|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HERPES SIMPLEX VIRUS (HSV-2)
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600271
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
IP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: BCBS Trust/PPO |
$36.78
|
| Rate for Payer: BCN Commercial |
$36.78
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$40.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.07
|
| Rate for Payer: Healthscope Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: PHP Commercial |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.88
|
| Rate for Payer: UHC Core |
$39.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.69
|
|
|
HC HERPES SIMPLEX VIRUS PCR, BLD
|
Facility
|
OP
|
$47.59
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
30600340
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: Aetna Medicare |
$12.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.87
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$37.00
|
| Rate for Payer: BCN Commercial |
$37.00
|
| Rate for Payer: BCN Medicare Advantage |
$11.90
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cash Price |
$38.07
|
| Rate for Payer: Cofinity Commercial |
$40.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.90
|
| Rate for Payer: Healthscope Commercial |
$42.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.69
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.45
|
| Rate for Payer: PACE Senior Care Partners |
$11.30
|
| Rate for Payer: PACE SWMI |
$11.90
|
| Rate for Payer: PHP Commercial |
$40.45
|
| Rate for Payer: PHP Medicare Advantage |
$11.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.40
|
| Rate for Payer: Priority Health Medicare |
$11.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.88
|
| Rate for Payer: UHC Core |
$39.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.90
|
| Rate for Payer: UHC Medicare Advantage |
$12.25
|
| Rate for Payer: VA VA |
$11.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.69
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
IP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.59
|
| Rate for Payer: UHC Core |
$14.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC HH ALOE VESTA CLEANSER
|
Facility
|
OP
|
$17.72
|
|
| Hospital Charge Code |
27100003
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$15.95 |
| Rate for Payer: Aetna Commercial |
$15.06
|
| Rate for Payer: Aetna Medicare |
$4.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.54
|
| Rate for Payer: BCBS Complete |
$7.09
|
| Rate for Payer: BCBS MAPPO |
$4.43
|
| Rate for Payer: BCBS Trust/PPO |
$13.78
|
| Rate for Payer: BCN Commercial |
$13.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.43
|
| Rate for Payer: Cash Price |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$15.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.21
|
| Rate for Payer: PACE SWMI |
$4.43
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: PHP Medicare Advantage |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.42
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.59
|
| Rate for Payer: UHC Core |
$14.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.43
|
| Rate for Payer: UHC Medicare Advantage |
$4.56
|
| Rate for Payer: VA VA |
$4.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.29
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
IP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: BCBS Trust/PPO |
$13.01
|
| Rate for Payer: BCN Commercial |
$13.01
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
HC HH POUCH CLOSURE CLAMP
|
Facility
|
OP
|
$16.83
|
|
| Hospital Charge Code |
27000138
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.26
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Healthscope Commercial |
$15.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.31
|
| Rate for Payer: PACE Senior Care Partners |
$4.00
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PHP Commercial |
$14.31
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.64
|
| Rate for Payer: Priority Health Medicare |
$4.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.26
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.33
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
HC HH WET ONES
|
Facility
|
IP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$12.40
|
| Rate for Payer: BCN Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
HC HH WET ONES
|
Facility
|
OP
|
$16.05
|
|
| Hospital Charge Code |
27000170
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.02
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS MAPPO |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$12.48
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.01
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PACE Senior Care Partners |
$3.81
|
| Rate for Payer: PACE SWMI |
$4.01
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Medicare |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$4.13
|
| Rate for Payer: VA VA |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
IP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.90
|
| Rate for Payer: BCN Commercial |
$33.90
