|
HC CHROMOSOME CULTURE
|
Facility
|
IP
|
$310.94
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.41 |
| Max. Negotiated Rate |
$279.85 |
| Rate for Payer: Aetna Commercial |
$264.30
|
| Rate for Payer: BCBS Trust/PPO |
$256.81
|
| Rate for Payer: BCN Commercial |
$256.81
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cofinity Commercial |
$267.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.75
|
| Rate for Payer: Healthscope Commercial |
$279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.30
|
| Rate for Payer: Nomi Health Commercial |
$254.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.21
|
| Rate for Payer: PHP Commercial |
$264.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$270.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.63
|
| Rate for Payer: UHC Core |
$259.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.21
|
|
|
HC CHROMOSOME CULTURE
|
Facility
|
OP
|
$310.94
|
|
|
Service Code
|
CPT 88235
|
| Hospital Charge Code |
31000015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$279.85 |
| Rate for Payer: Aetna Commercial |
$264.30
|
| Rate for Payer: Aetna Medicare |
$80.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97.17
|
| Rate for Payer: BCBS Complete |
$57.55
|
| Rate for Payer: BCBS MAPPO |
$77.73
|
| Rate for Payer: BCBS Trust/PPO |
$255.62
|
| Rate for Payer: BCN Commercial |
$255.62
|
| Rate for Payer: BCN Medicare Advantage |
$77.73
|
| Rate for Payer: Cash Price |
$248.75
|
| Rate for Payer: Cofinity Commercial |
$267.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.73
|
| Rate for Payer: Healthscope Commercial |
$279.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.21
|
| Rate for Payer: Mclaren Medicaid |
$54.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.62
|
| Rate for Payer: Meridian Medicaid |
$57.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.30
|
| Rate for Payer: Nomi Health Commercial |
$254.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.21
|
| Rate for Payer: PACE Senior Care Partners |
$73.85
|
| Rate for Payer: PACE SWMI |
$77.73
|
| Rate for Payer: PHP Commercial |
$264.30
|
| Rate for Payer: PHP Medicare Advantage |
$77.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$270.52
|
| Rate for Payer: Priority Health Medicare |
$78.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: Railroad Medicare Medicare |
$77.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.63
|
| Rate for Payer: UHC Core |
$259.63
|
| Rate for Payer: UHC Exchange |
$77.73
|
| Rate for Payer: UHC Medicaid |
$54.82
|
| Rate for Payer: UHC Medicare Advantage |
$77.73
|
| Rate for Payer: UHCCP Medicaid |
$54.82
|
| Rate for Payer: VA VA |
$77.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.21
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.38 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: Aetna Medicare |
$41.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.31
|
| Rate for Payer: BCBS Complete |
$29.80
|
| Rate for Payer: BCBS MAPPO |
$40.25
|
| Rate for Payer: BCBS Trust/PPO |
$132.36
|
| Rate for Payer: BCN Commercial |
$132.36
|
| Rate for Payer: BCN Medicare Advantage |
$40.25
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.25
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Mclaren Medicaid |
$28.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.26
|
| Rate for Payer: Meridian Medicaid |
$29.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Nomi Health Commercial |
$132.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PACE Senior Care Partners |
$38.24
|
| Rate for Payer: PACE SWMI |
$40.25
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: PHP Medicare Advantage |
$40.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.07
|
| Rate for Payer: Priority Health Medicare |
$40.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.06
|
| Rate for Payer: Railroad Medicare Medicare |
$40.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.68
|
| Rate for Payer: UHC Core |
$134.44
|
| Rate for Payer: UHC Exchange |
$40.25
|
| Rate for Payer: UHC Medicaid |
$28.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.25
|
| Rate for Payer: UHCCP Medicaid |
$28.38
|
| Rate for Payer: VA VA |
$40.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
HC CHRONIC CARE MGMT SVC PHYS 1ST 30 MIN CAL MO
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 99491
|
| Hospital Charge Code |
51000137
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.06 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$136.85
|
| Rate for Payer: BCBS Trust/PPO |
$132.97
|
| Rate for Payer: BCN Commercial |
$132.97
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$138.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.80
|
| Rate for Payer: Healthscope Commercial |
$144.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.85
|
| Rate for Payer: Nomi Health Commercial |
$132.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.75
|
| Rate for Payer: PHP Commercial |
$136.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$140.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.68
|
| Rate for Payer: UHC Core |
$134.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.75
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.96 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: BCBS Trust/PPO |
$214.73
|
| Rate for Payer: BCN Commercial |
$214.73
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.80
|
| Rate for Payer: UHC Core |
$217.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.00
|
|
|
HC CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
51000136
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna Medicare |
$67.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.25
|
| Rate for Payer: BCBS Complete |
$48.13
|
| Rate for Payer: BCBS MAPPO |
$65.00
|
