|
HC EXTENSION KIT
|
Facility
|
OP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.60 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: Aetna Medicare |
$528.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.99
|
| Rate for Payer: BCBS Complete |
$812.79
|
| Rate for Payer: BCBS MAPPO |
$508.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.49
|
| Rate for Payer: BCN Commercial |
$1,579.86
|
| Rate for Payer: BCN Medicare Advantage |
$508.00
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.00
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$584.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: PACE Senior Care Partners |
$482.60
|
| Rate for Payer: PACE SWMI |
$508.00
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: PHP Medicare Advantage |
$508.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.82
|
| Rate for Payer: Priority Health Medicare |
$513.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.43
|
| Rate for Payer: Railroad Medicare Medicare |
$508.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.14
|
| Rate for Payer: UHC Core |
$1,696.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.00
|
| Rate for Payer: UHC Exchange |
$508.00
|
| Rate for Payer: UHC Medicare Advantage |
$508.00
|
| Rate for Payer: VA VA |
$508.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.98
|
|
|
HC EXTENSION KIT
|
Facility
|
IP
|
$2,031.98
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,320.79 |
| Max. Negotiated Rate |
$1,828.78 |
| Rate for Payer: Aetna Commercial |
$1,727.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.71
|
| Rate for Payer: BCN Commercial |
$1,570.31
|
| Rate for Payer: Cash Price |
$1,625.58
|
| Rate for Payer: Cofinity Commercial |
$1,747.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.58
|
| Rate for Payer: Healthscope Commercial |
$1,828.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.18
|
| Rate for Payer: Nomi Health Commercial |
$1,666.22
|
| Rate for Payer: PHP Commercial |
$1,727.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.79
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,788.14
|
| Rate for Payer: UHC Core |
$1,696.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.98
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
OP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.03 |
| Max. Negotiated Rate |
$2,133.59 |
| Rate for Payer: Aetna Commercial |
$2,015.06
|
| Rate for Payer: Aetna Medicare |
$616.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$740.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$740.83
|
| Rate for Payer: BCBS Complete |
$948.26
|
| Rate for Payer: BCBS MAPPO |
$592.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,948.92
|
| Rate for Payer: BCN Commercial |
$1,843.19
|
| Rate for Payer: BCN Medicare Advantage |
$592.66
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,038.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.66
|
| Rate for Payer: Healthscope Commercial |
$2,133.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,778.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$681.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: PACE Senior Care Partners |
$563.03
|
| Rate for Payer: PACE SWMI |
$592.66
|
| Rate for Payer: PHP Commercial |
$2,015.06
|
| Rate for Payer: PHP Medicare Advantage |
$592.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2,062.47
|
| Rate for Payer: Priority Health Medicare |
$598.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,588.34
|
| Rate for Payer: Railroad Medicare Medicare |
$592.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,086.18
|
| Rate for Payer: UHC Core |
$1,979.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.66
|
| Rate for Payer: UHC Exchange |
$592.66
|
| Rate for Payer: UHC Medicare Advantage |
$592.66
|
| Rate for Payer: VA VA |
$592.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,778.00
|
|
|
HC EXTENSION ST JUDE
|
Facility
|
IP
|
$2,370.66
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27800053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,540.93 |
| Max. Negotiated Rate |
$2,133.59 |
| Rate for Payer: Aetna Commercial |
$2,015.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.17
|
| Rate for Payer: BCN Commercial |
$1,832.05
|
| Rate for Payer: Cash Price |
$1,896.53
|
| Rate for Payer: Cofinity Commercial |
$2,038.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,896.53
|
| Rate for Payer: Healthscope Commercial |
$2,133.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,778.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,015.06
|
| Rate for Payer: Nomi Health Commercial |
$1,943.94
|
| Rate for Payer: PHP Commercial |
$2,015.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,540.93
|
| Rate for Payer: Priority Health HMO/PPO |
$2,062.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,588.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,086.18
|
| Rate for Payer: UHC Core |
$1,979.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,778.00
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
