|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.22 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS MAPPO |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$28.99
|
| Rate for Payer: BCN Commercial |
$28.99
|
| Rate for Payer: BCN Medicare Advantage |
$8.81
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.81
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Mclaren Medicaid |
$6.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.26
|
| Rate for Payer: Meridian Medicaid |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PACE Senior Care Partners |
$8.37
|
| Rate for Payer: PACE SWMI |
$8.81
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: PHP Medicare Advantage |
$8.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.03
|
| Rate for Payer: UHC Core |
$29.44
|
| Rate for Payer: UHC Exchange |
$8.81
|
| Rate for Payer: UHC Medicaid |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$8.81
|
| Rate for Payer: UHCCP Medicaid |
$6.22
|
| Rate for Payer: VA VA |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$35.26
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna Commercial |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.12
|
| Rate for Payer: BCN Commercial |
$29.12
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.21
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.97
|
| Rate for Payer: Nomi Health Commercial |
$28.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.45
|
| Rate for Payer: PHP Commercial |
$29.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$30.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.03
|
| Rate for Payer: UHC Core |
$29.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.45
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.07
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: BCBS MAPPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$21.22
|
| Rate for Payer: BCN Commercial |
$21.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.45
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.45
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Mclaren Medicaid |
$4.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$4.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PACE Senior Care Partners |
$6.13
|
| Rate for Payer: PACE SWMI |
$6.45
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Medicare Advantage |
$6.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Medicare |
$6.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: UHC Exchange |
$6.45
|
| Rate for Payer: UHC Medicaid |
$4.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.45
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: VA VA |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCN Commercial |
$21.32
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.81
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare |
$6.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.07
|
| Rate for Payer: BCBS Complete |
$4.78
|
| Rate for Payer: BCBS MAPPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$21.22
|
| Rate for Payer: BCN Commercial |
$21.22
|
| Rate for Payer: BCN Medicare Advantage |
$6.45
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.45
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Mclaren Medicaid |
$4.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.78
|
| Rate for Payer: Meridian Medicaid |
$4.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Nomi Health Commercial |
$21.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PACE Senior Care Partners |
$6.13
|
| Rate for Payer: PACE SWMI |
$6.45
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Medicare Advantage |
$6.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.45
|
| Rate for Payer: Priority Health Medicare |
$6.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: UHC Exchange |
$6.45
|
| Rate for Payer: UHC Medicaid |
$4.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.45
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: VA VA |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$3,242.46 |
| Max. Negotiated Rate |
$4,192.84 |
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,847.63
|
| Rate for Payer: BCN Commercial |
$3,847.63
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$3,820.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,053.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,242.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,099.66
|
| Rate for Payer: UHC Core |
$3,890.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.03
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,658.71
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$821.33 |
| Max. Negotiated Rate |
$4,192.84 |
| Rate for Payer: Aetna Commercial |
$3,959.90
|
| Rate for Payer: Aetna Medicare |
$1,211.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,455.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,455.85
|
| Rate for Payer: BCBS Complete |
$862.33
|
| Rate for Payer: BCBS MAPPO |
$1,164.68
|
| Rate for Payer: BCBS Trust/PPO |
$3,829.93
|
| Rate for Payer: BCN Commercial |
$3,829.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,164.68