| Rate for Payer: BCBS Trust/PPO |
$213.75
|
| Rate for Payer: BCN Commercial |
$213.75
|
| Rate for Payer: BCN Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.00
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.00
|
| Rate for Payer: Mclaren Medicaid |
$45.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.25
|
| Rate for Payer: Meridian Medicaid |
$48.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$213.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PACE Senior Care Partners |
$61.75
|
| Rate for Payer: PACE SWMI |
$65.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: PHP Medicare Advantage |
$65.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$65.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$180.96
|
| Rate for Payer: Railroad Medicare Medicare |
$65.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.80
|
| Rate for Payer: UHC Core |
$217.10
|
| Rate for Payer: UHC Exchange |
$65.00
|
| Rate for Payer: UHC Medicaid |
$45.84
|
| Rate for Payer: UHC Medicare Advantage |
$65.00
|
| Rate for Payer: UHCCP Medicaid |
$45.84
|
| Rate for Payer: VA VA |
$65.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.00
|
|
|
HC CIRCUMCISION
|
Facility
|
OP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$733.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.24
|
| Rate for Payer: BCBS Complete |
$521.98
|
| Rate for Payer: BCBS MAPPO |
$705.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,318.31
|
| Rate for Payer: BCN Commercial |
$2,318.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.00
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.00
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$497.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.24
|
| Rate for Payer: Meridian Medicaid |
$521.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$810.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$775.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Senior Care Partners |
$669.75
|
| Rate for Payer: PACE SWMI |
$705.00
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$705.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Medicare |
$712.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: Railroad Medicare Medicare |
$705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: UHC Exchange |
$705.00
|
| Rate for Payer: UHC Medicaid |
$497.16
|
| Rate for Payer: UHC Medicare Advantage |
$705.00
|
| Rate for Payer: UHCCP Medicaid |
$497.16
|
| Rate for Payer: VA VA |
$705.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CIRCUMCISION
|
Facility
|
IP
|
$2,819.98
|
|
| Hospital Charge Code |
72300001
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$1,962.71 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.02
|
| Rate for Payer: BCN Commercial |
$2,329.02
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
OP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$488.24 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: Aetna Medicare |
$720.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$865.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$865.42
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS MAPPO |
$692.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,276.69
|
| Rate for Payer: BCN Commercial |
$2,276.69
|
| Rate for Payer: BCN Medicare Advantage |
$692.34
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$692.34
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Mclaren Medicaid |
$488.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$726.96
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$796.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$761.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PACE Senior Care Partners |
$657.72
|
| Rate for Payer: PACE SWMI |
$692.34
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: PHP Medicare Advantage |
$692.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Medicare |
$699.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: Railroad Medicare Medicare |
$692.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: UHC Exchange |
$692.34
|
| Rate for Payer: UHC Medicaid |
$488.24
|
| Rate for Payer: UHC Medicare Advantage |
$692.34
|
| Rate for Payer: UHCCP Medicaid |
$488.24
|
| Rate for Payer: VA VA |
$692.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CIRCUMCISION CLAMP NEWBORN
|
Facility
|
IP
|
$2,769.36
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
76100198
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,927.47 |
| Max. Negotiated Rate |
$2,492.42 |
| Rate for Payer: Aetna Commercial |
$2,353.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,287.21
|
| Rate for Payer: BCN Commercial |
$2,287.21
|
| Rate for Payer: Cash Price |
$2,215.49
|
| Rate for Payer: Cofinity Commercial |
$2,381.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,215.49
|
| Rate for Payer: Healthscope Commercial |
$2,492.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,077.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,353.96
|
| Rate for Payer: Nomi Health Commercial |
$2,270.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,077.02
|
| Rate for Payer: PHP Commercial |
$2,353.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,409.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,927.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,437.04
|
| Rate for Payer: UHC Core |
$2,312.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,077.02
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
IP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,962.71 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.02
|
| Rate for Payer: BCN Commercial |
$2,329.02
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CIRCUMCISION, SURG OTHER THAN CLAMP >28 DAYS OLD
|
Facility
|
OP
|
$2,819.98
|
|
|
Service Code
|
CPT 54161
|
