|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
IP
|
$40.30
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$36.27 |
| Rate for Payer: Aetna Commercial |
$34.26
|
| Rate for Payer: BCBS Trust/PPO |
$33.28
|
| Rate for Payer: BCN Commercial |
$33.28
|
| Rate for Payer: Cash Price |
$32.24
|
| Rate for Payer: Cofinity Commercial |
$34.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.24
|
| Rate for Payer: Healthscope Commercial |
$36.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.26
|
| Rate for Payer: Nomi Health Commercial |
$33.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.23
|
| Rate for Payer: PHP Commercial |
$34.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.46
|
| Rate for Payer: UHC Core |
$33.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.23
|
|
|
HC DSDNA AB WITH REFLEX, IGG, S
|
Facility
|
OP
|
$40.30
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
30200505
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$36.27 |
| Rate for Payer: Aetna Commercial |
$34.26
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.59
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$10.07
|
| Rate for Payer: BCBS Trust/PPO |
$33.13
|
| Rate for Payer: BCN Commercial |
$33.13
|
| Rate for Payer: BCN Medicare Advantage |
$10.07
|
| Rate for Payer: Cash Price |
$32.24
|
| Rate for Payer: Cofinity Commercial |
$34.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.07
|
| Rate for Payer: Healthscope Commercial |
$36.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.23
|
| Rate for Payer: Mclaren Medicaid |
$7.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.58
|
| Rate for Payer: Meridian Medicaid |
$7.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.26
|
| Rate for Payer: Nomi Health Commercial |
$33.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.23
|
| Rate for Payer: PACE Senior Care Partners |
$9.57
|
| Rate for Payer: PACE SWMI |
$10.07
|
| Rate for Payer: PHP Commercial |
$34.26
|
| Rate for Payer: PHP Medicare Advantage |
$10.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$35.06
|
| Rate for Payer: Priority Health Medicare |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.05
|
| Rate for Payer: Railroad Medicare Medicare |
$10.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.46
|
| Rate for Payer: UHC Core |
$33.65
|
| Rate for Payer: UHC Exchange |
$10.07
|
| Rate for Payer: UHC Medicaid |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$10.07
|
| Rate for Payer: UHCCP Medicaid |
$7.10
|
| Rate for Payer: VA VA |
$10.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.23
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
IP
|
$396.48
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$275.95 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: BCBS Trust/PPO |
$327.45
|
| Rate for Payer: BCN Commercial |
$327.45
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.90
|
| Rate for Payer: UHC Core |
$331.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.36
|
|
|
HC DSMA TC 99M PER STUDY
|
Facility
|
OP
|
$396.48
|
|
|
Service Code
|
HCPCS A9551
|
| Hospital Charge Code |
34300004
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$69.90 |
| Max. Negotiated Rate |
$356.83 |
| Rate for Payer: Aetna Commercial |
$337.01
|
| Rate for Payer: Aetna Medicare |
$103.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.90
|
| Rate for Payer: BCBS Complete |
$73.39
|
| Rate for Payer: BCBS MAPPO |
$99.12
|
| Rate for Payer: BCBS Trust/PPO |
$325.95
|
| Rate for Payer: BCN Commercial |
$325.95
|
| Rate for Payer: BCN Medicare Advantage |
$99.12
|
| Rate for Payer: Cash Price |
$317.18
|
| Rate for Payer: Cofinity Commercial |
$340.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.12
|
| Rate for Payer: Healthscope Commercial |
$356.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.36
|
| Rate for Payer: Mclaren Medicaid |
$69.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.08
|
| Rate for Payer: Meridian Medicaid |
$73.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$325.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.36
|
| Rate for Payer: PACE Senior Care Partners |
$94.16
|
| Rate for Payer: PACE SWMI |
$99.12
|
| Rate for Payer: PHP Commercial |
$337.01
|
| Rate for Payer: PHP Medicare Advantage |
$99.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$344.94
|
| Rate for Payer: Priority Health Medicare |
$100.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.95
|
| Rate for Payer: Railroad Medicare Medicare |
