|
HC FINGER SPLINT, STATIC, SUPPLY
|
Facility
|
OP
|
$20.40
|
|
| Hospital Charge Code |
27000646
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
IP
|
$165.24
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.78 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: BCBS Trust/PPO |
$127.70
|
| Rate for Payer: BCN Commercial |
$127.70
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.45
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.41
|
| Rate for Payer: UHC Core |
$137.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
|
|
HC FISH PRENATAL ANEUPLOIDY
|
Facility
|
OP
|
$165.24
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna Commercial |
$140.45
|
| Rate for Payer: Aetna Medicare |
$42.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.64
|
| Rate for Payer: BCBS Complete |
$39.67
|
| Rate for Payer: BCBS MAPPO |
$41.31
|
| Rate for Payer: BCBS Trust/PPO |
$128.47
|
| Rate for Payer: BCN Commercial |
$128.47
|
| Rate for Payer: BCN Medicare Advantage |
$41.31
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cash Price |
$132.19
|
| Rate for Payer: Cofinity Commercial |
$142.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.31
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.93
|
| Rate for Payer: Mclaren Medicaid |
$37.78
|
| Rate for Payer: Meridian Medicaid |
$39.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.45
|
| Rate for Payer: PACE Senior Care Partners |
$39.24
|
| Rate for Payer: PACE SWMI |
$41.31
|
| Rate for Payer: PHP Commercial |
$140.45
|
| Rate for Payer: PHP Medicare Advantage |
$41.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.76
|
| Rate for Payer: Priority Health Medicare |
$41.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.78
|
| Rate for Payer: Railroad Medicare Medicare |
$41.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.41
|
| Rate for Payer: UHC Core |
$137.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.31
|
| Rate for Payer: UHC Medicare Advantage |
$42.55
|
| Rate for Payer: VA VA |
$41.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.93
|
|
|
HC FISH PROBES
|
Facility
|
OP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: Aetna Medicare |
$19.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.86
|
| Rate for Payer: BCBS Complete |
$39.67
|
| Rate for Payer: BCBS MAPPO |
$19.08
|
| Rate for Payer: BCBS Trust/PPO |
$59.35
|
| Rate for Payer: BCN Commercial |
$59.35
|
| Rate for Payer: BCN Medicare Advantage |
$19.08
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$65.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.08
|
| Rate for Payer: Healthscope Commercial |
$68.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.26
|
| Rate for Payer: Mclaren Medicaid |
$37.78
|
| Rate for Payer: Meridian Medicaid |
$39.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: PACE Senior Care Partners |
$18.13
|
| Rate for Payer: PACE SWMI |
$19.08
|
| Rate for Payer: PHP Commercial |
$64.89
|
| Rate for Payer: PHP Medicare Advantage |
$19.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.42
|
| Rate for Payer: Priority Health Medicare |
$19.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.56
|
| Rate for Payer: Railroad Medicare Medicare |
$19.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.18
|
| Rate for Payer: UHC Core |
$63.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.08
|
| Rate for Payer: UHC Medicare Advantage |
$19.66
|
| Rate for Payer: VA VA |
$19.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.26
|
|
|
HC FISH PROBES
|
Facility
|
IP
|
$76.34
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
31000067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: Aetna Commercial |
$64.89
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCN Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$61.07
|
| Rate for Payer: Cofinity Commercial |
$65.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.07
|
| Rate for Payer: Healthscope Commercial |
$68.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.89
|
| Rate for Payer: PHP Commercial |
$64.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.18
|
| Rate for Payer: UHC Core |
$63.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.26
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
IP
|
$2,209.94
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,347.84 |
| Max. Negotiated Rate |
$1,988.95 |
| Rate for Payer: Aetna Commercial |
$1,878.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,707.84
|
| Rate for Payer: BCN Commercial |
$1,707.84
|
| Rate for Payer: Cash Price |
$1,767.95
|
| Rate for Payer: Cofinity Commercial |
$1,900.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.95
|
| Rate for Payer: Healthscope Commercial |
$1,988.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.45
|
| Rate for Payer: PHP Commercial |
$1,878.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,922.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,347.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.75
|
| Rate for Payer: UHC Core |
$1,845.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.46
|
|
|
HC FISTULA SHUNTOGRAM
|
Facility
|
OP
|
$2,209.94
|
|
| Hospital Charge Code |
32000264
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$524.86 |
| Max. Negotiated Rate |
$1,988.95 |
| Rate for Payer: Aetna Commercial |
$1,878.45
|
| Rate for Payer: Aetna Medicare |
$574.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$690.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$690.61
|
| Rate for Payer: BCBS Complete |
$883.98
|
| Rate for Payer: BCBS MAPPO |
$552.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,718.23
|
| Rate for Payer: BCN Commercial |
$1,718.23
|
| Rate for Payer: BCN Medicare Advantage |