|
| Rate for Payer: Cash Price |
$3,726.97
|
| Rate for Payer: Cofinity Commercial |
$4,006.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,726.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,164.68
|
| Rate for Payer: Healthscope Commercial |
$4,192.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,494.03
|
| Rate for Payer: Mclaren Medicaid |
$821.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,222.91
|
| Rate for Payer: Meridian Medicaid |
$862.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,339.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,281.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,959.90
|
| Rate for Payer: Nomi Health Commercial |
$3,820.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,494.03
|
| Rate for Payer: PACE Senior Care Partners |
$1,106.44
|
| Rate for Payer: PACE SWMI |
$1,164.68
|
| Rate for Payer: PHP Commercial |
$3,959.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,164.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,053.08
|
| Rate for Payer: Priority Health Medicare |
$1,176.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,242.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,164.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,099.66
|
| Rate for Payer: UHC Core |
$3,890.02
|
| Rate for Payer: UHC Exchange |
$1,164.68
|
| Rate for Payer: UHC Medicaid |
$821.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,164.68
|
| Rate for Payer: UHCCP Medicaid |
$821.33
|
| Rate for Payer: VA VA |
$1,164.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,494.03
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: BCBS Trust/PPO |
$38.24
|
| Rate for Payer: BCN Commercial |
$38.24
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.74
|
| Rate for Payer: UHC Core |
$38.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$46.30
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$41.67 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.47
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS MAPPO |
$11.57
|
| Rate for Payer: BCBS Trust/PPO |
$38.06
|
| Rate for Payer: BCN Commercial |
$38.06
|
| Rate for Payer: BCN Medicare Advantage |
$11.57
|
| Rate for Payer: Cash Price |
$37.04
|
| Rate for Payer: Cofinity Commercial |
$39.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.57
|
| Rate for Payer: Healthscope Commercial |
$41.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.73
|
| Rate for Payer: Mclaren Medicaid |
$8.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.15
|
| Rate for Payer: Meridian Medicaid |
$8.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.35
|
| Rate for Payer: Nomi Health Commercial |
$37.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.73
|
| Rate for Payer: PACE Senior Care Partners |
$11.00
|
| Rate for Payer: PACE SWMI |
$11.57
|
| Rate for Payer: PHP Commercial |
$39.35
|
| Rate for Payer: PHP Medicare Advantage |
$11.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.28
|
| Rate for Payer: Priority Health Medicare |
$11.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.74
|
| Rate for Payer: UHC Core |
$38.66
|
| Rate for Payer: UHC Exchange |
$11.57
|
| Rate for Payer: UHC Medicaid |
$8.16
|
| Rate for Payer: UHC Medicare Advantage |
$11.57
|
| Rate for Payer: UHCCP Medicaid |
$8.16
|
| Rate for Payer: VA VA |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.73
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.74 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: BCBS Trust/PPO |
$104.12
|
| Rate for Payer: BCN Commercial |
$104.12
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Nomi Health Commercial |
$103.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.94
|
| Rate for Payer: UHC Core |
$105.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.55
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$126.07
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$113.46 |
| Rate for Payer: Aetna Commercial |
$107.16
|
| Rate for Payer: Aetna Medicare |
$32.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.40
|
| Rate for Payer: BCBS Complete |
$23.34
|
| Rate for Payer: BCBS MAPPO |
$31.52
|
| Rate for Payer: BCBS Trust/PPO |
$103.64
|
| Rate for Payer: BCN Commercial |
$103.64
|
| Rate for Payer: BCN Medicare Advantage |
$31.52
|
| Rate for Payer: Cash Price |
$100.86
|
| Rate for Payer: Cofinity Commercial |
$108.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.52
|
| Rate for Payer: Healthscope Commercial |
$113.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.55
|
| Rate for Payer: Mclaren Medicaid |
$22.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.09
|
| Rate for Payer: Meridian Medicaid |
$23.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.16
|
| Rate for Payer: Nomi Health Commercial |
$103.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.55
|
| Rate for Payer: PACE Senior Care Partners |
$29.94
|
| Rate for Payer: PACE SWMI |
$31.52
|
| Rate for Payer: PHP Commercial |
$107.16
|
| Rate for Payer: PHP Medicare Advantage |
$31.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$109.68
|
| Rate for Payer: Priority Health Medicare |
