|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
OP
|
$260.10
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: Aetna Medicare |
$67.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.28
|
| Rate for Payer: BCBS Complete |
$48.14
|
| Rate for Payer: BCBS MAPPO |
$65.03
|
| Rate for Payer: BCBS Trust/PPO |
$213.83
|
| Rate for Payer: BCN Commercial |
$213.83
|
| Rate for Payer: BCN Medicare Advantage |
$65.03
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.03
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| Rate for Payer: Mclaren Medicaid |
$45.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.28
|
| Rate for Payer: Meridian Medicaid |
$48.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PACE Senior Care Partners |
$61.77
|
| Rate for Payer: PACE SWMI |
$65.03
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: PHP Medicare Advantage |
$65.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.29
|
| Rate for Payer: Priority Health Medicare |
$65.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.03
|
| Rate for Payer: Railroad Medicare Medicare |
$65.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.89
|
| Rate for Payer: UHC Core |
$217.18
|
| Rate for Payer: UHC Exchange |
$65.03
|
| Rate for Payer: UHC Medicaid |
$45.86
|
| Rate for Payer: UHC Medicare Advantage |
$65.03
|
| Rate for Payer: UHCCP Medicaid |
$45.86
|
| Rate for Payer: VA VA |
$65.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
HC COMP BURN GARM VEST SLEEVED
|
Facility
|
IP
|
$260.10
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300066
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$181.03 |
| Max. Negotiated Rate |
$234.09 |
| Rate for Payer: Aetna Commercial |
$221.09
|
| Rate for Payer: BCBS Trust/PPO |
$214.82
|
| Rate for Payer: BCN Commercial |
$214.82
|
| Rate for Payer: Cash Price |
$208.08
|
| Rate for Payer: Cofinity Commercial |
$223.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.08
|
| Rate for Payer: Healthscope Commercial |
$234.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.09
|
| Rate for Payer: Nomi Health Commercial |
$213.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.07
|
| Rate for Payer: PHP Commercial |
$221.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.89
|
| Rate for Payer: UHC Core |
$217.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.07
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
OP
|
$137.33
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.21 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: Aetna Medicare |
$35.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.92
|
| Rate for Payer: BCBS Complete |
$25.42
|
| Rate for Payer: BCBS MAPPO |
$34.33
|
| Rate for Payer: BCBS Trust/PPO |
$112.90
|
| Rate for Payer: BCN Commercial |
$112.90
|
| Rate for Payer: BCN Medicare Advantage |
$34.33
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: Mclaren Medicaid |
$24.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.05
|
| Rate for Payer: Meridian Medicaid |
$25.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Nomi Health Commercial |
$112.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PACE Senior Care Partners |
$32.62
|
| Rate for Payer: PACE SWMI |
$34.33
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: PHP Medicare Advantage |
$34.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$119.48
|
| Rate for Payer: Priority Health Medicare |
$34.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.58
|
| Rate for Payer: Railroad Medicare Medicare |
$34.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.85
|
| Rate for Payer: UHC Core |
$114.67
|
| Rate for Payer: UHC Exchange |
$34.33
|
| Rate for Payer: UHC Medicaid |
$24.21
|
| Rate for Payer: UHC Medicare Advantage |
$34.33
|
| Rate for Payer: UHCCP Medicaid |
$24.21
|
| Rate for Payer: VA VA |
$34.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM VEST SLEEVELESS
|
Facility
|
IP
|
$137.33
|
|
|
Service Code
|
HCPCS A6509
|
| Hospital Charge Code |
98300067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.58 |
| Max. Negotiated Rate |
$123.60 |
| Rate for Payer: Aetna Commercial |
$116.73
|
| Rate for Payer: BCBS Trust/PPO |
$113.42
|
| Rate for Payer: BCN Commercial |
$113.42
|
| Rate for Payer: Cash Price |
$109.86
|
| Rate for Payer: Cofinity Commercial |
$118.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$123.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.73
|
| Rate for Payer: Nomi Health Commercial |
$112.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.00
|
| Rate for Payer: PHP Commercial |
$116.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$119.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.85