$552.48
|
| Rate for Payer: Cash Price |
$1,767.95
|
| Rate for Payer: Cofinity Commercial |
$1,900.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,767.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.48
|
| Rate for Payer: Healthscope Commercial |
$1,988.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,657.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$580.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,878.45
|
| Rate for Payer: PACE Senior Care Partners |
$524.86
|
| Rate for Payer: PACE SWMI |
$552.48
|
| Rate for Payer: PHP Commercial |
$1,878.45
|
| Rate for Payer: PHP Medicare Advantage |
$552.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,546.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,922.65
|
| Rate for Payer: Priority Health Medicare |
$552.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,347.84
|
| Rate for Payer: Railroad Medicare Medicare |
$552.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,944.75
|
| Rate for Payer: UHC Core |
$1,845.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.48
|
| Rate for Payer: UHC Medicare Advantage |
$569.06
|
| Rate for Payer: VA VA |
$552.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,657.46
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
OP
|
$253.88
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$228.49 |
| Rate for Payer: Aetna Commercial |
$215.80
|
| Rate for Payer: Aetna Medicare |
$66.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.34
|
| Rate for Payer: BCBS Complete |
$42.13
|
| Rate for Payer: BCBS MAPPO |
$63.47
|
| Rate for Payer: BCBS Trust/PPO |
$197.39
|
| Rate for Payer: BCN Commercial |
$197.39
|
| Rate for Payer: BCN Medicare Advantage |
$63.47
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$228.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.41
|
| Rate for Payer: Mclaren Medicaid |
$40.13
|
| Rate for Payer: Meridian Medicaid |
$42.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.80
|
| Rate for Payer: PACE Senior Care Partners |
$60.30
|
| Rate for Payer: PACE SWMI |
$63.47
|
| Rate for Payer: PHP Commercial |
$215.80
|
| Rate for Payer: PHP Medicare Advantage |
$63.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.88
|
| Rate for Payer: Priority Health Medicare |
$63.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: Railroad Medicare Medicare |
$63.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.41
|
| Rate for Payer: UHC Core |
$211.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.47
|
| Rate for Payer: UHC Medicare Advantage |
$65.37
|
| Rate for Payer: VA VA |
$63.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.41
|
|
|
HC FIT INSERT INTRAVAG SUPPORT DEVICE
|
Facility
|
IP
|
$253.88
|
|
|
Service Code
|
CPT 57150
|
| Hospital Charge Code |
76100203
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$228.49 |
| Rate for Payer: Aetna Commercial |
$215.80
|
| Rate for Payer: BCBS Trust/PPO |
$196.20
|
| Rate for Payer: BCN Commercial |
$196.20
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cofinity Commercial |
$218.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.10
|
| Rate for Payer: Healthscope Commercial |
$228.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.80
|
| Rate for Payer: PHP Commercial |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.41
|
| Rate for Payer: UHC Core |
$211.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.41
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
IP
|
$514.66
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$313.89 |
| Max. Negotiated Rate |
$463.19 |
| Rate for Payer: Aetna Commercial |
$437.46
|
| Rate for Payer: BCBS Trust/PPO |
$397.73
|
| Rate for Payer: BCN Commercial |
$397.73
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cofinity Commercial |
$442.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.73
|
| Rate for Payer: Healthscope Commercial |
$463.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.46
|
| Rate for Payer: PHP Commercial |
$437.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.90
|
| Rate for Payer: UHC Core |
$429.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.00
|
|
|
HC FIT & INSERT PESSARY/OTHER DEVICE
|
Facility
|
OP
|
$514.66
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
76100357
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.23 |
| Max. Negotiated Rate |
$463.19 |
| Rate for Payer: Aetna Commercial |
$437.46
|
| Rate for Payer: Aetna Medicare |
$133.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.83
|
| Rate for Payer: BCBS Complete |
$137.25
|
| Rate for Payer: BCBS MAPPO |
$128.66
|
| Rate for Payer: BCBS Trust/PPO |
$400.15
|
| Rate for Payer: BCN Commercial |
$400.15
|
| Rate for Payer: BCN Medicare Advantage |
$128.66
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cash Price |
$411.73
|
| Rate for Payer: Cofinity Commercial |
$442.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$411.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.66
|
| Rate for Payer: Healthscope Commercial |
$463.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$386.00
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Meridian Medicaid |
$137.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$437.46
|
| Rate for Payer: PACE Senior Care Partners |
$122.23
|
| Rate for Payer: PACE SWMI |
$128.66
|
| Rate for Payer: PHP Commercial |
$437.46
|
| Rate for Payer: PHP Medicare Advantage |
$128.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$447.75
|
| Rate for Payer: Priority Health Medicare |
$128.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.89
|
| Rate for Payer: Railroad Medicare Medicare |
$128.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.90
|