$99.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.90
|
| Rate for Payer: UHC Core |
$331.06
|
| Rate for Payer: UHC Exchange |
$99.12
|
| Rate for Payer: UHC Medicaid |
$69.90
|
| Rate for Payer: UHC Medicare Advantage |
$99.12
|
| Rate for Payer: UHCCP Medicaid |
$69.90
|
| Rate for Payer: VA VA |
$99.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.36
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
OP
|
$179.71
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$152.75
|
| Rate for Payer: Aetna Medicare |
$46.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.16
|
| Rate for Payer: BCBS Complete |
$33.26
|
| Rate for Payer: BCBS MAPPO |
$44.93
|
| Rate for Payer: BCBS Trust/PPO |
$147.74
|
| Rate for Payer: BCN Commercial |
$147.74
|
| Rate for Payer: BCN Medicare Advantage |
$44.93
|
| Rate for Payer: Cash Price |
$143.77
|
| Rate for Payer: Cofinity Commercial |
$154.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.93
|
| Rate for Payer: Healthscope Commercial |
$161.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.78
|
| Rate for Payer: Mclaren Medicaid |
$31.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.17
|
| Rate for Payer: Meridian Medicaid |
$33.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.75
|
| Rate for Payer: Nomi Health Commercial |
$147.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.78
|
| Rate for Payer: PACE Senior Care Partners |
$42.68
|
| Rate for Payer: PACE SWMI |
$44.93
|
| Rate for Payer: PHP Commercial |
$152.75
|
| Rate for Payer: PHP Medicare Advantage |
$44.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.35
|
| Rate for Payer: Priority Health Medicare |
$45.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.08
|
| Rate for Payer: Railroad Medicare Medicare |
$44.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.14
|
| Rate for Payer: UHC Core |
$150.06
|
| Rate for Payer: UHC Exchange |
$44.93
|
| Rate for Payer: UHC Medicaid |
$31.68
|
| Rate for Payer: UHC Medicare Advantage |
$44.93
|
| Rate for Payer: UHCCP Medicaid |
$31.68
|
| Rate for Payer: VA VA |
$44.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.78
|
|
|
HC DTAP HEPB IPV VACCINE INTRAMUSCULAR
|
Facility
|
IP
|
$179.71
|
|
|
Service Code
|
CPT 90723
|
| Hospital Charge Code |
63600137
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.08 |
| Max. Negotiated Rate |
$161.74 |
| Rate for Payer: Aetna Commercial |
$152.75
|
| Rate for Payer: BCBS Trust/PPO |
$148.42
|
| Rate for Payer: BCN Commercial |
$148.42
|
| Rate for Payer: Cash Price |
$143.77
|
| Rate for Payer: Cofinity Commercial |
$154.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.77
|
| Rate for Payer: Healthscope Commercial |
$161.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.75
|
| Rate for Payer: Nomi Health Commercial |
$147.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.78
|
| Rate for Payer: PHP Commercial |
$152.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$156.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.14
|
| Rate for Payer: UHC Core |
$150.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.78
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
OP
|
$78.20
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: Aetna Medicare |
$20.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.44
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: BCBS MAPPO |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$64.29
|
| Rate for Payer: BCN Commercial |
$64.29
|
| Rate for Payer: BCN Medicare Advantage |
$19.55
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.65
|
| Rate for Payer: Mclaren Medicaid |
$13.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.53
|
| Rate for Payer: Meridian Medicaid |
$14.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.47
|
| Rate for Payer: Nomi Health Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.65
|
| Rate for Payer: PACE Senior Care Partners |
$18.57
|
| Rate for Payer: PACE SWMI |
$19.55
|
| Rate for Payer: PHP Commercial |
$66.47
|
| Rate for Payer: PHP Medicare Advantage |
$19.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.03
|
| Rate for Payer: Priority Health Medicare |
$19.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.43
|
| Rate for Payer: Railroad Medicare Medicare |
$19.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.82
|
| Rate for Payer: UHC Core |
$65.30
|
| Rate for Payer: UHC Exchange |
$19.55
|
| Rate for Payer: UHC Medicaid |
$13.79
|
| Rate for Payer: UHC Medicare Advantage |
$19.55
|
| Rate for Payer: UHCCP Medicaid |
$13.79