|
| Rate for Payer: UHC Core |
$114.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.00
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
IP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: BCBS Trust/PPO |
$38.67
|
| Rate for Payer: BCN Commercial |
$38.67
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC COMP BURN GARM ZIPPER
|
Facility
|
OP
|
$46.82
|
|
|
Service Code
|
HCPCS A9900
|
| Hospital Charge Code |
98300068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Aetna Commercial |
$39.80
|
| Rate for Payer: Aetna Medicare |
$12.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.63
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$38.49
|
| Rate for Payer: BCN Commercial |
$38.49
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$40.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.12
|
| Rate for Payer: Mclaren Medicaid |
$8.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.29
|
| Rate for Payer: Meridian Medicaid |
$8.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.80
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.12
|
| Rate for Payer: PACE Senior Care Partners |
$11.12
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Commercial |
$39.80
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.73
|
| Rate for Payer: Priority Health Medicare |
$11.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.59
|
| Rate for Payer: Railroad Medicare Medicare |
$11.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.20
|
| Rate for Payer: UHC Core |
$39.09
|
| Rate for Payer: UHC Exchange |
$11.71
|
| Rate for Payer: UHC Medicaid |
$8.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.71
|
| Rate for Payer: UHCCP Medicaid |
$8.25
|
| Rate for Payer: VA VA |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.12
|
|
|
HC COMPLEMENT C 3
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$30.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.74
|
| Rate for Payer: BCBS Complete |
$21.76
|
| Rate for Payer: BCBS MAPPO |
$29.39
|
| Rate for Payer: BCBS Trust/PPO |
$96.65
|
| Rate for Payer: BCN Commercial |
$96.65
|
| Rate for Payer: BCN Medicare Advantage |
$29.39
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.39
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Mclaren Medicaid |
$20.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.86
|
| Rate for Payer: Meridian Medicaid |
$21.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Senior Care Partners |
$27.92
|
| Rate for Payer: PACE SWMI |
$29.39
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$29.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Medicare |
$29.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: Railroad Medicare Medicare |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: UHC Exchange |
$29.39
|
| Rate for Payer: UHC Medicaid |
$20.73
|
| Rate for Payer: UHC Medicare Advantage |
$29.39
|
| Rate for Payer: UHCCP Medicaid |
$20.73
|
| Rate for Payer: VA VA |
$29.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC COMPLEMENT C 3
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200150
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: BCBS Trust/PPO |
$97.10
|
| Rate for Payer: BCN Commercial |
$97.10
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC COMPLEMENT C 4
|
Facility
|
IP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: BCBS Trust/PPO |
$97.10
|
| Rate for Payer: BCN Commercial |
$97.10
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC COMPLEMENT C 4
|
Facility
|
OP
|
$117.57
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200151
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$105.81 |
| Rate for Payer: Aetna Commercial |
$99.93
|
| Rate for Payer: Aetna Medicare |
$30.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.74
|
| Rate for Payer: BCBS Complete |
$21.76
|
| Rate for Payer: BCBS MAPPO |
$29.39
|
| Rate for Payer: BCBS Trust/PPO |
$96.65
|
| Rate for Payer: BCN Commercial |
$96.65
|
| Rate for Payer: BCN Medicare Advantage |
$29.39
|
| Rate for Payer: Cash Price |
$94.06
|
| Rate for Payer: Cofinity Commercial |
$101.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.39
|
| Rate for Payer: Healthscope Commercial |
$105.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.18
|
| Rate for Payer: Mclaren Medicaid |
$20.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.86
|
| Rate for Payer: Meridian Medicaid |
$21.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.93
|
| Rate for Payer: Nomi Health Commercial |
$96.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.18
|
| Rate for Payer: PACE Senior Care Partners |
$27.92
|
| Rate for Payer: PACE SWMI |
$29.39
|
| Rate for Payer: PHP Commercial |
$99.93
