/PPO |
$638.93
|
| Rate for Payer: Priority Health Medicare |
$185.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.05
|
| Rate for Payer: Railroad Medicare Medicare |
$183.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.27
|
| Rate for Payer: UHC Core |
$613.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.60
|
| Rate for Payer: UHC Exchange |
$183.60
|
| Rate for Payer: UHC Medicare Advantage |
$183.60
|
| Rate for Payer: VA VA |
$183.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$550.80
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
OP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.61 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: Aetna Medicare |
$230.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$277.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$277.12
|
| Rate for Payer: BCBS Complete |
$354.72
|
| Rate for Payer: BCBS MAPPO |
$221.70
|
| Rate for Payer: BCBS Trust/PPO |
$729.03
|
| Rate for Payer: BCN Commercial |
$689.48
|
| Rate for Payer: BCN Medicare Advantage |
$221.70
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.70
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: PACE Senior Care Partners |
$210.61
|
| Rate for Payer: PACE SWMI |
$221.70
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: PHP Medicare Advantage |
$221.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health HMO/PPO |
$771.51
|
| Rate for Payer: Priority Health Medicare |
$223.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.15
|
| Rate for Payer: Railroad Medicare Medicare |
$221.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.38
|
| Rate for Payer: UHC Core |
$740.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.70
|
| Rate for Payer: UHC Exchange |
$221.70
|
| Rate for Payer: UHC Medicare Advantage |
$221.70
|
| Rate for Payer: VA VA |
$221.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON CATH TRANSLUMINAL LVL 8
|
Facility
|
IP
|
$886.79
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.41 |
| Max. Negotiated Rate |
$798.11 |
| Rate for Payer: Aetna Commercial |
$753.77
|
| Rate for Payer: BCBS Trust/PPO |
$723.89
|
| Rate for Payer: BCN Commercial |
$685.31
|
| Rate for Payer: Cash Price |
$709.43
|
| Rate for Payer: Cofinity Commercial |
$762.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$709.43
|
| Rate for Payer: Healthscope Commercial |
$798.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.77
|
| Rate for Payer: Nomi Health Commercial |
$727.17
|
| Rate for Payer: PHP Commercial |
$753.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.41
|
| Rate for Payer: Priority Health HMO/PPO |
$771.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$594.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$780.38
|
| Rate for Payer: UHC Core |
$740.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.09
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
IP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$486.55 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: BCBS Trust/PPO |
$611.03
|
| Rate for Payer: BCN Commercial |
$578.47
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON DILITATION URETER
|
Facility
|
OP
|
$748.54
|
|
|
Service Code
|
CPT 50706
|
| Hospital Charge Code |
36100512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$177.78 |
| Max. Negotiated Rate |
$673.69 |
| Rate for Payer: Aetna Commercial |
$636.26
|
| Rate for Payer: Aetna Medicare |
$194.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$233.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$233.92
|
| Rate for Payer: BCBS Complete |
$299.42
|
| Rate for Payer: BCBS MAPPO |
$187.14
|
| Rate for Payer: BCBS Trust/PPO |
$615.37
|
| Rate for Payer: BCN Commercial |
$581.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.14
|
| Rate for Payer: Cash Price |
$598.83
|
| Rate for Payer: Cofinity Commercial |
$643.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$598.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.14
|
| Rate for Payer: Healthscope Commercial |
$673.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.26
|
| Rate for Payer: Nomi Health Commercial |
$613.80
|
| Rate for Payer: PACE Senior Care Partners |
$177.78
|
| Rate for Payer: PACE SWMI |
$187.14
|
| Rate for Payer: PHP Commercial |
$636.26
|
| Rate for Payer: PHP Medicare Advantage |
$187.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.55
|
| Rate for Payer: Priority Health HMO/PPO |
$651.23
|
| Rate for Payer: Priority Health Medicare |
$189.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.52
|
| Rate for Payer: Railroad Medicare Medicare |
$187.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.72
|
| Rate for Payer: UHC Core |
$625.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.14
|
| Rate for Payer: UHC Exchange |
$187.14
|
| Rate for Payer: UHC Medicare Advantage |