$31.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.74
|
| Rate for Payer: Railroad Medicare Medicare |
$31.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.94
|
| Rate for Payer: UHC Core |
$105.27
|
| Rate for Payer: UHC Exchange |
$31.52
|
| Rate for Payer: UHC Medicaid |
$22.23
|
| Rate for Payer: UHC Medicare Advantage |
$31.52
|
| Rate for Payer: UHCCP Medicaid |
$22.23
|
| Rate for Payer: VA VA |
$31.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.55
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCN Commercial |
$45.31
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Nomi Health Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.28
|
| Rate for Payer: UHC Core |
$45.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$54.86
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$49.37 |
| Rate for Payer: Aetna Commercial |
$46.63
|
| Rate for Payer: Aetna Medicare |
$14.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.14
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS MAPPO |
$13.71
|
| Rate for Payer: BCBS Trust/PPO |
$45.10
|
| Rate for Payer: BCN Commercial |
$45.10
|
| Rate for Payer: BCN Medicare Advantage |
$13.71
|
| Rate for Payer: Cash Price |
$43.89
|
| Rate for Payer: Cofinity Commercial |
$47.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$49.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.15
|
| Rate for Payer: Mclaren Medicaid |
$9.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.40
|
| Rate for Payer: Meridian Medicaid |
$10.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.63
|
| Rate for Payer: Nomi Health Commercial |
$44.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.15
|
| Rate for Payer: PACE Senior Care Partners |
$13.03
|
| Rate for Payer: PACE SWMI |
$13.71
|
| Rate for Payer: PHP Commercial |
$46.63
|
| Rate for Payer: PHP Medicare Advantage |
$13.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.73
|
| Rate for Payer: Priority Health Medicare |
$13.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.18
|
| Rate for Payer: Railroad Medicare Medicare |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.28
|
| Rate for Payer: UHC Core |
$45.81
|
| Rate for Payer: UHC Exchange |
$13.71
|
| Rate for Payer: UHC Medicaid |
$9.67
|
| Rate for Payer: UHC Medicare Advantage |
$13.71
|
| Rate for Payer: UHCCP Medicaid |
$9.67
|
| Rate for Payer: VA VA |
$13.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.15
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: Aetna Medicare |
$41.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.35
|
| Rate for Payer: BCBS Complete |
$29.23
|
| Rate for Payer: BCBS MAPPO |
$39.48
|
| Rate for Payer: BCBS Trust/PPO |
$129.83
|
| Rate for Payer: BCN Commercial |
$129.83
|
| Rate for Payer: BCN Medicare Advantage |
$39.48
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Mclaren Medicaid |
$27.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.46
|
| Rate for Payer: Meridian Medicaid |
$29.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PACE Senior Care Partners |
$37.51
|
| Rate for Payer: PACE SWMI |
$39.48
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: PHP Medicare Advantage |
$39.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.40
|
| Rate for Payer: Priority Health Medicare |
$39.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.92
|
| Rate for Payer: Railroad Medicare Medicare |
$39.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.98
|
| Rate for Payer: UHC Core |
$131.87
|
| Rate for Payer: UHC Exchange |
$39.48
|
| Rate for Payer: UHC Medicaid |
$27.84
|
| Rate for Payer: UHC Medicare Advantage |
$39.48
|
| Rate for Payer: UHCCP Medicaid |
$850.00
|
| Rate for Payer: VA VA |
$39.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$157.93
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: Aetna Commercial |
$134.24
|
| Rate for Payer: BCBS Trust/PPO |
$130.43
|
| Rate for Payer: BCN Commercial |
$130.43
|
| Rate for Payer: Cash Price |
$126.34
|
| Rate for Payer: Cofinity Commercial |
$135.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.34
|
| Rate for Payer: Healthscope Commercial |
$142.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.24
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.45
|
| Rate for Payer: PHP Commercial |
$134.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.98
|
| Rate for Payer: UHC Core |
$131.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.45
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: Aetna Medicare |
$17.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.93
|
| Rate for Payer: BCBS Complete |
$12.39
|
| Rate for Payer: BCBS MAPPO |
$16.74
|
| Rate for Payer: BCBS Trust/PPO |
$55.05
|
| Rate for Payer: BCN Commercial |
$55.05
|
| Rate for Payer: BCN Medicare Advantage |
$16.74
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.22
|
| Rate for Payer: Mclaren Medicaid |
$11.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.58
|
| Rate for Payer: Meridian Medicaid |
$12.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Nomi Health Commercial |
$54.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PACE Senior Care Partners |