|
| Rate for Payer: VA VA |
$19.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.65
|
|
|
HC DTAP-IPV VACCINE 4-6 YEARS IM
|
Facility
|
IP
|
$78.20
|
|
|
Service Code
|
CPT 90696
|
| Hospital Charge Code |
63600120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$70.38 |
| Rate for Payer: Aetna Commercial |
$66.47
|
| Rate for Payer: BCBS Trust/PPO |
$64.59
|
| Rate for Payer: BCN Commercial |
$64.59
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.56
|
| Rate for Payer: Healthscope Commercial |
$70.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.47
|
| Rate for Payer: Nomi Health Commercial |
$64.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.65
|
| Rate for Payer: PHP Commercial |
$66.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.82
|
| Rate for Payer: UHC Core |
$65.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.65
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
OP
|
$169.79
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: Aetna Medicare |
$44.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.06
|
| Rate for Payer: BCBS Complete |
$31.43
|
| Rate for Payer: BCBS MAPPO |
$42.45
|
| Rate for Payer: BCBS Trust/PPO |
$139.58
|
| Rate for Payer: BCN Commercial |
$139.58
|
| Rate for Payer: BCN Medicare Advantage |
$42.45
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.34
|
| Rate for Payer: Mclaren Medicaid |
$29.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.57
|
| Rate for Payer: Meridian Medicaid |
$31.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Nomi Health Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PACE Senior Care Partners |
$40.33
|
| Rate for Payer: PACE SWMI |
$42.45
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: PHP Medicare Advantage |
$42.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.72
|
| Rate for Payer: Priority Health Medicare |
$42.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.17
|
| Rate for Payer: Railroad Medicare Medicare |
$42.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.42
|
| Rate for Payer: UHC Core |
$141.77
|
| Rate for Payer: UHC Exchange |
$42.45
|
| Rate for Payer: UHC Medicaid |
$29.93
|
| Rate for Payer: UHC Medicare Advantage |
$42.45
|
| Rate for Payer: UHCCP Medicaid |
$29.93
|
| Rate for Payer: VA VA |
$42.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.34
|
|
|
HC DTAP-IVP-HIB-HEPB INTRAMUSCULAR
|
Facility
|
IP
|
$169.79
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
63600207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.17 |
| Max. Negotiated Rate |
$152.81 |
| Rate for Payer: Aetna Commercial |
$144.32
|
| Rate for Payer: BCBS Trust/PPO |
$140.23
|
| Rate for Payer: BCN Commercial |
$140.23
|
| Rate for Payer: Cash Price |
$135.83
|
| Rate for Payer: Cofinity Commercial |
$146.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.83
|
| Rate for Payer: Healthscope Commercial |
$152.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$144.32
|
| Rate for Payer: Nomi Health Commercial |
$139.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.34
|
| Rate for Payer: PHP Commercial |
$144.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$147.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.42
|
| Rate for Payer: UHC Core |
$141.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.34
|
|
|
HC DTPA PER STUDY
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$310.42 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna Commercial |
$379.10
|
| Rate for Payer: BCBS Trust/PPO |
$368.35
|
| Rate for Payer: BCN Commercial |
$368.35
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.80
|
| Rate for Payer: Healthscope Commercial |
$401.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.10
|
| Rate for Payer: Nomi Health Commercial |
$365.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.50
|
| Rate for Payer: PHP Commercial |
$379.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$388.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.48
|
| Rate for Payer: UHC Core |
$372.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.50
|
|
|
HC DTPA PER STUDY
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS A9539
|
| Hospital Charge Code |
34300005
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$78.63 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna Commercial |
$379.10
|
| Rate for Payer: Aetna Medicare |
$115.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.38
|
| Rate for Payer: BCBS Complete |
$82.55
|
| Rate for Payer: BCBS MAPPO |
$111.50
|