$187.14
|
| Rate for Payer: VA VA |
$187.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.40
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
OP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$457.19 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: Aetna Medicare |
$500.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$601.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$601.57
|
| Rate for Payer: BCBS Complete |
$770.01
|
| Rate for Payer: BCBS MAPPO |
$481.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,582.57
|
| Rate for Payer: BCN Commercial |
$1,496.71
|
| Rate for Payer: BCN Medicare Advantage |
$481.26
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.26
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$553.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: PACE Senior Care Partners |
$457.19
|
| Rate for Payer: PACE SWMI |
$481.26
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: PHP Medicare Advantage |
$481.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,674.78
|
| Rate for Payer: Priority Health Medicare |
$486.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.77
|
| Rate for Payer: Railroad Medicare Medicare |
$481.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.03
|
| Rate for Payer: UHC Core |
$1,607.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.26
|
| Rate for Payer: UHC Exchange |
$481.26
|
| Rate for Payer: UHC Medicare Advantage |
$481.26
|
| Rate for Payer: VA VA |
$481.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOON PUMP SETUP
|
Facility
|
IP
|
$1,925.03
|
|
| Hospital Charge Code |
27000090
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,251.27 |
| Max. Negotiated Rate |
$1,732.53 |
| Rate for Payer: Aetna Commercial |
$1,636.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,571.40
|
| Rate for Payer: BCN Commercial |
$1,487.66
|
| Rate for Payer: Cash Price |
$1,540.02
|
| Rate for Payer: Cofinity Commercial |
$1,655.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,540.02
|
| Rate for Payer: Healthscope Commercial |
$1,732.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,443.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,636.28
|
| Rate for Payer: Nomi Health Commercial |
$1,578.52
|
| Rate for Payer: PHP Commercial |
$1,636.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,251.27
|
| Rate for Payer: Priority Health HMO/PPO |
$1,674.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,289.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,694.03
|
| Rate for Payer: UHC Core |
$1,607.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,443.77
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
IP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: BCBS Trust/PPO |
$67.32
|
| Rate for Payer: BCN Commercial |
$63.73
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Nomi Health Commercial |
$67.63
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: Priority Health HMO/PPO |
$71.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.57
|
| Rate for Payer: UHC Core |
$68.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 1
|
Facility
|
OP
|
$82.47
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$74.22 |
| Rate for Payer: Aetna Commercial |
$70.10
|
| Rate for Payer: Aetna Medicare |
$21.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.77
|
| Rate for Payer: BCBS Complete |
$32.99
|
| Rate for Payer: BCBS MAPPO |
$20.62
|
| Rate for Payer: BCBS Trust/PPO |
$67.80
|
| Rate for Payer: BCN Commercial |
$64.12
|
| Rate for Payer: BCN Medicare Advantage |
$20.62
|
| Rate for Payer: Cash Price |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$70.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.62
|
| Rate for Payer: Healthscope Commercial |
$74.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.10
|
| Rate for Payer: Nomi Health Commercial |
$67.63
|
| Rate for Payer: PACE Senior Care Partners |
$19.59
|
| Rate for Payer: PACE SWMI |
$20.62
|
| Rate for Payer: PHP Commercial |
$70.10
|
| Rate for Payer: PHP Medicare Advantage |
$20.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.61
|
| Rate for Payer: Priority Health HMO/PPO |
$71.75
|
| Rate for Payer: Priority Health Medicare |
$20.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.25
|
| Rate for Payer: Railroad Medicare Medicare |
$20.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.57
|
| Rate for Payer: UHC Core |
$68.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.62
|
| Rate for Payer: UHC Exchange |
$20.62
|
| Rate for Payer: UHC Medicare Advantage |
$20.62
|
| Rate for Payer: VA VA |
$20.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.85
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
OP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: Aetna Medicare |
$64.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.83
