|
HC EXERCISE TEST FOR BRONCHOSPASM WO ECG
|
Facility
|
OP
|
$133.58
|
|
|
Service Code
|
CPT 94619
|
| Hospital Charge Code |
46000032
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$120.22 |
| Rate for Payer: Aetna Commercial |
$113.54
|
| Rate for Payer: Aetna Medicare |
$34.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.74
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$33.40
|
| Rate for Payer: BCBS Trust/PPO |
$103.86
|
| Rate for Payer: BCN Commercial |
$103.86
|
| Rate for Payer: BCN Medicare Advantage |
$33.40
|
| Rate for Payer: Cash Price |
$106.86
|
| Rate for Payer: Cash Price |
$106.86
|
| Rate for Payer: Cofinity Commercial |
$114.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.40
|
| Rate for Payer: Healthscope Commercial |
$120.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.18
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.54
|
| Rate for Payer: PACE Senior Care Partners |
$31.73
|
| Rate for Payer: PACE SWMI |
$33.40
|
| Rate for Payer: PHP Commercial |
$113.54
|
| Rate for Payer: PHP Medicare Advantage |
$33.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.21
|
| Rate for Payer: Priority Health Medicare |
$33.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.47
|
| Rate for Payer: Railroad Medicare Medicare |
$33.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.55
|
| Rate for Payer: UHC Core |
$111.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.40
|
| Rate for Payer: UHC Medicare Advantage |
$34.40
|
| Rate for Payer: VA VA |
$33.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.18
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
IP
|
$1,904.25
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,161.40 |
| Max. Negotiated Rate |
$1,713.82 |
| Rate for Payer: Aetna Commercial |
$1,618.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,471.60
|
| Rate for Payer: BCN Commercial |
$1,471.60
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cofinity Commercial |
$1,637.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.40
|
| Rate for Payer: Healthscope Commercial |
$1,713.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.61
|
| Rate for Payer: PHP Commercial |
$1,618.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,656.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.74
|
| Rate for Payer: UHC Core |
$1,590.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.19
|
|
|
HC EXPLORE WOUND EXTREMITY
|
Facility
|
OP
|
$1,904.25
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
45000007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.26 |
| Max. Negotiated Rate |
$1,713.82 |
| Rate for Payer: Aetna Commercial |
$1,618.61
|
| Rate for Payer: Aetna Medicare |
$495.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$595.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$595.08
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$476.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,480.55
|
| Rate for Payer: BCN Commercial |
$1,480.55
|
| Rate for Payer: BCN Medicare Advantage |
$476.06
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cash Price |
$1,523.40
|
| Rate for Payer: Cofinity Commercial |
$1,637.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,523.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.06
|
| Rate for Payer: Healthscope Commercial |
$1,713.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,428.19
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$499.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$547.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,618.61
|
| Rate for Payer: PACE Senior Care Partners |
$452.26
|
| Rate for Payer: PACE SWMI |
$476.06
|
| Rate for Payer: PHP Commercial |
$1,618.61
|
| Rate for Payer: PHP Medicare Advantage |
$476.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,332.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,656.70
|
| Rate for Payer: Priority Health Medicare |
$476.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,161.40
|
| Rate for Payer: Railroad Medicare Medicare |
$476.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,675.74
|
| Rate for Payer: UHC Core |
$1,590.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.06
|
| Rate for Payer: UHC Medicare Advantage |
$490.34
|
| Rate for Payer: VA VA |
$476.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,428.19
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
OP
|
$1,726.39
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$410.02 |
| Max. Negotiated Rate |
$1,553.75 |
| Rate for Payer: Aetna Commercial |
$1,467.43
|
| Rate for Payer: Aetna Medicare |
$448.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$539.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$539.50
|
| Rate for Payer: BCBS Complete |
$690.56
|
| Rate for Payer: BCBS MAPPO |
$431.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,342.27
|
| Rate for Payer: BCN Commercial |
$1,342.27
|
| Rate for Payer: BCN Medicare Advantage |
$431.60
|
| Rate for Payer: Cash Price |
$1,381.11
|
| Rate for Payer: Cofinity Commercial |
$1,484.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,381.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.60
|
| Rate for Payer: Healthscope Commercial |