| Rate for Payer: BCBS Trust/PPO |
$366.66
|
| Rate for Payer: BCN Commercial |
$366.66
|
| Rate for Payer: BCN Medicare Advantage |
$111.50
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.50
|
| Rate for Payer: Healthscope Commercial |
$401.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.50
|
| Rate for Payer: Mclaren Medicaid |
$78.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.08
|
| Rate for Payer: Meridian Medicaid |
$82.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.10
|
| Rate for Payer: Nomi Health Commercial |
$365.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.50
|
| Rate for Payer: PACE Senior Care Partners |
$105.92
|
| Rate for Payer: PACE SWMI |
$111.50
|
| Rate for Payer: PHP Commercial |
$379.10
|
| Rate for Payer: PHP Medicare Advantage |
$111.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$388.02
|
| Rate for Payer: Priority Health Medicare |
$112.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.42
|
| Rate for Payer: Railroad Medicare Medicare |
$111.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.48
|
| Rate for Payer: UHC Core |
$372.41
|
| Rate for Payer: UHC Exchange |
$111.50
|
| Rate for Payer: UHC Medicaid |
$78.63
|
| Rate for Payer: UHC Medicare Advantage |
$111.50
|
| Rate for Payer: UHCCP Medicaid |
$78.63
|
| Rate for Payer: VA VA |
$111.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.50
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
IP
|
$12,964.56
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,023.33 |
| Max. Negotiated Rate |
$11,668.10 |
| Rate for Payer: Aetna Commercial |
$11,019.88
|
| Rate for Payer: BCBS Trust/PPO |
$10,707.43
|
| Rate for Payer: BCN Commercial |
$10,707.43
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cofinity Commercial |
$11,149.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,371.65
|
| Rate for Payer: Healthscope Commercial |
$11,668.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,723.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,019.88
|
| Rate for Payer: Nomi Health Commercial |
$10,630.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,723.42
|
| Rate for Payer: PHP Commercial |
$11,019.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,279.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,023.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,408.81
|
| Rate for Payer: UHC Core |
$10,825.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,723.42
|
|
|
HC DUAL LEAD INSERTION
|
Facility
|
OP
|
$12,964.56
|
|
|
Service Code
|
CPT 33217
|
| Hospital Charge Code |
36100066
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,285.65 |
| Max. Negotiated Rate |
$11,668.10 |
| Rate for Payer: Aetna Commercial |
$11,019.88
|
| Rate for Payer: Aetna Medicare |
$3,370.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,051.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,051.43
|
| Rate for Payer: BCBS Complete |
$2,399.74
|
| Rate for Payer: BCBS MAPPO |
$3,241.14
|
| Rate for Payer: BCBS Trust/PPO |
$10,658.16
|
| Rate for Payer: BCN Commercial |
$10,658.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,241.14
|
| Rate for Payer: Cash Price |
$10,371.65
|
| Rate for Payer: Cofinity Commercial |
$11,149.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,371.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,241.14
|
| Rate for Payer: Healthscope Commercial |
$11,668.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,723.42
|
| Rate for Payer: Mclaren Medicaid |
$2,285.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,403.20
|
| Rate for Payer: Meridian Medicaid |
$2,399.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,727.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,565.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,019.88
|
| Rate for Payer: Nomi Health Commercial |
$10,630.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,723.42
|
| Rate for Payer: PACE Senior Care Partners |
$3,079.08
|
| Rate for Payer: PACE SWMI |
$3,241.14
|
| Rate for Payer: PHP Commercial |
$11,019.88
|
| Rate for Payer: PHP Medicare Advantage |
$3,241.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,285.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11,279.17
|
| Rate for Payer: Priority Health Medicare |
$3,273.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,023.33
|
| Rate for Payer: Railroad Medicare Medicare |
$3,241.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,408.81
|
| Rate for Payer: UHC Core |
$10,825.41
|
| Rate for Payer: UHC Exchange |
$3,241.14