|
| Rate for Payer: PHP Medicare Advantage |
$29.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.29
|
| Rate for Payer: Priority Health Medicare |
$29.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.83
|
| Rate for Payer: Railroad Medicare Medicare |
$29.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.46
|
| Rate for Payer: UHC Core |
$98.17
|
| Rate for Payer: UHC Exchange |
$29.39
|
| Rate for Payer: UHC Medicaid |
$20.73
|
| Rate for Payer: UHC Medicare Advantage |
$29.39
|
| Rate for Payer: UHCCP Medicaid |
$20.73
|
| Rate for Payer: VA VA |
$29.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.18
|
|
|
HC COMPLEMENT C 5
|
Facility
|
IP
|
$74.29
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.71 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$61.36
|
| Rate for Payer: BCN Commercial |
$61.36
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC COMPLEMENT C 5
|
Facility
|
OP
|
$74.29
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
30200152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$66.86 |
| Rate for Payer: Aetna Commercial |
$63.15
|
| Rate for Payer: Aetna Medicare |
$19.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.22
|
| Rate for Payer: BCBS Complete |
$13.75
|
| Rate for Payer: BCBS MAPPO |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$61.07
|
| Rate for Payer: BCN Commercial |
$61.07
|
| Rate for Payer: BCN Medicare Advantage |
$18.57
|
| Rate for Payer: Cash Price |
$59.43
|
| Rate for Payer: Cofinity Commercial |
$63.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.57
|
| Rate for Payer: Healthscope Commercial |
$66.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.72
|
| Rate for Payer: Mclaren Medicaid |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.50
|
| Rate for Payer: Meridian Medicaid |
$13.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.15
|
| Rate for Payer: Nomi Health Commercial |
$60.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.72
|
| Rate for Payer: PACE Senior Care Partners |
$17.64
|
| Rate for Payer: PACE SWMI |
$18.57
|
| Rate for Payer: PHP Commercial |
$63.15
|
| Rate for Payer: PHP Medicare Advantage |
$18.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.63
|
| Rate for Payer: Priority Health Medicare |
$18.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.38
|
| Rate for Payer: UHC Core |
$62.03
|
| Rate for Payer: UHC Exchange |
$18.57
|
| Rate for Payer: UHC Medicaid |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$18.57
|
| Rate for Payer: UHCCP Medicaid |
$13.10
|
| Rate for Payer: VA VA |
$18.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.72
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
IP
|
$40.33
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.31
|
| Rate for Payer: BCN Commercial |
$33.31
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC COMPLEMENT CH50 TOTAL
|
Facility
|
OP
|
$40.33
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
30200154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$36.30 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.60
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS MAPPO |
$10.08
|
| Rate for Payer: BCBS Trust/PPO |
$33.16
|
| Rate for Payer: BCN Commercial |
$33.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.08
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.08
|
| Rate for Payer: Healthscope Commercial |
$36.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.25
|
| Rate for Payer: Mclaren Medicaid |
$7.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Meridian Medicaid |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.28
|
| Rate for Payer: Nomi Health Commercial |
$33.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.25
|
| Rate for Payer: PACE Senior Care Partners |
$9.58
|
| Rate for Payer: PACE SWMI |
$10.08
|
| Rate for Payer: PHP Commercial |
$34.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.09
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.49
|
| Rate for Payer: UHC Core |
$33.68
|
| Rate for Payer: UHC Exchange |
$10.08
|
| Rate for Payer: UHC Medicaid |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$10.08
|
| Rate for Payer: UHCCP Medicaid |
$7.11
|
| Rate for Payer: VA VA |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.25
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$405.22
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.03 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$344.44
|
| Rate for Payer: BCBS Trust/PPO |
$334.67
|
| Rate for Payer: BCN Commercial |
$334.67
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cofinity Commercial |
$348.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.18
|