$1,553.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,294.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$453.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$496.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,467.43
|
| Rate for Payer: PACE Senior Care Partners |
$410.02
|
| Rate for Payer: PACE SWMI |
$431.60
|
| Rate for Payer: PHP Commercial |
$1,467.43
|
| Rate for Payer: PHP Medicare Advantage |
$431.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,501.96
|
| Rate for Payer: Priority Health Medicare |
$431.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,052.93
|
| Rate for Payer: Railroad Medicare Medicare |
$431.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,519.22
|
| Rate for Payer: UHC Core |
$1,441.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.60
|
| Rate for Payer: UHC Medicare Advantage |
$444.55
|
| Rate for Payer: VA VA |
$431.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,294.79
|
|
|
HC EXTENDED RECOVERY 0-6 HRS
|
Facility
|
IP
|
$1,726.39
|
|
| Hospital Charge Code |
71000005
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,052.93 |
| Max. Negotiated Rate |
$1,553.75 |
| Rate for Payer: Aetna Commercial |
$1,467.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,334.15
|
| Rate for Payer: BCN Commercial |
$1,334.15
|
| Rate for Payer: Cash Price |
$1,381.11
|
| Rate for Payer: Cofinity Commercial |
$1,484.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,381.11
|
| Rate for Payer: Healthscope Commercial |
$1,553.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,294.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,467.43
|
| Rate for Payer: PHP Commercial |
$1,467.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,501.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,052.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,519.22
|
| Rate for Payer: UHC Core |
$1,441.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,294.79
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
OP
|
$2,018.44
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$479.38 |
| Max. Negotiated Rate |
$1,816.60 |
| Rate for Payer: Aetna Commercial |
$1,715.67
|
| Rate for Payer: Aetna Medicare |
$524.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$630.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$630.76
|
| Rate for Payer: BCBS Complete |
$807.38
|
| Rate for Payer: BCBS MAPPO |
$504.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.34
|
| Rate for Payer: BCN Commercial |
$1,569.34
|
| Rate for Payer: BCN Medicare Advantage |
$504.61
|
| Rate for Payer: Cash Price |
$1,614.75
|
| Rate for Payer: Cofinity Commercial |
$1,735.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,614.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.61
|
| Rate for Payer: Healthscope Commercial |
$1,816.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,513.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$529.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$580.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,715.67
|
| Rate for Payer: PACE Senior Care Partners |
$479.38
|
| Rate for Payer: PACE SWMI |
$504.61
|
| Rate for Payer: PHP Commercial |
$1,715.67
|
| Rate for Payer: PHP Medicare Advantage |
$504.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,756.04
|
| Rate for Payer: Priority Health Medicare |
$504.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.05
|
| Rate for Payer: Railroad Medicare Medicare |
$504.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,776.23
|
| Rate for Payer: UHC Core |
$1,685.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$504.61
|
| Rate for Payer: UHC Medicare Advantage |
$519.75
|
| Rate for Payer: VA VA |
$504.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,513.83
|
|
|
HC EXTENDED RECOVERY 12-18 HRS
|
Facility
|
IP
|
$2,018.44
|
|
| Hospital Charge Code |
71000006
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,231.05 |
| Max. Negotiated Rate |
$1,816.60 |
| Rate for Payer: Aetna Commercial |
$1,715.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,559.85
|
| Rate for Payer: BCN Commercial |
$1,559.85
|
| Rate for Payer: Cash Price |
$1,614.75
|
| Rate for Payer: Cofinity Commercial |
$1,735.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,614.75
|
| Rate for Payer: Healthscope Commercial |
$1,816.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,513.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,715.67
|
| Rate for Payer: PHP Commercial |
$1,715.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,412.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,756.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,231.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,776.23
|
| Rate for Payer: UHC Core |
$1,685.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,513.83
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
OP
|
$2,206.16
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$523.96 |
| Max. Negotiated Rate |
$1,985.54 |
| Rate for Payer: Aetna Commercial |
$1,875.24
|
| Rate for Payer: Aetna Medicare |
$573.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$689.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$689.42