| Hospital Charge Code |
76100256
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$497.16 |
| Max. Negotiated Rate |
$2,537.98 |
| Rate for Payer: Aetna Commercial |
$2,396.98
|
| Rate for Payer: Aetna Medicare |
$733.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.24
|
| Rate for Payer: BCBS Complete |
$521.98
|
| Rate for Payer: BCBS MAPPO |
$705.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,318.31
|
| Rate for Payer: BCN Commercial |
$2,318.31
|
| Rate for Payer: BCN Medicare Advantage |
$705.00
|
| Rate for Payer: Cash Price |
$2,255.98
|
| Rate for Payer: Cofinity Commercial |
$2,425.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,255.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.00
|
| Rate for Payer: Healthscope Commercial |
$2,537.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,114.99
|
| Rate for Payer: Mclaren Medicaid |
$497.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.24
|
| Rate for Payer: Meridian Medicaid |
$521.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$810.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$775.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,396.98
|
| Rate for Payer: Nomi Health Commercial |
$2,312.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.99
|
| Rate for Payer: PACE Senior Care Partners |
$669.75
|
| Rate for Payer: PACE SWMI |
$705.00
|
| Rate for Payer: PHP Commercial |
$2,396.98
|
| Rate for Payer: PHP Medicare Advantage |
$705.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$497.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,453.38
|
| Rate for Payer: Priority Health Medicare |
$712.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,962.71
|
| Rate for Payer: Railroad Medicare Medicare |
$705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,481.58
|
| Rate for Payer: UHC Core |
$2,354.68
|
| Rate for Payer: UHC Exchange |
$705.00
|
| Rate for Payer: UHC Medicaid |
$497.16
|
| Rate for Payer: UHC Medicare Advantage |
$705.00
|
| Rate for Payer: UHCCP Medicaid |
$497.16
|
| Rate for Payer: VA VA |
$705.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,114.99
|
|
|
HC CITRIC ACID URINE
|
Facility
|
OP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: Aetna Medicare |
$14.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.91
|
| Rate for Payer: BCBS Complete |
$10.02
|
| Rate for Payer: BCBS MAPPO |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$44.49
|
| Rate for Payer: BCN Commercial |
$44.49
|
| Rate for Payer: BCN Medicare Advantage |
$13.53
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.59
|
| Rate for Payer: Mclaren Medicaid |
$9.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.21
|
| Rate for Payer: Meridian Medicaid |
$10.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PACE Senior Care Partners |
$12.85
|
| Rate for Payer: PACE SWMI |
$13.53
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicare Advantage |
$13.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.08
|
| Rate for Payer: Priority Health Medicare |
$13.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.67
|
| Rate for Payer: Railroad Medicare Medicare |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.63
|
| Rate for Payer: UHC Core |
$45.19
|
| Rate for Payer: UHC Exchange |
$13.53
|
| Rate for Payer: UHC Medicaid |
$9.54
|
| Rate for Payer: UHC Medicare Advantage |
$13.53
|
| Rate for Payer: UHCCP Medicaid |
$9.54
|
| Rate for Payer: VA VA |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
|
HC CITRIC ACID URINE
|
Facility
|
IP
|
$54.12
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
30100166
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$48.71 |
| Rate for Payer: Aetna Commercial |
$46.00
|
| Rate for Payer: BCBS Trust/PPO |
$44.70
|
| Rate for Payer: BCN Commercial |
$44.70
|
| Rate for Payer: Cash Price |
$43.30
|
| Rate for Payer: Cofinity Commercial |
$46.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$48.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$44.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.59
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.63
|
| Rate for Payer: UHC Core |
$45.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.59
|
|
|
HC CK-MB FRACTION
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: Aetna Medicare |
$27.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.50
|
| Rate for Payer: BCBS Complete |
$19.25
|
| Rate for Payer: BCBS MAPPO |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$85.50
|
| Rate for Payer: BCN Commercial |
$85.50
|
| Rate for Payer: BCN Medicare Advantage |
$26.00
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Mclaren Medicaid |
$18.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.30
|
| Rate for Payer: Meridian Medicaid |
$19.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PACE Senior Care Partners |
$24.70
|
| Rate for Payer: PACE SWMI |
$26.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: PHP Medicare Advantage |
$26.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.48
|
| Rate for Payer: Priority Health Medicare |
$26.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.52
|
| Rate for Payer: UHC Core |
$86.84
|
| Rate for Payer: UHC Exchange |
$26.00
|
| Rate for Payer: UHC Medicaid |
$18.34
|
| Rate for Payer: UHC Medicare Advantage |
$26.00
|
| Rate for Payer: UHCCP Medicaid |
$18.34
|
| Rate for Payer: VA VA |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC CK-MB FRACTION
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
30100179
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$88.40
|
| Rate for Payer: BCBS Trust/PPO |
$85.89
|
| Rate for Payer: BCN Commercial |
$85.89
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$89.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.20