$15.90
|
| Rate for Payer: PACE SWMI |
$16.74
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: PHP Medicare Advantage |
$16.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.26
|
| Rate for Payer: Priority Health Medicare |
$16.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.60
|
| Rate for Payer: Railroad Medicare Medicare |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.92
|
| Rate for Payer: UHC Core |
$55.91
|
| Rate for Payer: UHC Exchange |
$16.74
|
| Rate for Payer: UHC Medicaid |
$11.81
|
| Rate for Payer: UHC Medicare Advantage |
$16.74
|
| Rate for Payer: UHCCP Medicaid |
$11.81
|
| Rate for Payer: VA VA |
$16.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.22
|
|
|
HC DIRECT COOMBS
|
Facility
|
IP
|
$66.96
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$60.26 |
| Rate for Payer: Aetna Commercial |
$56.92
|
| Rate for Payer: BCBS Trust/PPO |
$55.30
|
| Rate for Payer: BCN Commercial |
$55.30
|
| Rate for Payer: Cash Price |
$53.57
|
| Rate for Payer: Cofinity Commercial |
$57.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.57
|
| Rate for Payer: Healthscope Commercial |
$60.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.92
|
| Rate for Payer: Nomi Health Commercial |
$54.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.22
|
| Rate for Payer: PHP Commercial |
$56.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$58.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.92
|
| Rate for Payer: UHC Core |
$55.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.22
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
OP
|
$156.06
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.51 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: Aetna Medicare |
$40.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.77
|
| Rate for Payer: BCBS Complete |
$28.89
|
| Rate for Payer: BCBS MAPPO |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$128.30
|
| Rate for Payer: BCN Commercial |
$128.30
|
| Rate for Payer: BCN Medicare Advantage |
$39.02
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.02
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Mclaren Medicaid |
$27.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.97
|
| Rate for Payer: Meridian Medicaid |
$28.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PACE Senior Care Partners |
$37.06
|
| Rate for Payer: PACE SWMI |
$39.02
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: PHP Medicare Advantage |
$39.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$39.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: Railroad Medicare Medicare |
$39.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: UHC Exchange |
$39.02
|
| Rate for Payer: UHC Medicaid |
$27.51
|
| Rate for Payer: UHC Medicare Advantage |
$39.02
|
| Rate for Payer: UHCCP Medicaid |
$27.51
|
| Rate for Payer: VA VA |
$39.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC DISACCHARIDASE ANALYSIS
|
Facility
|
IP
|
$156.06
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
30100755
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$140.45 |
| Rate for Payer: Aetna Commercial |
$132.65
|
| Rate for Payer: BCBS Trust/PPO |
$128.89
|
| Rate for Payer: BCN Commercial |
$128.89
|
| Rate for Payer: Cash Price |
$124.85
|
| Rate for Payer: Cofinity Commercial |
$134.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.85
|
| Rate for Payer: Healthscope Commercial |
$140.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.65
|
| Rate for Payer: Nomi Health Commercial |
$127.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.05
|
| Rate for Payer: PHP Commercial |
$132.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.33
|
| Rate for Payer: UHC Core |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.05
|
|
|
HC DISASTER COVERAGE
|
Facility
|
IP
|
$147.74
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$102.83 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: BCBS Trust/PPO |
$122.02
|
| Rate for Payer: BCN Commercial |
$122.02
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Nomi Health Commercial |
$121.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.01
|
| Rate for Payer: UHC Core |
$123.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
HC DISASTER COVERAGE
|
Facility
|
OP
|
$147.74
|
|
| Hospital Charge Code |
27000704
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$132.97 |
| Rate for Payer: Aetna Commercial |
$125.58
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.17
|
| Rate for Payer: BCBS Complete |
$27.35
|
| Rate for Payer: BCBS MAPPO |
$36.94
|
| Rate for Payer: BCBS Trust/PPO |
$121.46
|
| Rate for Payer: BCN Commercial |
$121.46
|
| Rate for Payer: BCN Medicare Advantage |
$36.94
|
| Rate for Payer: Cash Price |
$118.19
|
| Rate for Payer: Cofinity Commercial |
$127.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.94
|
| Rate for Payer: Healthscope Commercial |
$132.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.81
|
| Rate for Payer: Mclaren Medicaid |
$26.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.78
|
| Rate for Payer: Meridian Medicaid |