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC HIAA SEROTONIN URINE
|
Facility
|
OP
|
$43.86
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
30100248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$39.47 |
| Rate for Payer: Aetna Commercial |
$37.28
|
| Rate for Payer: Aetna Medicare |
$11.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.71
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$34.10
|
| Rate for Payer: BCN Commercial |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.96
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$39.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.90
|
| Rate for Payer: Mclaren Medicaid |
$9.52
|
| Rate for Payer: Meridian Medicaid |
$10.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.28
|
| Rate for Payer: PACE Senior Care Partners |
$10.42
|
| Rate for Payer: PACE SWMI |
$10.96
|
| Rate for Payer: PHP Commercial |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$10.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Medicare |
$10.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.60
|
| Rate for Payer: UHC Core |
$36.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.29
|
| Rate for Payer: VA VA |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.90
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
OP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.92
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$10.34
|
| Rate for Payer: BCBS Trust/PPO |
$32.14
|
| Rate for Payer: BCN Commercial |
$32.14
|
| Rate for Payer: BCN Medicare Advantage |
$10.34
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.34
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: PACE Senior Care Partners |
$9.82
|
| Rate for Payer: PACE SWMI |
$10.34
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: PHP Medicare Advantage |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.97
|
| Rate for Payer: Priority Health Medicare |
$10.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.21
|
| Rate for Payer: Railroad Medicare Medicare |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.38
|
| Rate for Payer: UHC Core |
$34.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.34
|
| Rate for Payer: UHC Medicare Advantage |
$10.65
|
| Rate for Payer: VA VA |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
HC HIB PRP-OMP VACC 3 DOSE IM
|
Facility
|
IP
|
$41.34
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
63600180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$37.21 |
| Rate for Payer: Aetna Commercial |
$35.14
|
| Rate for Payer: BCBS Trust/PPO |
$31.95
|
| Rate for Payer: BCN Commercial |
$31.95
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cofinity Commercial |
$35.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.07
|
| Rate for Payer: Healthscope Commercial |
$37.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.14
|
| Rate for Payer: PHP Commercial |
$35.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.38
|
| Rate for Payer: UHC Core |
$34.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.00
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
OP
|
$1,023.00
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$242.96 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$869.55
|
| Rate for Payer: Aetna Medicare |
$265.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$319.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$319.69
|
| Rate for Payer: BCBS Complete |
$409.20
|
| Rate for Payer: BCBS MAPPO |
$255.75
|
| Rate for Payer: BCBS Trust/PPO |
$795.38
|
| Rate for Payer: BCN Commercial |
$795.38
|
| Rate for Payer: BCN Medicare Advantage |
$255.75
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$879.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$818.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.75
|
| Rate for Payer: Healthscope Commercial |
$920.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$767.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$869.55
|
| Rate for Payer: PACE Senior Care Partners |
$242.96
|
| Rate for Payer: PACE SWMI |
$255.75
|
| Rate for Payer: PHP Commercial |
$869.55
|
| Rate for Payer: PHP Medicare Advantage |
$255.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.01
|
| Rate for Payer: Priority Health Medicare |
$255.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$623.93
|
| Rate for Payer: Railroad Medicare Medicare |
$255.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$900.24
|
| Rate for Payer: UHC Core |
$854.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.75
|
| Rate for Payer: UHC Medicare Advantage |
$263.42
|
| Rate for Payer: VA VA |
$255.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$767.25
|
|
|
HC HIGH FLOW JET VENT
|
Facility
|
IP
|
$1,023.00
|
|
| Hospital Charge Code |
27000699
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$623.93 |
| Max. Negotiated Rate |
$920.70 |
| Rate for Payer: Aetna Commercial |
$869.55
|
| Rate for Payer: BCBS Trust/PPO |
$790.57
|
| Rate for Payer: BCN Commercial |
$790.57
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$879.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$818.40
|
| Rate for Payer: Healthscope Commercial |