|
| Rate for Payer: UHC Medicaid |
$2,285.65
|
| Rate for Payer: UHC Medicare Advantage |
$3,241.14
|
| Rate for Payer: UHCCP Medicaid |
$2,285.65
|
| Rate for Payer: VA VA |
$3,241.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,723.42
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC DUCK FEATHERS IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200083
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
OP
|
$4,487.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.19 |
| Max. Negotiated Rate |
$4,038.99 |
| Rate for Payer: Aetna Commercial |
$3,814.60
|
| Rate for Payer: Aetna Medicare |
$1,166.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,402.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,402.43
|
| Rate for Payer: BCBS Complete |
$830.69
|
| Rate for Payer: BCBS MAPPO |
$1,121.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,689.40
|
| Rate for Payer: BCN Commercial |
$3,689.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,121.94
|
| Rate for Payer: Cash Price |
$3,590.22
|
| Rate for Payer: Cofinity Commercial |
$3,859.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,590.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,121.94
|
| Rate for Payer: Healthscope Commercial |
$4,038.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,365.83
|
| Rate for Payer: Mclaren Medicaid |
$791.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,178.04
|
| Rate for Payer: Meridian Medicaid |
$830.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,290.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,234.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.60
|
| Rate for Payer: Nomi Health Commercial |
$3,679.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.83
|
| Rate for Payer: PACE Senior Care Partners |
$1,065.85
|
| Rate for Payer: PACE SWMI |
$1,121.94
|
| Rate for Payer: PHP Commercial |
$3,814.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,121.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$791.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,904.36
|
| Rate for Payer: Priority Health Medicare |
$1,133.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,123.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,121.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,949.24
|
| Rate for Payer: UHC Core |
$3,747.29
|
| Rate for Payer: UHC Exchange |
$1,121.94
|
| Rate for Payer: UHC Medicaid |
$791.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,121.94
|
| Rate for Payer: UHCCP Medicaid |
$791.19
|
| Rate for Payer: VA VA |
$1,121.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,365.83
|
|
|
HC DUODENOSCOPY/COLONOSCOPY
|
Facility
|
IP
|
$4,487.77
|
|
| Hospital Charge Code |
36000033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,123.49 |
| Max. Negotiated Rate |
$4,038.99 |
| Rate for Payer: Aetna Commercial |
$3,814.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,706.45
|
| Rate for Payer: BCN Commercial |
$3,706.45
|
| Rate for Payer: Cash Price |
$3,590.22
|
| Rate for Payer: Cofinity Commercial |
$3,859.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,590.22
|
| Rate for Payer: Healthscope Commercial |
$4,038.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,365.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,814.60
|
| Rate for Payer: Nomi Health Commercial |
$3,679.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,365.83
|
| Rate for Payer: PHP Commercial |
$3,814.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,904.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,123.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,949.24
|
| Rate for Payer: UHC Core |
$3,747.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,365.83
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
OP
|
$2,237.45
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.46 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,901.83
|
| Rate for Payer: Aetna Medicare |
$581.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$699.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$699.20
|
| Rate for Payer: BCBS Complete |
$414.15
|
| Rate for Payer: BCBS MAPPO |
$559.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,839.41
|
| Rate for Payer: BCN Commercial |
$1,839.41
|
| Rate for Payer: BCN Medicare Advantage |
$559.36
|
| Rate for Payer: Cash Price |
$1,789.96
|
| Rate for Payer: Cofinity Commercial |
$1,924.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$559.36
|
| Rate for Payer: Healthscope Commercial |
