|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
IP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,263.68 |
| Max. Negotiated Rate |
$1,749.71 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.99
|
| Rate for Payer: BCN Commercial |
$1,502.42
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,691.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,710.83
|
| Rate for Payer: UHC Core |
$1,623.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION BILIARY DUCT WO STENT
|
Facility
|
OP
|
$1,944.12
|
|
|
Service Code
|
CPT 47555
|
| Hospital Charge Code |
36100208
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$461.73 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$1,652.50
|
| Rate for Payer: Aetna Medicare |
$505.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$607.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$607.54
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$486.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,598.26
|
| Rate for Payer: BCN Commercial |
$1,511.55
|
| Rate for Payer: BCN Medicare Advantage |
$486.03
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cash Price |
$1,555.30
|
| Rate for Payer: Cofinity Commercial |
$1,671.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,555.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.03
|
| Rate for Payer: Healthscope Commercial |
$1,749.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.09
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.33
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$558.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,652.50
|
| Rate for Payer: Nomi Health Commercial |
$1,594.18
|
| Rate for Payer: PACE Senior Care Partners |
$461.73
|
| Rate for Payer: PACE SWMI |
$486.03
|
| Rate for Payer: PHP Commercial |
$1,652.50
|
| Rate for Payer: PHP Medicare Advantage |
$486.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,691.38
|
| Rate for Payer: Priority Health Medicare |
$490.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.56
|
| Rate for Payer: Railroad Medicare Medicare |
$486.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,710.83
|
| Rate for Payer: UHC Core |
$1,623.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.03
|
| Rate for Payer: UHC Exchange |
$486.03
|
| Rate for Payer: UHC Medicare Advantage |
$486.03
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$486.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.09
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
OP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,886.57 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: Aetna Medicare |
$2,065.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,482.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,482.33
|
| Rate for Payer: BCBS Complete |
$2,413.90
|
| Rate for Payer: BCBS MAPPO |
$1,985.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,530.31
|
| Rate for Payer: BCN Commercial |
$6,176.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,985.86
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,985.86
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Mclaren Medicaid |
$2,298.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.16
|
| Rate for Payer: Meridian Medicaid |
$2,413.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,283.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: PACE Senior Care Partners |
$1,886.57
|
| Rate for Payer: PACE SWMI |
$1,985.86
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,985.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO |
$6,910.80
|
| Rate for Payer: Priority Health Medicare |
$2,005.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,985.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,990.24
|
| Rate for Payer: UHC Core |
$6,632.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,985.86
|
| Rate for Payer: UHC Exchange |
$1,985.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,985.86
|
| Rate for Payer: UHCCP Medicaid |
$2,298.80
|
| Rate for Payer: VA VA |
$1,985.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION CERVICAL CANAL
|
Facility
|
IP
|
$7,943.45
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
36000112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,163.24 |
| Max. Negotiated Rate |
$7,149.10 |
| Rate for Payer: Aetna Commercial |
$6,751.93
|
| Rate for Payer: BCBS Trust/PPO |
$6,484.24
|
| Rate for Payer: BCN Commercial |
$6,138.70
|
| Rate for Payer: Cash Price |
$6,354.76
|
| Rate for Payer: Cofinity Commercial |
$6,831.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,354.76
|
| Rate for Payer: Healthscope Commercial |
$7,149.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,957.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,751.93
|
| Rate for Payer: Nomi Health Commercial |
$6,513.63
|
| Rate for Payer: PHP Commercial |
$6,751.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,163.24
|
| Rate for Payer: Priority Health HMO/PPO |
$6,910.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,322.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,990.24
|