$920.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$767.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$869.55
|
| Rate for Payer: PHP Commercial |
$869.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$890.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$623.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$900.24
|
| Rate for Payer: UHC Core |
$854.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$767.25
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
OP
|
$213.13
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$191.82 |
| Rate for Payer: Aetna Commercial |
$181.16
|
| Rate for Payer: Aetna Medicare |
$55.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.60
|
| Rate for Payer: BCBS Complete |
$85.25
|
| Rate for Payer: BCBS MAPPO |
$53.28
|
| Rate for Payer: BCBS Trust/PPO |
$165.71
|
| Rate for Payer: BCN Commercial |
$165.71
|
| Rate for Payer: BCN Medicare Advantage |
$53.28
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$183.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.28
|
| Rate for Payer: Healthscope Commercial |
$191.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.16
|
| Rate for Payer: PACE Senior Care Partners |
$50.62
|
| Rate for Payer: PACE SWMI |
$53.28
|
| Rate for Payer: PHP Commercial |
$181.16
|
| Rate for Payer: PHP Medicare Advantage |
$53.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.42
|
| Rate for Payer: Priority Health Medicare |
$53.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.99
|
| Rate for Payer: Railroad Medicare Medicare |
$53.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.55
|
| Rate for Payer: UHC Core |
$177.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.28
|
| Rate for Payer: UHC Medicare Advantage |
$54.88
|
| Rate for Payer: VA VA |
$53.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.85
|
|
|
HC HIGH FLOW OXYGEN THERAPY
|
Facility
|
IP
|
$213.13
|
|
| Hospital Charge Code |
27000632
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$129.99 |
| Max. Negotiated Rate |
$191.82 |
| Rate for Payer: Aetna Commercial |
$181.16
|
| Rate for Payer: BCBS Trust/PPO |
$164.71
|
| Rate for Payer: BCN Commercial |
$164.71
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$183.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Healthscope Commercial |
$191.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.16
|
| Rate for Payer: PHP Commercial |
$181.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.55
|
| Rate for Payer: UHC Core |
$177.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.85
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
OP
|
$1,511.64
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$359.01 |
| Max. Negotiated Rate |
$1,360.48 |
| Rate for Payer: Aetna Commercial |
$1,284.89
|
| Rate for Payer: Aetna Medicare |
$393.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$472.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$472.39
|
| Rate for Payer: BCBS Complete |
$604.66
|
| Rate for Payer: BCBS MAPPO |
$377.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.30
|
| Rate for Payer: BCN Commercial |
$1,175.30
|
| Rate for Payer: BCN Medicare Advantage |
$377.91
|
| Rate for Payer: Cash Price |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.91
|
| Rate for Payer: Healthscope Commercial |
$1,360.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$396.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$434.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,284.89
|
| Rate for Payer: PACE Senior Care Partners |
$359.01
|
| Rate for Payer: PACE SWMI |
$377.91
|
| Rate for Payer: PHP Commercial |
$1,284.89
|
| Rate for Payer: PHP Medicare Advantage |
$377.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,315.13
|
| Rate for Payer: Priority Health Medicare |
$377.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$921.95
|
| Rate for Payer: Railroad Medicare Medicare |
$377.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,330.24
|
| Rate for Payer: UHC Core |
$1,262.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$377.91
|
| Rate for Payer: UHC Medicare Advantage |
$389.25
|
| Rate for Payer: VA VA |
$377.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.73
|
|
|
HC HINGE EXTENSION/FLEX WRIST/F
|
Facility
|
IP
|
$1,511.64
|
|
|
Service Code
|
HCPCS L3900
|
| Hospital Charge Code |
27400048
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$921.95 |
| Max. Negotiated Rate |
$1,360.48 |
| Rate for Payer: Aetna Commercial |
$1,284.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.20
|
| Rate for Payer: BCN Commercial |
$1,168.20
|
| Rate for Payer: Cash Price |
$1,209.31
|
| Rate for Payer: Cofinity Commercial |
$1,300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,209.31
|
| Rate for Payer: Healthscope Commercial |
$1,360.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,133.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,284.89
|
| Rate for Payer: PHP Commercial |
$1,284.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,315.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$921.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,330.24
|
| Rate for Payer: UHC Core |