| Rate for Payer: UHC Core |
$429.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.66
|
| Rate for Payer: UHC Medicare Advantage |
$132.52
|
| Rate for Payer: VA VA |
$128.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$386.00
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,743.04
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,063.08 |
| Max. Negotiated Rate |
$1,568.74 |
| Rate for Payer: Aetna Commercial |
$1,481.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,347.02
|
| Rate for Payer: BCN Commercial |
$1,347.02
|
| Rate for Payer: Cash Price |
$1,394.43
|
| Rate for Payer: Cofinity Commercial |
$1,499.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,394.43
|
| Rate for Payer: Healthscope Commercial |
$1,568.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,307.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,481.58
|
| Rate for Payer: PHP Commercial |
$1,481.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,220.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,063.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,533.88
|
| Rate for Payer: UHC Core |
$1,455.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,307.28
|
|
|
HC FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,743.04
|
|
| Hospital Charge Code |
36000044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.97 |
| Max. Negotiated Rate |
$1,568.74 |
| Rate for Payer: Aetna Commercial |
$1,481.58
|
| Rate for Payer: Aetna Medicare |
$453.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$544.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$544.70
|
| Rate for Payer: BCBS Complete |
$697.22
|
| Rate for Payer: BCBS MAPPO |
$435.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.21
|
| Rate for Payer: BCN Commercial |
$1,355.21
|
| Rate for Payer: BCN Medicare Advantage |
$435.76
|
| Rate for Payer: Cash Price |
$1,394.43
|
| Rate for Payer: Cofinity Commercial |
$1,499.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,394.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.76
|
| Rate for Payer: Healthscope Commercial |
$1,568.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,307.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$457.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$501.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,481.58
|
| Rate for Payer: PACE Senior Care Partners |
$413.97
|
| Rate for Payer: PACE SWMI |
$435.76
|
| Rate for Payer: PHP Commercial |
$1,481.58
|
| Rate for Payer: PHP Medicare Advantage |
$435.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,220.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,516.44
|
| Rate for Payer: Priority Health Medicare |
$435.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,063.08
|
| Rate for Payer: Railroad Medicare Medicare |
$435.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,533.88
|
| Rate for Payer: UHC Core |
$1,455.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.76
|
| Rate for Payer: UHC Medicare Advantage |
$448.83
|
| Rate for Payer: VA VA |
$435.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,307.28
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
OP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.36 |
| Max. Negotiated Rate |
$224.94 |
| Rate for Payer: Aetna Commercial |
$212.44
|
| Rate for Payer: Aetna Medicare |
$64.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.10
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCBS MAPPO |
$62.48
|
| Rate for Payer: BCBS Trust/PPO |
$194.32
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: BCN Medicare Advantage |
$62.48
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$214.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.48
|
| Rate for Payer: Healthscope Commercial |
$224.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: PACE Senior Care Partners |
$59.36
|
| Rate for Payer: PACE SWMI |
$62.48
|
| Rate for Payer: PHP Commercial |
$212.44
|
| Rate for Payer: PHP Medicare Advantage |
$62.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.44
|
| Rate for Payer: Priority Health Medicare |
$62.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.43
|
| Rate for Payer: Railroad Medicare Medicare |
$62.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.94
|
| Rate for Payer: UHC Core |
$208.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.48
|
| Rate for Payer: UHC Medicare Advantage |
$64.36
|
| Rate for Payer: VA VA |
$62.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.45
|
|
|
HC FLEX SHEATH INTRO
|
Facility
|
IP
|
$249.93
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27200041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.43 |
| Max. Negotiated Rate |
$224.94 |
| Rate for Payer: Aetna Commercial |
$212.44
|
| Rate for Payer: BCBS Trust/PPO |
$193.15
|
| Rate for Payer: BCN Commercial |
$193.15
|
| Rate for Payer: Cash Price |
$199.94
|
| Rate for Payer: Cofinity Commercial |
$214.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.94
|
| Rate for Payer: Healthscope Commercial |
$224.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.44
|
| Rate for Payer: PHP Commercial |
$212.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.94
|
| Rate for Payer: UHC Core |
$208.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.45
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
IP
|
$730.90
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.78 |
| Max. Negotiated Rate |
$657.81 |
| Rate for Payer: Aetna Commercial |
$621.26
|
| Rate for Payer: BCBS Trust/PPO |
$564.84
|
| Rate for Payer: BCN Commercial |
$564.84
|
| Rate for Payer: Cash Price |
$584.72
|
| Rate for Payer: Cofinity Commercial |
$628.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.72
|