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: BCBS MAPPO |
$62.27
|
| Rate for Payer: BCBS Trust/PPO |
$204.76
|
| Rate for Payer: BCN Commercial |
$193.65
|
| Rate for Payer: BCN Medicare Advantage |
$62.27
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.27
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Nomi Health Commercial |
$204.24
|
| Rate for Payer: PACE Senior Care Partners |
$59.15
|
| Rate for Payer: PACE SWMI |
$62.27
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: PHP Medicare Advantage |
$62.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health HMO/PPO |
$216.69
|
| Rate for Payer: Priority Health Medicare |
$62.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.88
|
| Rate for Payer: Railroad Medicare Medicare |
$62.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.18
|
| Rate for Payer: UHC Core |
$207.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.27
|
| Rate for Payer: UHC Exchange |
$62.27
|
| Rate for Payer: UHC Medicare Advantage |
$62.27
|
| Rate for Payer: VA VA |
$62.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOONS CATH TRANSLUMINAL LVL 2
|
Facility
|
IP
|
$249.07
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27200263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.90 |
| Max. Negotiated Rate |
$224.16 |
| Rate for Payer: Aetna Commercial |
$211.71
|
| Rate for Payer: BCBS Trust/PPO |
$203.32
|
| Rate for Payer: BCN Commercial |
$192.48
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$214.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.71
|
| Rate for Payer: Nomi Health Commercial |
$204.24
|
| Rate for Payer: PHP Commercial |
$211.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health HMO/PPO |
$216.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.18
|
| Rate for Payer: UHC Core |
$207.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.80
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
IP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,073.00 |
| Max. Negotiated Rate |
$2,870.31 |
| Rate for Payer: Aetna Commercial |
$2,710.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,603.37
|
| Rate for Payer: BCN Commercial |
$2,464.64
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,742.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Healthscope Commercial |
$2,870.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: Nomi Health Commercial |
$2,615.17
|
| Rate for Payer: PHP Commercial |
$2,710.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2,774.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,136.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,806.52
|
| Rate for Payer: UHC Core |
$2,663.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.92
|
|
|
HC BALLOON STONE EXTRACTION
|
Facility
|
OP
|
$3,189.23
|
|
| Hospital Charge Code |
36000008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$757.44 |
| Max. Negotiated Rate |
$2,870.31 |
| Rate for Payer: Aetna Commercial |
$2,710.85
|
| Rate for Payer: Aetna Medicare |
$829.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$996.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$996.63
|
| Rate for Payer: BCBS Complete |
$1,275.69
|
| Rate for Payer: BCBS MAPPO |
$797.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,621.87
|
| Rate for Payer: BCN Commercial |
$2,479.63
|
| Rate for Payer: BCN Medicare Advantage |
$797.31
|
| Rate for Payer: Cash Price |
$2,551.38
|
| Rate for Payer: Cofinity Commercial |
$2,742.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,551.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$797.31
|
| Rate for Payer: Healthscope Commercial |
$2,870.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,391.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$837.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$916.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,710.85
|
| Rate for Payer: Nomi Health Commercial |
$2,615.17
|
| Rate for Payer: PACE Senior Care Partners |
$757.44
|
| Rate for Payer: PACE SWMI |
$797.31
|
| Rate for Payer: PHP Commercial |
$2,710.85
|
| Rate for Payer: PHP Medicare Advantage |
$797.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,073.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2,774.63
|
| Rate for Payer: Priority Health Medicare |
$805.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,136.78
|
| Rate for Payer: Railroad Medicare Medicare |
$797.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,806.52
|
| Rate for Payer: UHC Core |
$2,663.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$797.31
|
| Rate for Payer: UHC Exchange |
$797.31
|
| Rate for Payer: UHC Medicare Advantage |
$797.31
|
| Rate for Payer: VA VA |
$797.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,391.92
|
|
|
HC BANANA IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BANANA IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200073