|
| Rate for Payer: BCBS Complete |
$882.46
|
| Rate for Payer: BCBS MAPPO |
$551.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,715.29
|
| Rate for Payer: BCN Commercial |
$1,715.29
|
| Rate for Payer: BCN Medicare Advantage |
$551.54
|
| Rate for Payer: Cash Price |
$1,764.93
|
| Rate for Payer: Cofinity Commercial |
$1,897.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.54
|
| Rate for Payer: Healthscope Commercial |
$1,985.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,654.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$579.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$634.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.24
|
| Rate for Payer: PACE Senior Care Partners |
$523.96
|
| Rate for Payer: PACE SWMI |
$551.54
|
| Rate for Payer: PHP Commercial |
$1,875.24
|
| Rate for Payer: PHP Medicare Advantage |
$551.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,919.36
|
| Rate for Payer: Priority Health Medicare |
$551.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.54
|
| Rate for Payer: Railroad Medicare Medicare |
$551.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,941.42
|
| Rate for Payer: UHC Core |
$1,842.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.54
|
| Rate for Payer: UHC Medicare Advantage |
$568.09
|
| Rate for Payer: VA VA |
$551.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,654.62
|
|
|
HC EXTENDED RECOVERY 18-24 HRS
|
Facility
|
IP
|
$2,206.16
|
|
| Hospital Charge Code |
71000007
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,345.54 |
| Max. Negotiated Rate |
$1,985.54 |
| Rate for Payer: Aetna Commercial |
$1,875.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.92
|
| Rate for Payer: BCN Commercial |
$1,704.92
|
| Rate for Payer: Cash Price |
$1,764.93
|
| Rate for Payer: Cofinity Commercial |
$1,897.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,764.93
|
| Rate for Payer: Healthscope Commercial |
$1,985.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,654.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,875.24
|
| Rate for Payer: PHP Commercial |
$1,875.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,544.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,919.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,345.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,941.42
|
| Rate for Payer: UHC Core |
$1,842.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,654.62
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
OP
|
$1,888.04
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$448.41 |
| Max. Negotiated Rate |
$1,699.24 |
| Rate for Payer: Aetna Commercial |
$1,604.83
|
| Rate for Payer: Aetna Medicare |
$490.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.01
|
| Rate for Payer: BCBS Complete |
$755.22
|
| Rate for Payer: BCBS MAPPO |
$472.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,467.95
|
| Rate for Payer: BCN Commercial |
$1,467.95
|
| Rate for Payer: BCN Medicare Advantage |
$472.01
|
| Rate for Payer: Cash Price |
$1,510.43
|
| Rate for Payer: Cofinity Commercial |
$1,623.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.01
|
| Rate for Payer: Healthscope Commercial |
$1,699.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$495.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$542.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.83
|
| Rate for Payer: PACE Senior Care Partners |
$448.41
|
| Rate for Payer: PACE SWMI |
$472.01
|
| Rate for Payer: PHP Commercial |
$1,604.83
|
| Rate for Payer: PHP Medicare Advantage |
$472.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.59
|
| Rate for Payer: Priority Health Medicare |
$472.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.52
|
| Rate for Payer: Railroad Medicare Medicare |
$472.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.48
|
| Rate for Payer: UHC Core |
$1,576.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$472.01
|
| Rate for Payer: UHC Medicare Advantage |
$486.17
|
| Rate for Payer: VA VA |
$472.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.03
|
|
|
HC EXTENDED RECOVERY 6-12 HRS
|
Facility
|
IP
|
$1,888.04
|
|
| Hospital Charge Code |
71000008
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$1,151.52 |
| Max. Negotiated Rate |
$1,699.24 |
| Rate for Payer: Aetna Commercial |
$1,604.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,459.08
|
| Rate for Payer: BCN Commercial |
$1,459.08
|
| Rate for Payer: Cash Price |
$1,510.43
|
| Rate for Payer: Cofinity Commercial |
$1,623.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,510.43
|
| Rate for Payer: Healthscope Commercial |
$1,699.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,416.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,604.83
|
| Rate for Payer: PHP Commercial |
$1,604.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,642.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,661.48
|
| Rate for Payer: UHC Core |
$1,576.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,416.03
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.01 |
| Max. Negotiated Rate |
$1,792.93 |
| Rate for Payer: Aetna Commercial |