$1,262.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,133.73
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
IP
|
$383.75
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.05 |
| Max. Negotiated Rate |
$345.38 |
| Rate for Payer: Aetna Commercial |
$326.19
|
| Rate for Payer: BCBS Trust/PPO |
$296.56
|
| Rate for Payer: BCN Commercial |
$296.56
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cofinity Commercial |
$330.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.00
|
| Rate for Payer: Healthscope Commercial |
$345.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.19
|
| Rate for Payer: PHP Commercial |
$326.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.70
|
| Rate for Payer: UHC Core |
$320.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.81
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 2 VIEWS
|
Facility
|
OP
|
$383.75
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
32000312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$345.38 |
| Rate for Payer: Aetna Commercial |
$326.19
|
| Rate for Payer: Aetna Medicare |
$99.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.92
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$95.94
|
| Rate for Payer: BCBS Trust/PPO |
$298.37
|
| Rate for Payer: BCN Commercial |
$298.37
|
| Rate for Payer: BCN Medicare Advantage |
$95.94
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cash Price |
$307.00
|
| Rate for Payer: Cofinity Commercial |
$330.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.94
|
| Rate for Payer: Healthscope Commercial |
$345.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.81
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.19
|
| Rate for Payer: PACE Senior Care Partners |
$91.14
|
| Rate for Payer: PACE SWMI |
$95.94
|
| Rate for Payer: PHP Commercial |
$326.19
|
| Rate for Payer: PHP Medicare Advantage |
$95.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.86
|
| Rate for Payer: Priority Health Medicare |
$95.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.05
|
| Rate for Payer: Railroad Medicare Medicare |
$95.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.70
|
| Rate for Payer: UHC Core |
$320.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.94
|
| Rate for Payer: UHC Medicare Advantage |
$98.82
|
| Rate for Payer: VA VA |
$95.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.81
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
OP
|
$472.31
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: Aetna Medicare |
$122.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.60
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$118.08
|
| Rate for Payer: BCBS Trust/PPO |
$367.22
|
| Rate for Payer: BCN Commercial |
$367.22
|
| Rate for Payer: BCN Medicare Advantage |
$118.08
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.08
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.23
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PACE Senior Care Partners |
$112.17
|
| Rate for Payer: PACE SWMI |
$118.08
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: PHP Medicare Advantage |
$118.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.91
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.06
|
| Rate for Payer: Railroad Medicare Medicare |
$118.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.63
|
| Rate for Payer: UHC Core |
$394.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.08
|
| Rate for Payer: UHC Medicare Advantage |
$121.62
|
| Rate for Payer: VA VA |
$118.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.23
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED 3 TO 4 VIEWS
|
Facility
|
IP
|
$472.31
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
32000313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.06 |
| Max. Negotiated Rate |
$425.08 |
| Rate for Payer: Aetna Commercial |
$401.46
|
| Rate for Payer: BCBS Trust/PPO |
$365.00
|
| Rate for Payer: BCN Commercial |
$365.00
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cofinity Commercial |
$406.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.85
|
| Rate for Payer: Healthscope Commercial |
$425.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$401.46
|
| Rate for Payer: PHP Commercial |
$401.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.63
|
| Rate for Payer: UHC Core |
$394.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.23
|
|
|
HC HIPS BIL WITH PELVIS IF PERFORMED MIN 5 VIEWS
|
Facility
|
IP
|
$531.36
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
32000314
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.08 |
| Max. Negotiated Rate |
$478.22 |
| Rate for Payer: Aetna Commercial |
$451.66
|
| Rate for Payer: BCBS Trust/PPO |
$410.64
|
| Rate for Payer: BCN Commercial |
$410.64
|
| Rate for Payer: Cash Price |
$425.09
|
| Rate for Payer: Cofinity Commercial |
$456.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.09
|
| Rate for Payer: Healthscope Commercial |
$478.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$451.66
|
| Rate for Payer: PHP Commercial |
$451.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.60
|
| Rate for Payer: UHC Core |
$443.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.52
|
|