| Rate for Payer: Healthscope Commercial |
$364.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.44
|
| Rate for Payer: Nomi Health Commercial |
$332.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.92
|
| Rate for Payer: PHP Commercial |
$344.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.59
|
| Rate for Payer: UHC Core |
$338.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.92
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$405.22
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
76100190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$344.44
|
| Rate for Payer: Aetna Medicare |
$105.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.63
|
| Rate for Payer: BCBS Complete |
$75.01
|
| Rate for Payer: BCBS MAPPO |
$101.31
|
| Rate for Payer: BCBS Trust/PPO |
$333.13
|
| Rate for Payer: BCN Commercial |
$333.13
|
| Rate for Payer: BCN Medicare Advantage |
$101.31
|
| Rate for Payer: Cash Price |
$324.18
|
| Rate for Payer: Cofinity Commercial |
$348.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.31
|
| Rate for Payer: Healthscope Commercial |
$364.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.92
|
| Rate for Payer: Mclaren Medicaid |
$71.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.37
|
| Rate for Payer: Meridian Medicaid |
$75.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.44
|
| Rate for Payer: Nomi Health Commercial |
$332.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.92
|
| Rate for Payer: PACE Senior Care Partners |
$96.24
|
| Rate for Payer: PACE SWMI |
$101.31
|
| Rate for Payer: PHP Commercial |
$344.44
|
| Rate for Payer: PHP Medicare Advantage |
$101.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.54
|
| Rate for Payer: Priority Health Medicare |
$102.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.03
|
| Rate for Payer: Railroad Medicare Medicare |
$101.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.59
|
| Rate for Payer: UHC Core |
$338.36
|
| Rate for Payer: UHC Exchange |
$101.31
|
| Rate for Payer: UHC Medicaid |
$71.44
|
| Rate for Payer: UHC Medicare Advantage |
$101.31
|
| Rate for Payer: UHCCP Medicaid |
$71.44
|
| Rate for Payer: VA VA |
$101.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.92
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
IP
|
$894.60
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.64 |
| Max. Negotiated Rate |
$805.14 |
| Rate for Payer: Aetna Commercial |
$760.41
|
| Rate for Payer: BCBS Trust/PPO |
$738.85
|
| Rate for Payer: BCN Commercial |
$738.85
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cofinity Commercial |
$769.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.68
|
| Rate for Payer: Healthscope Commercial |
$805.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.41
|
| Rate for Payer: Nomi Health Commercial |
$733.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.95
|
| Rate for Payer: PHP Commercial |
$760.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.25
|
| Rate for Payer: UHC Core |
$746.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.95
|
|
|
HC COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Facility
|
OP
|
$894.60
|
|
|
Service Code
|
CPT 51727
|
| Hospital Charge Code |
76100220
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.72 |
| Max. Negotiated Rate |
$805.14 |
| Rate for Payer: Aetna Commercial |
$760.41
|
| Rate for Payer: Aetna Medicare |
$232.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.56
|
| Rate for Payer: BCBS Complete |
$165.59
|
| Rate for Payer: BCBS MAPPO |
$223.65
|
| Rate for Payer: BCBS Trust/PPO |
$735.45
|
| Rate for Payer: BCN Commercial |
$735.45
|
| Rate for Payer: BCN Medicare Advantage |
$223.65
|
| Rate for Payer: Cash Price |
$715.68
|
| Rate for Payer: Cofinity Commercial |
$769.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.65
|
| Rate for Payer: Healthscope Commercial |
$805.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$670.95
|
| Rate for Payer: Mclaren Medicaid |
$157.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.83
|
| Rate for Payer: Meridian Medicaid |
$165.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$246.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.41
|
| Rate for Payer: Nomi Health Commercial |
$733.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.95
|
| Rate for Payer: PACE Senior Care Partners |
$212.47
|
| Rate for Payer: PACE SWMI |
$223.65
|
| Rate for Payer: PHP Commercial |
$760.41
|
| Rate for Payer: PHP Medicare Advantage |
$223.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.30
|
| Rate for Payer: Priority Health Medicare |
$225.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.64
|
| Rate for Payer: Railroad Medicare Medicare |