| Rate for Payer: UHC Core |
$6,632.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,957.59
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
IP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.34 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: BCBS Trust/PPO |
$176.25
|
| Rate for Payer: BCN Commercial |
$166.86
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO |
$187.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.00
|
| Rate for Payer: UHC Core |
$180.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRA, INITIAL
|
Facility
|
OP
|
$215.91
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
76100266
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$194.32 |
| Rate for Payer: Aetna Commercial |
$183.52
|
| Rate for Payer: Aetna Medicare |
$56.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.47
|
| Rate for Payer: BCBS Complete |
$118.78
|
| Rate for Payer: BCBS MAPPO |
$53.98
|
| Rate for Payer: BCBS Trust/PPO |
$177.50
|
| Rate for Payer: BCN Commercial |
$167.87
|
| Rate for Payer: BCN Medicare Advantage |
$53.98
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cash Price |
$172.73
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.98
|
| Rate for Payer: Healthscope Commercial |
$194.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.93
|
| Rate for Payer: Mclaren Medicaid |
$113.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.68
|
| Rate for Payer: Meridian Medicaid |
$118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.52
|
| Rate for Payer: Nomi Health Commercial |
$177.05
|
| Rate for Payer: PACE Senior Care Partners |
$51.28
|
| Rate for Payer: PACE SWMI |
$53.98
|
| Rate for Payer: PHP Commercial |
$183.52
|
| Rate for Payer: PHP Medicare Advantage |
$53.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.34
|
| Rate for Payer: Priority Health HMO/PPO |
$187.84
|
| Rate for Payer: Priority Health Medicare |
$54.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.66
|
| Rate for Payer: Railroad Medicare Medicare |
$53.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.00
|
| Rate for Payer: UHC Core |
$180.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.98
|
| Rate for Payer: UHC Exchange |
$53.98
|
| Rate for Payer: UHC Medicare Advantage |
$53.98
|
| Rate for Payer: UHCCP Medicaid |
$113.12
|
| Rate for Payer: VA VA |
$53.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.93
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
OP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Medicare |
$95.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.56
|
| Rate for Payer: BCBS Complete |
$184.65
|
| Rate for Payer: BCBS MAPPO |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$301.37
|
| Rate for Payer: BCN Commercial |
$285.02
|
| Rate for Payer: BCN Medicare Advantage |
$91.65
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.65
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Mclaren Medicaid |
$175.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.23
|
| Rate for Payer: Meridian Medicaid |
$184.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: PACE Senior Care Partners |
$87.07
|
| Rate for Payer: PACE SWMI |
$91.65
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: PHP Medicare Advantage |
$91.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO |
$318.93
|
| Rate for Payer: Priority Health Medicare |
$92.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: Railroad Medicare Medicare |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.60
|
| Rate for Payer: UHC Core |
$306.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.65
|
| Rate for Payer: UHC Exchange |
$91.65
|
| Rate for Payer: UHC Medicare Advantage |
$91.65
|
| Rate for Payer: UHCCP Medicaid |
$175.84
|
| Rate for Payer: VA VA |
$91.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATION URETHRAL STRICTURE MALE
|
Facility
|
IP
|
$366.59
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
76100231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$329.93 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: BCBS Trust/PPO |
$299.25
|
| Rate for Payer: BCN Commercial |
$283.30
|
| Rate for Payer: Cash Price |
$293.27
|
| Rate for Payer: Cofinity Commercial |
$315.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.27
|
| Rate for Payer: Healthscope Commercial |
$329.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.60
|
| Rate for Payer: Nomi Health Commercial |
$300.60
|
| Rate for Payer: PHP Commercial |
$311.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.28
|
| Rate for Payer: Priority Health HMO/PPO |
$318.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.60
|
| Rate for Payer: UHC Core |
$306.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.94
|
|
|
HC DILATOR SIZE 12
|
Facility
|
OP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.80
|
| Rate for Payer: BCBS Complete |
$13.83
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$26.88
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: PACE Senior Care Partners |
$8.21
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO |
$30.08