$1,693.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,539.53
|
| Rate for Payer: BCN Commercial |
$1,539.53
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,713.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Healthscope Commercial |
$1,792.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: PHP Commercial |
$1,693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,215.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,753.08
|
| Rate for Payer: UHC Core |
$1,663.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.10
|
|
|
HC EXTENSION KIT
|
Facility
|
OP
|
$1,992.14
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.13 |
| Max. Negotiated Rate |
$1,792.93 |
| Rate for Payer: Aetna Commercial |
$1,693.32
|
| Rate for Payer: Aetna Medicare |
$517.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$622.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$622.54
|
| Rate for Payer: BCBS Complete |
$796.86
|
| Rate for Payer: BCBS MAPPO |
$498.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,548.89
|
| Rate for Payer: BCN Commercial |
$1,548.89
|
| Rate for Payer: BCN Medicare Advantage |
$498.04
|
| Rate for Payer: Cash Price |
$1,593.71
|
| Rate for Payer: Cofinity Commercial |
$1,713.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.04
|
| Rate for Payer: Healthscope Commercial |
$1,792.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,494.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$522.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$572.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,693.32
|
| Rate for Payer: PACE Senior Care Partners |
$473.13
|
| Rate for Payer: PACE SWMI |
$498.04
|
| Rate for Payer: PHP Commercial |
$1,693.32
|
| Rate for Payer: PHP Medicare Advantage |
$498.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,733.16
|
| Rate for Payer: Priority Health Medicare |
$498.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,215.01
|
| Rate for Payer: Railroad Medicare Medicare |
$498.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,753.08
|
| Rate for Payer: UHC Core |
$1,663.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.04
|
| Rate for Payer: UHC Medicare Advantage |
$512.98
|
| Rate for Payer: VA VA |
$498.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,494.10
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.52 |
| Max. Negotiated Rate |
$2,091.76 |
| Rate for Payer: Aetna Commercial |
$1,975.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,796.13
|
| Rate for Payer: BCN Commercial |
$1,796.13
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$1,998.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Healthscope Commercial |
$2,091.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: PHP Commercial |
$1,975.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,022.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,417.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,045.28
|
| Rate for Payer: UHC Core |
$1,940.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.14
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,324.18
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.99 |
| Max. Negotiated Rate |
$2,091.76 |
| Rate for Payer: Aetna Commercial |
$1,975.55
|
| Rate for Payer: Aetna Medicare |
$604.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$726.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$726.31
|
| Rate for Payer: BCBS Complete |
$929.67
|
| Rate for Payer: BCBS MAPPO |
$581.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,807.05
|
| Rate for Payer: BCN Commercial |
$1,807.05
|
| Rate for Payer: BCN Medicare Advantage |
$581.04
|
| Rate for Payer: Cash Price |
$1,859.34
|
| Rate for Payer: Cofinity Commercial |
$1,998.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,859.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.04
|
| Rate for Payer: Healthscope Commercial |
$2,091.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,743.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$610.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$668.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,975.55
|
| Rate for Payer: PACE Senior Care Partners |
$551.99
|
| Rate for Payer: PACE SWMI |
$581.04
|
| Rate for Payer: PHP Commercial |
$1,975.55
|
| Rate for Payer: PHP Medicare Advantage |
$581.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,626.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,022.04
|
| Rate for Payer: Priority Health Medicare |
$581.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,417.52
|
| Rate for Payer: Railroad Medicare Medicare |
$581.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,045.28
|
| Rate for Payer: UHC Core |
$1,940.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.04
|
| Rate for Payer: UHC Medicare Advantage |
$598.48
|
| Rate for Payer: VA VA |
$581.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,743.14
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.92
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$22.34
|
| Rate for Payer: BCBS Trust/PPO |
$69.46
|
| Rate for Payer: BCN Commercial |
$69.46
|
| Rate for Payer: BCN Medicare Advantage |
$22.34
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.00