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
IP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.18
|
| Rate for Payer: BCN Commercial |
$10.58
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$12.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: Nomi Health Commercial |
$11.23
|
| Rate for Payer: PHP Commercial |
$11.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health HMO/PPO |
$11.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Core |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.27
|
|
|
HC BANDAGE SCISSORS
|
Facility
|
OP
|
$13.69
|
|
| Hospital Charge Code |
27000029
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$12.32 |
| Rate for Payer: Aetna Commercial |
$11.64
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.28
|
| Rate for Payer: BCBS Complete |
$5.48
|
| Rate for Payer: BCBS MAPPO |
$3.42
|
| Rate for Payer: BCBS Trust/PPO |
$11.25
|
| Rate for Payer: BCN Commercial |
$10.64
|
| Rate for Payer: BCN Medicare Advantage |
$3.42
|
| Rate for Payer: Cash Price |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$12.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.64
|
| Rate for Payer: Nomi Health Commercial |
$11.23
|
| Rate for Payer: PACE Senior Care Partners |
$3.25
|
| Rate for Payer: PACE SWMI |
$3.42
|
| Rate for Payer: PHP Commercial |
$11.64
|
| Rate for Payer: PHP Medicare Advantage |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health HMO/PPO |
$11.91
|
| Rate for Payer: Priority Health Medicare |
$3.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.05
|
| Rate for Payer: UHC Core |
$11.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.42
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UHC Medicare Advantage |
$3.42
|
| Rate for Payer: VA VA |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.27
|
|
|
HC BANDING
|
Facility
|
OP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$229.34 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$820.79
|
| Rate for Payer: Aetna Medicare |
$251.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.76
|
| Rate for Payer: BCBS Complete |
$386.26
|
| Rate for Payer: BCBS MAPPO |
$241.41
|
| Rate for Payer: BCBS Trust/PPO |
$793.85
|
| Rate for Payer: BCN Commercial |
$750.79
|
| Rate for Payer: BCN Medicare Advantage |
$241.41
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$830.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.41
|
| Rate for Payer: Healthscope Commercial |
$869.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: Nomi Health Commercial |
$791.82
|
| Rate for Payer: PACE Senior Care Partners |
$229.34
|
| Rate for Payer: PACE SWMI |
$241.41
|
| Rate for Payer: PHP Commercial |
$820.79
|
| Rate for Payer: PHP Medicare Advantage |
$241.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health HMO/PPO |
$840.11
|
| Rate for Payer: Priority Health Medicare |
$243.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.98
|
| Rate for Payer: Railroad Medicare Medicare |
$241.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.76
|
| Rate for Payer: UHC Core |
$806.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.41
|
| Rate for Payer: UHC Exchange |
$241.41
|
| Rate for Payer: UHC Medicare Advantage |
$241.41
|
| Rate for Payer: VA VA |
$241.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.23
|
|
|
HC BANDING
|
Facility
|
IP
|
$965.64
|
|
| Hospital Charge Code |
36000009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$627.67 |
| Max. Negotiated Rate |
$869.08 |
| Rate for Payer: Aetna Commercial |
$820.79
|
| Rate for Payer: BCBS Trust/PPO |
$788.25
|
| Rate for Payer: BCN Commercial |
$746.25
|
| Rate for Payer: Cash Price |
$772.51
|
| Rate for Payer: Cofinity Commercial |
$830.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.51
|
| Rate for Payer: Healthscope Commercial |
$869.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$724.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.79
|
| Rate for Payer: Nomi Health Commercial |
$791.82
|
| Rate for Payer: PHP Commercial |
$820.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$627.67
|
| Rate for Payer: Priority Health HMO/PPO |
$840.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$646.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.76
|
| Rate for Payer: UHC Core |
$806.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$724.23
|
|
|
HC BARBITURATE URIN
|
Facility
|
IP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: BCBS Trust/PPO |
$82.99
|
| Rate for Payer: BCN Commercial |
$78.56
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC BARBITURATE URIN
|
Facility
|
OP
|
$101.66
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
30000137
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$91.49 |
| Rate for Payer: Aetna Commercial |
$86.41
|