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Core |
$28.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Exchange |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: VA VA |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 12
|
Facility
|
IP
|
$34.57
|
|
| Hospital Charge Code |
27000055
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$31.11 |
| Rate for Payer: Aetna Commercial |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$28.22
|
| Rate for Payer: BCN Commercial |
$26.72
|
| Rate for Payer: Cash Price |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$29.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.66
|
| Rate for Payer: Healthscope Commercial |
$31.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$28.35
|
| Rate for Payer: PHP Commercial |
$29.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO |
$30.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.42
|
| Rate for Payer: UHC Core |
$28.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.93
|
|
|
HC DILATOR SIZE 7
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$19.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.33
|
| Rate for Payer: UHC Exchange |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 7
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
OP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$19.67
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.33
|
| Rate for Payer: UHC Exchange |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DILATOR SIZE 9
|
Facility
|
IP
|
$25.30
|
|
| Hospital Charge Code |
27000057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: Aetna Commercial |
$21.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.65
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: Cash Price |
$20.24
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.24
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.50
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PHP Commercial |
$21.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.26
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
IP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,968.78 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,728.34
|
| Rate for Payer: BCN Commercial |
$3,529.66
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,973.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,060.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,019.28
|
| Rate for Payer: UHC Core |
$3,813.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
|
HC DIL PERC EXISTING TRACT INCLUDE NEW ACCESS
|
Facility
|
OP
|
$4,567.36
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
32000329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,084.75 |
| Max. Negotiated Rate |
$4,110.62 |
| Rate for Payer: Aetna Commercial |
$3,882.26
|
| Rate for Payer: Aetna Medicare |
$1,187.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,427.30
|
| Rate for Payer: BCBS Complete |
$2,618.46
|
| Rate for Payer: BCBS MAPPO |
$1,141.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,754.83
|
| Rate for Payer: BCN Commercial |
$3,551.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,141.84
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cash Price |
$3,653.89
|
| Rate for Payer: Cofinity Commercial |
$3,927.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,653.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,141.84
|
| Rate for Payer: Healthscope Commercial |
$4,110.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,425.52
|
| Rate for Payer: Mclaren Medicaid |
$2,493.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,198.93
|
| Rate for Payer: Meridian Medicaid |
$2,618.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,313.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,882.26
|
| Rate for Payer: Nomi Health Commercial |
$3,745.24
|
| Rate for Payer: PACE Senior Care Partners |
$1,084.75
|
| Rate for Payer: PACE SWMI |
$1,141.84
|
| Rate for Payer: PHP Commercial |
$3,882.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,141.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,493.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,968.78
|
| Rate for Payer: Priority Health HMO/PPO |
$3,973.60
|
| Rate for Payer: Priority Health Medicare |
$1,153.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,060.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,019.28
|
| Rate for Payer: UHC Core |
$3,813.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,141.84
|
| Rate for Payer: UHC Exchange |
$1,141.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,141.84
|
| Rate for Payer: UHCCP Medicaid |
$2,493.61
|
| Rate for Payer: VA VA |
$1,141.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,425.52
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
OP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.58
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.18
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$37.32
|
| Rate for Payer: BCN Commercial |
$35.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.35
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.35