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: PACE Senior Care Partners |
$21.22
|
| Rate for Payer: PACE SWMI |
$22.34
|
| Rate for Payer: PHP Commercial |
$75.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.73
|
| Rate for Payer: Priority Health Medicare |
$22.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.49
|
| Rate for Payer: Railroad Medicare Medicare |
$22.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.62
|
| Rate for Payer: UHC Core |
$74.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.34
|
| Rate for Payer: UHC Medicare Advantage |
$23.01
|
| Rate for Payer: VA VA |
$22.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.00
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$89.34
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$80.41 |
| Rate for Payer: Aetna Commercial |
$75.94
|
| Rate for Payer: BCBS Trust/PPO |
$69.04
|
| Rate for Payer: BCN Commercial |
$69.04
|
| Rate for Payer: Cash Price |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$76.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.47
|
| Rate for Payer: Healthscope Commercial |
$80.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.94
|
| Rate for Payer: PHP Commercial |
$75.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.62
|
| Rate for Payer: UHC Core |
$74.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.00
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: Aetna Medicare |
$35.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.09
|
| Rate for Payer: BCBS Complete |
$27.63
|
| Rate for Payer: BCBS MAPPO |
$33.68
|
| Rate for Payer: BCBS Trust/PPO |
$104.73
|
| Rate for Payer: BCN Commercial |
$104.73
|
| Rate for Payer: BCN Medicare Advantage |
$33.68
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$115.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.68
|
| Rate for Payer: Healthscope Commercial |
$121.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.02
|
| Rate for Payer: Mclaren Medicaid |
$26.31
|
| Rate for Payer: Meridian Medicaid |
$27.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PACE Senior Care Partners |
$31.99
|
| Rate for Payer: PACE SWMI |
$33.68
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: PHP Medicare Advantage |
$33.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.19
|
| Rate for Payer: Priority Health Medicare |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.15
|
| Rate for Payer: Railroad Medicare Medicare |
$33.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.68
|
| Rate for Payer: UHC Medicare Advantage |
$34.69
|
| Rate for Payer: VA VA |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.02
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$134.70
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$82.15 |
| Max. Negotiated Rate |
$121.23 |
| Rate for Payer: Aetna Commercial |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$104.10
|
| Rate for Payer: BCN Commercial |
$104.10
|
| Rate for Payer: Cash Price |
$107.76
|
| Rate for Payer: Cofinity Commercial |
$115.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$121.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.50
|
| Rate for Payer: PHP Commercial |
$114.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.54
|
| Rate for Payer: UHC Core |
$112.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.02
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$134.22 |
| Max. Negotiated Rate |
$508.62 |
| Rate for Payer: Aetna Commercial |
$480.36
|
| Rate for Payer: Aetna Medicare |
$146.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.60
|
| Rate for Payer: BCBS Complete |
$448.28
|
| Rate for Payer: BCBS MAPPO |
$141.28
|
| Rate for Payer: BCBS Trust/PPO |
$439.39
|
| Rate for Payer: BCN Commercial |
$439.39
|
| Rate for Payer: BCN Medicare Advantage |
$141.28
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$486.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.28
|
| Rate for Payer: Healthscope Commercial |
$508.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.85
|
| Rate for Payer: Mclaren Medicaid |
$426.93
|
| Rate for Payer: Meridian Medicaid |
$448.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: PACE Senior Care Partners |
$134.22
|
| Rate for Payer: PACE SWMI |
$141.28
|
| Rate for Payer: PHP Commercial |
$480.36
|
| Rate for Payer: PHP Medicare Advantage |
$141.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$491.66
|
| Rate for Payer: Priority Health Medicare |
$141.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.67
|
| Rate for Payer: Railroad Medicare Medicare |
$141.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.31
|
| Rate for Payer: UHC Core |
$471.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.28
|
| Rate for Payer: UHC Medicare Advantage |
$145.52
|
| Rate for Payer: VA VA |
$141.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.85
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$565.13
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$344.67 |
| Max. Negotiated Rate |
$508.62 |
| Rate for Payer: Aetna Commercial |
$480.36
|
| Rate for Payer: BCBS Trust/PPO |
$436.73
|
| Rate for Payer: BCN Commercial |
$436.73
|
| Rate for Payer: Cash Price |
$452.10
|