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.77
|
| Rate for Payer: BCBS Complete |
$47.18
|
| Rate for Payer: BCBS MAPPO |
$25.42
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: BCN Medicare Advantage |
$25.42
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cash Price |
$81.33
|
| Rate for Payer: Cofinity Commercial |
$87.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$91.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.24
|
| Rate for Payer: Mclaren Medicaid |
$44.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.69
|
| Rate for Payer: Meridian Medicaid |
$47.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.41
|
| Rate for Payer: Nomi Health Commercial |
$83.36
|
| Rate for Payer: PACE Senior Care Partners |
$24.14
|
| Rate for Payer: PACE SWMI |
$25.42
|
| Rate for Payer: PHP Commercial |
$86.41
|
| Rate for Payer: PHP Medicare Advantage |
$25.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.08
|
| Rate for Payer: Priority Health HMO/PPO |
$88.44
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.11
|
| Rate for Payer: Railroad Medicare Medicare |
$25.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.46
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.42
|
| Rate for Payer: UHC Exchange |
$25.42
|
| Rate for Payer: UHC Medicare Advantage |
$25.42
|
| Rate for Payer: UHCCP Medicaid |
$44.93
|
| Rate for Payer: VA VA |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.24
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
OP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.02 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: Aetna Medicare |
$16.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.76
|
| Rate for Payer: BCBS Complete |
$25.30
|
| Rate for Payer: BCBS MAPPO |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.99
|
| Rate for Payer: BCN Commercial |
$49.17
|
| Rate for Payer: BCN Medicare Advantage |
$15.81
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PACE Senior Care Partners |
$15.02
|
| Rate for Payer: PACE SWMI |
$15.81
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: PHP Medicare Advantage |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Medicare |
$15.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: Railroad Medicare Medicare |
$15.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.81
|
| Rate for Payer: UHC Exchange |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$15.81
|
| Rate for Payer: VA VA |
$15.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC BARBITURATE URINE CONFIRM
|
Facility
|
IP
|
$63.24
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
30100571
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.75
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$48.87
|
| Rate for Payer: Cash Price |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$54.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.59
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.75
|
| Rate for Payer: Nomi Health Commercial |
$51.86
|
| Rate for Payer: PHP Commercial |
$53.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.65
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.43
|
|
|
HC BARRIER ADHESION
|
Facility
|
OP
|
$589.96
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
27000463
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$140.12 |
| Max. Negotiated Rate |
$530.96 |
| Rate for Payer: Aetna Commercial |
$501.47
|
| Rate for Payer: Aetna Medicare |
$153.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.36
|
| Rate for Payer: BCBS Complete |
$235.98
|
| Rate for Payer: BCBS MAPPO |
$147.49
|
| Rate for Payer: BCBS Trust/PPO |
$485.01
|
| Rate for Payer: BCN Commercial |
$458.69
|
| Rate for Payer: BCN Medicare Advantage |
$147.49
|
| Rate for Payer: Cash Price |
$471.97
|
| Rate for Payer: Cofinity Commercial |
$507.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.49
|
| Rate for Payer: Healthscope Commercial |
$530.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.47
|
| Rate for Payer: Nomi Health Commercial |
$483.77
|
| Rate for Payer: PACE Senior Care Partners |
$140.12
|
| Rate for Payer: PACE SWMI |
$147.49
|
| Rate for Payer: PHP Commercial |
$501.47
|
| Rate for Payer: PHP Medicare Advantage |
$147.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.47
|
| Rate for Payer: Priority Health HMO/PPO |
$513.27
|
| Rate for Payer: Priority Health Medicare |
$148.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.27
|
| Rate for Payer: Railroad Medicare Medicare |
$147.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.16
|
| Rate for Payer: UHC Core |
$492.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.49
|
| Rate for Payer: UHC Exchange |
$147.49
|
| Rate for Payer: UHC Medicare Advantage |
$147.49
|
| Rate for Payer: VA VA |
$147.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.47
|
|