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Nomi Health Commercial |
$85.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.00
|
| Rate for Payer: PHP Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$90.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.52
|
| Rate for Payer: UHC Core |
$86.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.00
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC CLADOSPORIUM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200032
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC CLAM IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC CLAM IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200033
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
IP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.76 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$686.05
|
| Rate for Payer: BCBS Trust/PPO |
$666.60
|
| Rate for Payer: BCN Commercial |
$666.60
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Commercial |
$694.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Healthscope Commercial |
$726.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Nomi Health Commercial |
$661.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: PHP Commercial |
$686.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$702.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.27
|
| Rate for Payer: UHC Core |
$673.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.34
|
|
|
HC CLIP FIX DEVICE ROTATABLE
|
Facility
|
OP
|
$807.12
|
|
| Hospital Charge Code |
27200290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.30 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$686.05
|
| Rate for Payer: Aetna Medicare |
$209.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$252.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$252.22
|
| Rate for Payer: BCBS Complete |
$149.40
|
| Rate for Payer: BCBS MAPPO |
$201.78
|
| Rate for Payer: BCBS Trust/PPO |
$663.53
|
| Rate for Payer: BCN Commercial |
$663.53
|
| Rate for Payer: BCN Medicare Advantage |
$201.78
|
| Rate for Payer: Cash Price |
$645.70
|
| Rate for Payer: Cofinity Commercial |
$694.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.78
|
| Rate for Payer: Healthscope Commercial |
$726.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$605.34
|
| Rate for Payer: Mclaren Medicaid |
$142.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.87
|
| Rate for Payer: Meridian Medicaid |
$149.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$686.05
|
| Rate for Payer: Nomi Health Commercial |
$661.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$605.34
|
| Rate for Payer: PACE Senior Care Partners |
$191.69
|
| Rate for Payer: PACE SWMI |
$201.78
|
| Rate for Payer: PHP Commercial |
$686.05
|
| Rate for Payer: PHP Medicare Advantage |
$201.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$702.19
|
| Rate for Payer: Priority Health Medicare |
$203.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.76
|
| Rate for Payer: Railroad Medicare Medicare |
$201.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.27
|
| Rate for Payer: UHC Core |
$673.95
|
| Rate for Payer: UHC Exchange |
$201.78
|
| Rate for Payer: UHC Medicaid |
$142.30
|
| Rate for Payer: UHC Medicare Advantage |
$201.78
|
| Rate for Payer: UHCCP Medicaid |
$142.30
|
| Rate for Payer: VA VA |
$201.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$605.34
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
OP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.17 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$93.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.97
|
| Rate for Payer: BCBS Complete |
$66.32
|
| Rate for Payer: BCBS MAPPO |
$89.58
|
| Rate for Payer: BCBS Trust/PPO |
$294.57
|
| Rate for Payer: BCN Commercial |
$294.57
|
| Rate for Payer: BCN Medicare Advantage |
$89.58
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Mclaren Medicaid |
$63.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.06
|
| Rate for Payer: Meridian Medicaid |
$66.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PACE Senior Care Partners |
$85.10
|
| Rate for Payer: PACE SWMI |
$89.58
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: PHP Medicare Advantage |
$89.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Medicare |
$90.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: Railroad Medicare Medicare |
$89.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: UHC Exchange |
$89.58
|
| Rate for Payer: UHC Medicaid |
$63.17
|
| Rate for Payer: UHC Medicare Advantage |
$89.58
|
| Rate for Payer: UHCCP Medicaid |
$63.17
|
| Rate for Payer: VA VA |
$89.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX CARPAL FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
76100165
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
|
HC CLOSED RX DIST FIBULA FX
|
Facility
|
IP
|
$358.31
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
76100174
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.38 |
| Max. Negotiated Rate |
$322.48 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: BCBS Trust/PPO |
$295.93
|
| Rate for Payer: BCN Commercial |
$295.93
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cofinity Commercial |
$308.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.65
|
| Rate for Payer: Healthscope Commercial |
$322.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$268.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.56
|
| Rate for Payer: Nomi Health Commercial |
$293.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.73
|
| Rate for Payer: PHP Commercial |
$304.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$311.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.31
|
| Rate for Payer: UHC Core |
$299.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$268.73
|
|