$2,013.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,678.09
|
| Rate for Payer: Mclaren Medicaid |
$394.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$587.33
|
| Rate for Payer: Meridian Medicaid |
$414.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$643.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$615.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.83
|
| Rate for Payer: Nomi Health Commercial |
$1,834.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.09
|
| Rate for Payer: PACE Senior Care Partners |
$531.39
|
| Rate for Payer: PACE SWMI |
$559.36
|
| Rate for Payer: PHP Commercial |
$1,901.83
|
| Rate for Payer: PHP Medicare Advantage |
$559.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,946.58
|
| Rate for Payer: Priority Health Medicare |
$564.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,557.27
|
| Rate for Payer: Railroad Medicare Medicare |
$559.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,968.96
|
| Rate for Payer: UHC Core |
$1,868.27
|
| Rate for Payer: UHC Exchange |
$559.36
|
| Rate for Payer: UHC Medicaid |
$394.46
|
| Rate for Payer: UHC Medicare Advantage |
$559.36
|
| Rate for Payer: UHCCP Medicaid |
$394.46
|
| Rate for Payer: VA VA |
$559.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,678.09
|
|
|
HC DUODENOSCOPY (EGD)
|
Facility
|
IP
|
$2,237.45
|
|
| Hospital Charge Code |
36000029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,557.27 |
| Max. Negotiated Rate |
$2,013.70 |
| Rate for Payer: Aetna Commercial |
$1,901.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.91
|
| Rate for Payer: BCN Commercial |
$1,847.91
|
| Rate for Payer: Cash Price |
$1,789.96
|
| Rate for Payer: Cofinity Commercial |
$1,924.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,789.96
|
| Rate for Payer: Healthscope Commercial |
$2,013.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,678.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,901.83
|
| Rate for Payer: Nomi Health Commercial |
$1,834.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,678.09
|
| Rate for Payer: PHP Commercial |
$1,901.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,946.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,557.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,968.96
|
| Rate for Payer: UHC Core |
$1,868.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,678.09
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
IP
|
$3,971.88
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,764.43 |
| Max. Negotiated Rate |
$3,574.69 |
| Rate for Payer: Aetna Commercial |
$3,376.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,280.38
|
| Rate for Payer: BCN Commercial |
$3,280.38
|
| Rate for Payer: Cash Price |
$3,177.50
|
| Rate for Payer: Cofinity Commercial |
$3,415.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,177.50
|
| Rate for Payer: Healthscope Commercial |
$3,574.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,978.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,376.10
|
| Rate for Payer: Nomi Health Commercial |
$3,256.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,978.91
|
| Rate for Payer: PHP Commercial |
$3,376.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,455.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,764.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,495.25
|
| Rate for Payer: UHC Core |
$3,316.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,978.91
|
|
|
HC DUODENUM/FLEX SIGMOID
|
Facility
|
OP
|
$3,971.88
|
|
| Hospital Charge Code |
36000034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.24 |
| Max. Negotiated Rate |
$3,574.69 |
| Rate for Payer: Aetna Commercial |
$3,376.10
|
| Rate for Payer: Aetna Medicare |
$1,032.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,241.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,241.21
|
| Rate for Payer: BCBS Complete |
$735.19
|
| Rate for Payer: BCBS MAPPO |
$992.97
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.28
|
| Rate for Payer: BCN Commercial |
$3,265.28
|
| Rate for Payer: BCN Medicare Advantage |
$992.97
|
| Rate for Payer: Cash Price |
$3,177.50
|
| Rate for Payer: Cofinity Commercial |
$3,415.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.97
|
| Rate for Payer: Healthscope Commercial |
$3,574.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,978.91
|
| Rate for Payer: Mclaren Medicaid |
$700.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.62
|
| Rate for Payer: Meridian Medicaid |