|
| Rate for Payer: Healthscope Commercial |
$40.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.04
|
| Rate for Payer: Mclaren Medicaid |
$10.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.91
|
| Rate for Payer: Meridian Medicaid |
$11.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: PACE Senior Care Partners |
$10.78
|
| Rate for Payer: PACE SWMI |
$11.35
|
| Rate for Payer: PHP Commercial |
$38.58
|
| Rate for Payer: PHP Medicare Advantage |
$11.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: Priority Health HMO/PPO |
$39.49
|
| Rate for Payer: Priority Health Medicare |
$11.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.41
|
| Rate for Payer: Railroad Medicare Medicare |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.94
|
| Rate for Payer: UHC Core |
$37.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.35
|
| Rate for Payer: UHC Exchange |
$11.35
|
| Rate for Payer: UHC Medicare Advantage |
$11.35
|
| Rate for Payer: UHCCP Medicaid |
$10.84
|
| Rate for Payer: VA VA |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.04
|
|
|
HC DIPHTHERIA/TETANUS AB PANEL, S
|
Facility
|
IP
|
$45.39
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
30200506
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.50 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.58
|
| Rate for Payer: BCBS Trust/PPO |
$37.05
|
| Rate for Payer: BCN Commercial |
$35.08
|
| Rate for Payer: Cash Price |
$36.31
|
| Rate for Payer: Cofinity Commercial |
$39.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.31
|
| Rate for Payer: Healthscope Commercial |
$40.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.58
|
| Rate for Payer: Nomi Health Commercial |
$37.22
|
| Rate for Payer: PHP Commercial |
$38.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.50
|
| Rate for Payer: Priority Health HMO/PPO |
$39.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.94
|
| Rate for Payer: UHC Core |
$37.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.04
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
IP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: BCBS Trust/PPO |
$100.89
|
| Rate for Payer: BCN Commercial |
$95.52
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health HMO/PPO |
$107.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.77
|
| Rate for Payer: UHC Core |
$103.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.70
|
|
|
HC DIP, TET TOX, HAEMO INFLU TYPE B, INACTIV POLIO VAC, (DTAP-IPV/HIB) IM
|
Facility
|
OP
|
$123.60
|
|
|
Service Code
|
CPT 90698
|
| Hospital Charge Code |
63600080
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.36 |
| Max. Negotiated Rate |
$111.24 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$32.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.62
|
| Rate for Payer: BCBS Complete |
$49.44
|
| Rate for Payer: BCBS MAPPO |
$30.90
|
| Rate for Payer: BCBS Trust/PPO |
$101.61
|
| Rate for Payer: BCN Commercial |
$96.10
|
| Rate for Payer: BCN Medicare Advantage |
$30.90
|
| Rate for Payer: Cash Price |
$98.88
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$111.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.06
|
| Rate for Payer: Nomi Health Commercial |
$101.35
|
| Rate for Payer: PACE Senior Care Partners |
$29.36
|
| Rate for Payer: PACE SWMI |
$30.90
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: PHP Medicare Advantage |
$30.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.34
|
| Rate for Payer: Priority Health HMO/PPO |
$107.53
|
| Rate for Payer: Priority Health Medicare |
$31.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.81
|
| Rate for Payer: Railroad Medicare Medicare |
$30.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.77
|
| Rate for Payer: UHC Core |
$103.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.90
|
| Rate for Payer: UHC Exchange |
$30.90
|
| Rate for Payer: UHC Medicare Advantage |
$30.90
|
| Rate for Payer: VA VA |
$30.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.70
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
OP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.77 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.81
|
| Rate for Payer: BCBS Complete |
$21.51
|
| Rate for Payer: BCBS MAPPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$44.21
|
| Rate for Payer: BCN Commercial |
$41.81
|
| Rate for Payer: BCN Medicare Advantage |
$13.45
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.45
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: PACE Senior Care Partners |
$12.77
|
| Rate for Payer: PACE SWMI |
$13.45
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: PHP Medicare Advantage |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO |
$46.79
|
| Rate for Payer: Priority Health Medicare |
$13.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.03
|
| Rate for Payer: Railroad Medicare Medicare |
$13.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.33
|
| Rate for Payer: UHC Core |
$44.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.45
|
| Rate for Payer: UHC Exchange |
$13.45
|