$223.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.25
|
| Rate for Payer: UHC Core |
$746.99
|
| Rate for Payer: UHC Exchange |
$223.65
|
| Rate for Payer: UHC Medicaid |
$157.72
|
| Rate for Payer: UHC Medicare Advantage |
$223.65
|
| Rate for Payer: UHCCP Medicaid |
$157.72
|
| Rate for Payer: VA VA |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$670.95
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
OP
|
$895.01
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$805.51 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: Aetna Medicare |
$232.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$279.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$279.69
|
| Rate for Payer: BCBS Complete |
$165.67
|
| Rate for Payer: BCBS MAPPO |
$223.75
|
| Rate for Payer: BCBS Trust/PPO |
$735.79
|
| Rate for Payer: BCN Commercial |
$735.79
|
| Rate for Payer: BCN Medicare Advantage |
$223.75
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cofinity Commercial |
$769.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.75
|
| Rate for Payer: Healthscope Commercial |
$805.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.26
|
| Rate for Payer: Mclaren Medicaid |
$157.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.94
|
| Rate for Payer: Meridian Medicaid |
$165.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$246.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.76
|
| Rate for Payer: Nomi Health Commercial |
$733.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.26
|
| Rate for Payer: PACE Senior Care Partners |
$212.56
|
| Rate for Payer: PACE SWMI |
$223.75
|
| Rate for Payer: PHP Commercial |
$760.76
|
| Rate for Payer: PHP Medicare Advantage |
$223.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.66
|
| Rate for Payer: Priority Health Medicare |
$225.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.93
|
| Rate for Payer: Railroad Medicare Medicare |
$223.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.61
|
| Rate for Payer: UHC Core |
$747.33
|
| Rate for Payer: UHC Exchange |
$223.75
|
| Rate for Payer: UHC Medicaid |
$157.79
|
| Rate for Payer: UHC Medicare Advantage |
$223.75
|
| Rate for Payer: UHCCP Medicaid |
$157.79
|
| Rate for Payer: VA VA |
$223.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.26
|
|
|
HC COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Facility
|
IP
|
$895.01
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
76100191
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$622.93 |
| Max. Negotiated Rate |
$805.51 |
| Rate for Payer: Aetna Commercial |
$760.76
|
| Rate for Payer: BCBS Trust/PPO |
$739.19
|
| Rate for Payer: BCN Commercial |
$739.19
|
| Rate for Payer: Cash Price |
$716.01
|
| Rate for Payer: Cofinity Commercial |
$769.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$716.01
|
| Rate for Payer: Healthscope Commercial |
$805.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$671.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.76
|
| Rate for Payer: Nomi Health Commercial |
$733.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$671.26
|
| Rate for Payer: PHP Commercial |
$760.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$778.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$622.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.61
|
| Rate for Payer: UHC Core |
$747.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$671.26
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
OP
|
$827.12
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.82 |
| Max. Negotiated Rate |
$744.41 |
| Rate for Payer: Aetna Commercial |
$703.05
|
| Rate for Payer: Aetna Medicare |
$215.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$258.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$258.48
|
| Rate for Payer: BCBS Complete |
$153.10
|
| Rate for Payer: BCBS MAPPO |
$206.78
|
| Rate for Payer: BCBS Trust/PPO |
$679.98
|
| Rate for Payer: BCN Commercial |
$679.98
|
| Rate for Payer: BCN Medicare Advantage |
$206.78
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cofinity Commercial |
$711.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.78
|
| Rate for Payer: Healthscope Commercial |
$744.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.34
|
| Rate for Payer: Mclaren Medicaid |
$145.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$153.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.05
|
| Rate for Payer: Nomi Health Commercial |
$678.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.34
|
| Rate for Payer: PACE Senior Care Partners |
$196.44
|
| Rate for Payer: PACE SWMI |
$206.78
|
| Rate for Payer: PHP Commercial |
$703.05
|