| Rate for Payer: Healthscope Commercial |
$657.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.26
|
| Rate for Payer: PHP Commercial |
$621.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$643.19
|
| Rate for Payer: UHC Core |
$610.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.18
|
|
|
HC FLOSEAL HEMOSTATIC MATRIX
|
Facility
|
OP
|
$730.90
|
|
| Hospital Charge Code |
27200123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.59 |
| Max. Negotiated Rate |
$657.81 |
| Rate for Payer: Aetna Commercial |
$621.26
|
| Rate for Payer: Aetna Medicare |
$190.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.41
|
| Rate for Payer: BCBS Complete |
$292.36
|
| Rate for Payer: BCBS MAPPO |
$182.72
|
| Rate for Payer: BCBS Trust/PPO |
$568.27
|
| Rate for Payer: BCN Commercial |
$568.27
|
| Rate for Payer: BCN Medicare Advantage |
$182.72
|
| Rate for Payer: Cash Price |
$584.72
|
| Rate for Payer: Cofinity Commercial |
$628.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.72
|
| Rate for Payer: Healthscope Commercial |
$657.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.26
|
| Rate for Payer: PACE Senior Care Partners |
$173.59
|
| Rate for Payer: PACE SWMI |
$182.72
|
| Rate for Payer: PHP Commercial |
$621.26
|
| Rate for Payer: PHP Medicare Advantage |
$182.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.88
|
| Rate for Payer: Priority Health Medicare |
$182.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.78
|
| Rate for Payer: Railroad Medicare Medicare |
$182.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$643.19
|
| Rate for Payer: UHC Core |
$610.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.72
|
| Rate for Payer: UHC Medicare Advantage |
$188.21
|
| Rate for Payer: VA VA |
$182.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.18
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
IP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: BCBS Trust/PPO |
$41.54
|
| Rate for Payer: BCN Commercial |
$41.54
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, ADDL
|
Facility
|
OP
|
$53.75
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
31100041
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.80
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$41.79
|
| Rate for Payer: BCN Commercial |
$41.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$43.00
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.69
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$45.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.76
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.78
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.30
|
| Rate for Payer: UHC Core |
$44.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.84
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.31
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$247.59 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$247.59
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.95
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$235.80
|
| Rate for Payer: Meridian Medicaid |
$247.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$46.35
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC FLOW CYTOMETRY, CELL SURFACE, FIRST
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
31100040
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$109.78 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$139.10
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
HC FLUID CREATININE
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$4.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC FLUID CREATININE
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
30100498
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
OP
|
$106.08
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.19 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: Aetna Medicare |
$27.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.15
|
| Rate for Payer: BCBS Complete |
$42.43
|
| Rate for Payer: BCBS MAPPO |
$26.52
|
| Rate for Payer: BCBS Trust/PPO |
$82.48
|
| Rate for Payer: BCN Commercial |
$82.48
|
| Rate for Payer: BCN Medicare Advantage |
$26.52
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.52
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.17
|
| Rate for Payer: PACE Senior Care Partners |
$25.19
|
| Rate for Payer: PACE SWMI |
$26.52
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: PHP Medicare Advantage |
$26.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.29
|
| Rate for Payer: Priority Health Medicare |
$26.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.70
|
| Rate for Payer: Railroad Medicare Medicare |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.35
|
| Rate for Payer: UHC Core |
$88.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.52
|
| Rate for Payer: UHC Medicare Advantage |
$27.32
|
| Rate for Payer: VA VA |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.56
|
|
|
HC FLUIDOTHERAPY
|
Facility
|
IP
|
$106.08
|
|
|
Service Code
|
CPT 97022
|
| Hospital Charge Code |
42000051
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.70 |
| Max. Negotiated Rate |
$95.47 |
| Rate for Payer: Aetna Commercial |
$90.17
|
| Rate for Payer: BCBS Trust/PPO |
$81.98
|
| Rate for Payer: BCN Commercial |
$81.98
|
| Rate for Payer: Cash Price |
$84.86
|
| Rate for Payer: Cofinity Commercial |
$91.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.86
|
| Rate for Payer: Healthscope Commercial |
$95.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.17
|
| Rate for Payer: PHP Commercial |
$90.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.35
|
| Rate for Payer: UHC Core |
$88.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.56
|
|