$27.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.58
|
| Rate for Payer: Nomi Health Commercial |
$121.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.81
|
| Rate for Payer: PACE Senior Care Partners |
$35.09
|
| Rate for Payer: PACE SWMI |
$36.94
|
| Rate for Payer: PHP Commercial |
$125.58
|
| Rate for Payer: PHP Medicare Advantage |
$36.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.53
|
| Rate for Payer: Priority Health Medicare |
$37.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.83
|
| Rate for Payer: Railroad Medicare Medicare |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.01
|
| Rate for Payer: UHC Core |
$123.36
|
| Rate for Payer: UHC Exchange |
$36.94
|
| Rate for Payer: UHC Medicaid |
$26.05
|
| Rate for Payer: UHC Medicare Advantage |
$36.94
|
| Rate for Payer: UHCCP Medicaid |
$26.05
|
| Rate for Payer: VA VA |
$36.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.81
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
IP
|
$494.19
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$343.96 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: BCBS Trust/PPO |
$408.15
|
| Rate for Payer: BCN Commercial |
$408.15
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$429.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.89
|
| Rate for Payer: UHC Core |
$412.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.64
|
|
|
HC DISP FEE CONTRALATERAL BINAURAL
|
Facility
|
OP
|
$494.19
|
|
|
Service Code
|
CPT V5240
|
| Hospital Charge Code |
27100022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$444.77 |
| Rate for Payer: Aetna Commercial |
$420.06
|
| Rate for Payer: Aetna Medicare |
$128.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.43
|
| Rate for Payer: BCBS Complete |
$91.47
|
| Rate for Payer: BCBS MAPPO |
$123.55
|
| Rate for Payer: BCBS Trust/PPO |
$406.27
|
| Rate for Payer: BCN Commercial |
$406.27
|
| Rate for Payer: BCN Medicare Advantage |
$123.55
|
| Rate for Payer: Cash Price |
$395.35
|
| Rate for Payer: Cofinity Commercial |
$425.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$395.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.55
|
| Rate for Payer: Healthscope Commercial |
$444.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.64
|
| Rate for Payer: Mclaren Medicaid |
$87.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.72
|
| Rate for Payer: Meridian Medicaid |
$91.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$420.06
|
| Rate for Payer: Nomi Health Commercial |
$405.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.64
|
| Rate for Payer: PACE Senior Care Partners |
$117.37
|
| Rate for Payer: PACE SWMI |
$123.55
|
| Rate for Payer: PHP Commercial |
$420.06
|
| Rate for Payer: PHP Medicare Advantage |
$123.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$429.95
|
| Rate for Payer: Priority Health Medicare |
$124.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.96
|
| Rate for Payer: Railroad Medicare Medicare |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.89
|
| Rate for Payer: UHC Core |
$412.65
|
| Rate for Payer: UHC Exchange |
$123.55
|
| Rate for Payer: UHC Medicaid |
$87.13
|
| Rate for Payer: UHC Medicare Advantage |
$123.55
|
| Rate for Payer: UHCCP Medicaid |
$87.13
|
| Rate for Payer: VA VA |
$123.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.64
|
|
|
HC DISP FEE CONTRALATERAL MONAURAL
|
Facility
|
OP
|
$286.11
|
|
|
Service Code
|
CPT V5200
|
| Hospital Charge Code |
27100021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$257.50 |
| Rate for Payer: Aetna Commercial |
$243.19
|
| Rate for Payer: Aetna Medicare |
$74.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.41
|
| Rate for Payer: BCBS Complete |
$52.96
|
| Rate for Payer: BCBS MAPPO |
$71.53
|
| Rate for Payer: BCBS Trust/PPO |
$235.21
|
| Rate for Payer: BCN Commercial |
$235.21
|
| Rate for Payer: BCN Medicare Advantage |
$71.53
|
| Rate for Payer: Cash Price |
$228.89
|
| Rate for Payer: Cofinity Commercial |
$246.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.53
|
| Rate for Payer: Healthscope Commercial |
$257.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.58
|
| Rate for Payer: Mclaren Medicaid |
$50.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Meridian Medicaid |
$52.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.19
|
| Rate for Payer: Nomi Health Commercial |
$234.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.58
|
| Rate for Payer: PACE Senior Care Partners |
$67.95
|
| Rate for Payer: PACE SWMI |
$71.53
|
| Rate for Payer: PHP Commercial |
$243.19
|
| Rate for Payer: PHP Medicare Advantage |
$71.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.92
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.13
|
| Rate for Payer: Railroad Medicare Medicare |
$71.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.78
|
| Rate for Payer: UHC Core |
$238.90
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicaid |
$50.44
|
| Rate for Payer: UHC Medicare Advantage |
$71.53
|
| Rate for Payer: UHCCP Medicaid |
$50.44
|
| Rate for Payer: VA VA |
$71.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.58
|
|