| Rate for Payer: Cofinity Commercial |
$486.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.10
|
| Rate for Payer: Healthscope Commercial |
$508.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.36
|
| Rate for Payer: PHP Commercial |
$480.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$491.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.31
|
| Rate for Payer: UHC Core |
$471.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.85
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,697.15 |
| Max. Negotiated Rate |
$2,504.40 |
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,150.45
|
| Rate for Payer: BCN Commercial |
$2,150.45
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$2,393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Healthscope Commercial |
$2,504.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,087.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: PHP Commercial |
$2,365.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,420.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,697.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.75
|
| Rate for Payer: UHC Core |
$2,323.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,087.00
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,782.67
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.88 |
| Max. Negotiated Rate |
$2,504.40 |
| Rate for Payer: Aetna Commercial |
$2,365.27
|
| Rate for Payer: Aetna Medicare |
$723.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$869.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$869.58
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$695.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,163.53
|
| Rate for Payer: BCN Commercial |
$2,163.53
|
| Rate for Payer: BCN Medicare Advantage |
$695.67
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cash Price |
$2,226.14
|
| Rate for Payer: Cofinity Commercial |
$2,393.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,226.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.67
|
| Rate for Payer: Healthscope Commercial |
$2,504.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,087.00
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$730.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$800.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,365.27
|
| Rate for Payer: PACE Senior Care Partners |
$660.88
|
| Rate for Payer: PACE SWMI |
$695.67
|
| Rate for Payer: PHP Commercial |
$2,365.27
|
| Rate for Payer: PHP Medicare Advantage |
$695.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,947.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,420.92
|
| Rate for Payer: Priority Health Medicare |
$695.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,697.15
|
| Rate for Payer: Railroad Medicare Medicare |
$695.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,448.75
|
| Rate for Payer: UHC Core |
$2,323.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.67
|
| Rate for Payer: UHC Medicare Advantage |
$716.54
|
| Rate for Payer: VA VA |
$695.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,087.00
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$378.97 |
| Rate for Payer: Aetna Commercial |
$325.58
|
| Rate for Payer: Aetna Medicare |
$99.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.70
|
| Rate for Payer: BCBS Complete |
$378.97
|
| Rate for Payer: BCBS MAPPO |
$95.76
|
| Rate for Payer: BCBS Trust/PPO |
$297.81
|
| Rate for Payer: BCN Commercial |
$297.81
|
| Rate for Payer: BCN Medicare Advantage |
$95.76
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$329.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.27
|
| Rate for Payer: Mclaren Medicaid |
$360.93
|
| Rate for Payer: Meridian Medicaid |
$378.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: PACE Senior Care Partners |
$90.97
|
| Rate for Payer: PACE SWMI |
$95.76
|
| Rate for Payer: PHP Commercial |
$325.58
|
| Rate for Payer: PHP Medicare Advantage |
$95.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.24
|
| Rate for Payer: Priority Health Medicare |
$95.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.61
|
| Rate for Payer: Railroad Medicare Medicare |
$95.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.07
|
| Rate for Payer: UHC Core |
$319.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.76
|
| Rate for Payer: UHC Medicare Advantage |
$98.63
|
| Rate for Payer: VA VA |
$95.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.27
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$383.03
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.61 |
| Max. Negotiated Rate |
$344.73 |
| Rate for Payer: Aetna Commercial |
$325.58
|
| Rate for Payer: BCBS Trust/PPO |
$296.01
|
| Rate for Payer: BCN Commercial |
$296.01
|
| Rate for Payer: Cash Price |
$306.42
|
| Rate for Payer: Cofinity Commercial |
$329.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.42
|
| Rate for Payer: Healthscope Commercial |
$344.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$325.58
|
| Rate for Payer: PHP Commercial |
$325.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.07
|
| Rate for Payer: UHC Core |
$319.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.27
|
|