| Rate for Payer: PHP Medicare Advantage |
$206.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$719.59
|
| Rate for Payer: Priority Health Medicare |
$208.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$575.68
|
| Rate for Payer: Railroad Medicare Medicare |
$206.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.87
|
| Rate for Payer: UHC Core |
$690.65
|
| Rate for Payer: UHC Exchange |
$206.78
|
| Rate for Payer: UHC Medicaid |
$145.82
|
| Rate for Payer: UHC Medicare Advantage |
$206.78
|
| Rate for Payer: UHCCP Medicaid |
$145.82
|
| Rate for Payer: VA VA |
$206.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.34
|
|
|
HC COMPLEX MULTILAYER COMP DSG
|
Facility
|
IP
|
$827.12
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
76100024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$575.68 |
| Max. Negotiated Rate |
$744.41 |
| Rate for Payer: Aetna Commercial |
$703.05
|
| Rate for Payer: BCBS Trust/PPO |
$683.12
|
| Rate for Payer: BCN Commercial |
$683.12
|
| Rate for Payer: Cash Price |
$661.70
|
| Rate for Payer: Cofinity Commercial |
$711.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$661.70
|
| Rate for Payer: Healthscope Commercial |
$744.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$620.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.05
|
| Rate for Payer: Nomi Health Commercial |
$678.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.34
|
| Rate for Payer: PHP Commercial |
$703.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$719.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$575.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.87
|
| Rate for Payer: UHC Core |
$690.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$620.34
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$238.06
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$41.97 |
| Max. Negotiated Rate |
$214.25 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.39
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$59.52
|
| Rate for Payer: BCBS Trust/PPO |
$195.71
|
| Rate for Payer: BCN Commercial |
$195.71
|
| Rate for Payer: BCN Medicare Advantage |
$59.52
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cofinity Commercial |
$204.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.52
|
| Rate for Payer: Healthscope Commercial |
$214.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.54
|
| Rate for Payer: Mclaren Medicaid |
$41.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.49
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.35
|
| Rate for Payer: Nomi Health Commercial |
$195.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.54
|
| Rate for Payer: PACE Senior Care Partners |
$56.54
|
| Rate for Payer: PACE SWMI |
$59.52
|
| Rate for Payer: PHP Commercial |
$202.35
|
| Rate for Payer: PHP Medicare Advantage |
$59.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.11
|
| Rate for Payer: Priority Health Medicare |
$60.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.69
|
| Rate for Payer: Railroad Medicare Medicare |
$59.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.49
|
| Rate for Payer: UHC Core |
$198.78
|
| Rate for Payer: UHC Exchange |
$59.52
|
| Rate for Payer: UHC Medicaid |
$41.97
|
| Rate for Payer: UHC Medicare Advantage |
$59.52
|
| Rate for Payer: UHCCP Medicaid |
$41.97
|
| Rate for Payer: VA VA |
$59.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.54
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$238.06
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.69 |
| Max. Negotiated Rate |
$214.25 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: BCBS Trust/PPO |
$196.61
|
| Rate for Payer: BCN Commercial |
$196.61
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Cofinity Commercial |
$204.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.45
|
| Rate for Payer: Healthscope Commercial |
$214.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.35
|
| Rate for Payer: Nomi Health Commercial |
$195.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.54
|
| Rate for Payer: PHP Commercial |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.49
|
| Rate for Payer: UHC Core |
$198.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.54
|
|
|
HC COMP METABOLIC PANEL
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
CPT 80053
|
| Hospital Charge Code |
30100013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: BCBS Trust/PPO |
$32.99
|
| Rate for Payer: BCN Commercial |
$32.99
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Nomi Health Commercial |
$32.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.16
|
| Rate for Payer: UHC Core |
$33.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