| Rate for Payer: UHC Medicare Advantage |
$13.45
|
| Rate for Payer: VA VA |
$13.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.34
|
|
|
HC DIPTH, TET TOX, AND ACELLUEAR PERTUSSIS VAC (DTAP), LESS THAN 7 YRS IM
|
Facility
|
IP
|
$53.78
|
|
|
Service Code
|
CPT 90700
|
| Hospital Charge Code |
63600081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$48.40 |
| Rate for Payer: Aetna Commercial |
$45.71
|
| Rate for Payer: BCBS Trust/PPO |
$43.90
|
| Rate for Payer: BCN Commercial |
$41.56
|
| Rate for Payer: Cash Price |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$46.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.02
|
| Rate for Payer: Healthscope Commercial |
$48.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.71
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: PHP Commercial |
$45.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.96
|
| Rate for Payer: Priority Health HMO/PPO |
$46.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.33
|
| Rate for Payer: UHC Core |
$44.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.34
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
IP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$100.64 |
| Max. Negotiated Rate |
$139.35 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: BCBS Trust/PPO |
$126.39
|
| Rate for Payer: BCN Commercial |
$119.65
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC DIRECT ADMIT TO OBS
|
Facility
|
OP
|
$154.83
|
|
|
Service Code
|
HCPCS G0379
|
| Hospital Charge Code |
76200001
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$465.47 |
| Rate for Payer: Aetna Commercial |
$131.61
|
| Rate for Payer: Aetna Medicare |
$40.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.38
|
| Rate for Payer: BCBS Complete |
$465.47
|
| Rate for Payer: BCBS MAPPO |
$38.71
|
| Rate for Payer: BCBS Trust/PPO |
$127.29
|
| Rate for Payer: BCN Commercial |
$120.38
|
| Rate for Payer: BCN Medicare Advantage |
$38.71
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cash Price |
$123.86
|
| Rate for Payer: Cofinity Commercial |
$133.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$139.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.12
|
| Rate for Payer: Mclaren Medicaid |
$443.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.64
|
| Rate for Payer: Meridian Medicaid |
$465.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.61
|
| Rate for Payer: Nomi Health Commercial |
$126.96
|
| Rate for Payer: PACE Senior Care Partners |
$36.77
|
| Rate for Payer: PACE SWMI |
$38.71
|
| Rate for Payer: PHP Commercial |
$131.61
|
| Rate for Payer: PHP Medicare Advantage |
$38.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.64
|
| Rate for Payer: Priority Health HMO/PPO |
$134.70
|
| Rate for Payer: Priority Health Medicare |
$39.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.74
|
| Rate for Payer: Railroad Medicare Medicare |
$38.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.25
|
| Rate for Payer: UHC Core |
$129.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.71
|
| Rate for Payer: UHC Exchange |
$38.71
|
| Rate for Payer: UHC Medicare Advantage |
$38.71
|
| Rate for Payer: UHCCP Medicaid |
$443.27
|
| Rate for Payer: VA VA |
$38.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.12
|
|
|
HC DIRECT COOMBS
|
Facility
|
OP
|
$65.65
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
30200343
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$59.09 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Medicare |
$17.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.52
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS MAPPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$53.97
|
| Rate for Payer: BCN Commercial |
$51.04
|
| Rate for Payer: BCN Medicare Advantage |
$16.41
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cash Price |
$52.52
|
| Rate for Payer: Cofinity Commercial |
$56.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.41
|
| Rate for Payer: Healthscope Commercial |
$59.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.24
|
| Rate for Payer: Mclaren Medicaid |
$3.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.23
|
| Rate for Payer: Meridian Medicaid |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.80
|
| Rate for Payer: Nomi Health Commercial |
$53.83
|
| Rate for Payer: PACE Senior Care Partners |
$15.59
|
| Rate for Payer: PACE SWMI |
$16.41
|
| Rate for Payer: PHP Commercial |
$55.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.67
|
| Rate for Payer: Priority Health HMO/PPO |
$57.12
|
| Rate for Payer: Priority Health Medicare |
$16.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.99
|
| Rate for Payer: Railroad Medicare Medicare |
$16.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.77
|
| Rate for Payer: UHC Core |
$54.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.41
|
| Rate for Payer: UHC Exchange |
$16.41
|
| Rate for Payer: UHC Medicare Advantage |
$16.41
|
| Rate for Payer: UHCCP Medicaid |
$3.90
|
| Rate for Payer: VA VA |
$16.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.24
|
|