$735.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,141.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,092.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,376.10
|
| Rate for Payer: Nomi Health Commercial |
$3,256.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,978.91
|
| Rate for Payer: PACE Senior Care Partners |
$943.32
|
| Rate for Payer: PACE SWMI |
$992.97
|
| Rate for Payer: PHP Commercial |
$3,376.10
|
| Rate for Payer: PHP Medicare Advantage |
$992.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,455.54
|
| Rate for Payer: Priority Health Medicare |
$1,002.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,764.43
|
| Rate for Payer: Railroad Medicare Medicare |
$992.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,495.25
|
| Rate for Payer: UHC Core |
$3,316.52
|
| Rate for Payer: UHC Exchange |
$992.97
|
| Rate for Payer: UHC Medicaid |
$700.24
|
| Rate for Payer: UHC Medicare Advantage |
$992.97
|
| Rate for Payer: UHCCP Medicaid |
$700.24
|
| Rate for Payer: VA VA |
$992.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,978.91
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
IP
|
$48.68
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.51
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.84
|
| Rate for Payer: UHC Core |
$40.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.51
|
|
|
HC DUODERM CGF 4X4
|
Facility
|
OP
|
$48.68
|
|
| Hospital Charge Code |
27100010
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$43.81 |
| Rate for Payer: Aetna Commercial |
$41.38
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.21
|
| Rate for Payer: BCBS Complete |
$9.01
|
| Rate for Payer: BCBS MAPPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$40.02
|
| Rate for Payer: BCN Commercial |
$40.02
|
| Rate for Payer: BCN Medicare Advantage |
$12.17
|
| Rate for Payer: Cash Price |
$38.94
|
| Rate for Payer: Cofinity Commercial |
$41.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$43.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.51
|
| Rate for Payer: Mclaren Medicaid |
$8.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.78
|
| Rate for Payer: Meridian Medicaid |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.38
|
| Rate for Payer: Nomi Health Commercial |
$39.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.51
|
| Rate for Payer: PACE Senior Care Partners |
$11.56
|
| Rate for Payer: PACE SWMI |
$12.17
|
| Rate for Payer: PHP Commercial |
$41.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.35
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.84
|
| Rate for Payer: UHC Core |
$40.65
|
| Rate for Payer: UHC Exchange |
$12.17
|
| Rate for Payer: UHC Medicaid |
$8.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.17
|
| Rate for Payer: UHCCP Medicaid |
$8.58
|
| Rate for Payer: VA VA |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.51
|
|
|
HC DUODERM CGF 6X6
|
Facility
|
OP
|
$77.11
|
|
| Hospital Charge Code |
27100011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.59 |
| Max. Negotiated Rate |
$69.40 |
| Rate for Payer: Aetna Commercial |
$65.54
|
| Rate for Payer: Aetna Medicare |
$20.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.10
|
| Rate for Payer: BCBS Complete |
$14.27
|
| Rate for Payer: BCBS MAPPO |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$63.39
|
| Rate for Payer: BCN Commercial |
$63.39
|
| Rate for Payer: BCN Medicare Advantage |
$19.28
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cofinity Commercial |
$66.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$69.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.83
|
| Rate for Payer: Mclaren Medicaid |
$13.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.24
|
| Rate for Payer: Meridian Medicaid |
$14.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.83
|
| Rate for Payer: PACE Senior Care Partners |
$18.31
|
| Rate for Payer: PACE SWMI |
$19.28
|
| Rate for Payer: PHP Commercial |
$65.54
|
| Rate for Payer: PHP Medicare Advantage |
$19.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.09
|
| Rate for Payer: Priority Health Medicare |
$19.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: Railroad Medicare Medicare |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.86
|
| Rate for Payer: UHC Core |
$64.39
|
| Rate for Payer: UHC Exchange |
$19.28
|
| Rate for Payer: UHC Medicaid |
$13.59
|
| Rate for Payer: UHC Medicare Advantage |
$19.28
|
| Rate for Payer: UHCCP Medicaid |
$13.59
|
| Rate for Payer: VA VA |
$19.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.83
|
|