OP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$82.02 |
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: Aetna Medicare |
$23.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.48
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$22.78
|
| Rate for Payer: BCBS Trust/PPO |
$74.92
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: BCN Medicare Advantage |
$22.78
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.78
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Mclaren Medicaid |
$27.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.92
|
| Rate for Payer: Meridian Medicaid |
$29.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PACE Senior Care Partners |
$21.64
|
| Rate for Payer: PACE SWMI |
$22.78
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: PHP Medicare Advantage |
$22.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO |
$79.28
|
| Rate for Payer: Priority Health Medicare |
$23.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.06
|
| Rate for Payer: Railroad Medicare Medicare |
$22.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.19
|
| Rate for Payer: UHC Core |
$76.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.78
|
| Rate for Payer: UHC Exchange |
$22.78
|
| Rate for Payer: UHC Medicare Advantage |
$22.78
|
| Rate for Payer: UHCCP Medicaid |
$27.81
|
| Rate for Payer: VA VA |
$22.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
HC EXTERNAL EKG RECORDIN >48 HRS UP TO 7 DAYS
|
Facility
|
IP
|
$91.13
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
48000030
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$59.23 |
| Max. Negotiated Rate |
$82.02 |
| Rate for Payer: Aetna Commercial |
$77.46
|
| Rate for Payer: BCBS Trust/PPO |
$74.39
|
| Rate for Payer: BCN Commercial |
$70.43
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cofinity Commercial |
$78.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$82.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.46
|
| Rate for Payer: Nomi Health Commercial |
$74.73
|
| Rate for Payer: PHP Commercial |
$77.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.23
|
| Rate for Payer: Priority Health HMO/PPO |
$79.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.19
|
| Rate for Payer: UHC Core |
$76.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.35
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
IP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$123.65 |
| Rate for Payer: Aetna Commercial |
$116.78
|
| Rate for Payer: BCBS Trust/PPO |
$112.15
|
| Rate for Payer: BCN Commercial |
$106.17
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$118.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Healthscope Commercial |
$123.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PHP Commercial |
$116.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO |
$119.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Core |
$114.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.04
|
|
|
HC EXTERNAL EKG RECORDING >7 DAYS UP TO 15 DAYS
|
Facility
|
OP
|
$137.39
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
48000031
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$123.65 |
| Rate for Payer: Aetna Commercial |
$116.78
|
| Rate for Payer: Aetna Medicare |
$35.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.93
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$34.35
|
| Rate for Payer: BCBS Trust/PPO |
$112.95
|
| Rate for Payer: BCN Commercial |
$106.82
|
| Rate for Payer: BCN Medicare Advantage |
$34.35
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cash Price |
$109.91
|
| Rate for Payer: Cofinity Commercial |
$118.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.35
|
| Rate for Payer: Healthscope Commercial |
$123.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.04
|
| Rate for Payer: Mclaren Medicaid |
$27.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.06
|
| Rate for Payer: Meridian Medicaid |
$29.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.78
|
| Rate for Payer: Nomi Health Commercial |
$112.66
|
| Rate for Payer: PACE Senior Care Partners |
$32.63
|
| Rate for Payer: PACE SWMI |
$34.35
|
| Rate for Payer: PHP Commercial |
$116.78
|
| Rate for Payer: PHP Medicare Advantage |
$34.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.30
|
| Rate for Payer: Priority Health HMO/PPO |
$119.53
|
| Rate for Payer: Priority Health Medicare |
$34.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.05
|
| Rate for Payer: Railroad Medicare Medicare |
$34.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.90
|
| Rate for Payer: UHC Core |
$114.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.35
|
| Rate for Payer: UHC Exchange |
$34.35
|
| Rate for Payer: UHC Medicare Advantage |
$34.35
|
| Rate for Payer: UHCCP Medicaid |
$27.81
|
| Rate for Payer: VA VA |
$34.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.04
|
|
|
HC EXTERNAL PACER
|
Facility
|
IP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$374.68 |
| Max. Negotiated Rate |
$518.79 |
| Rate for Payer: Aetna Commercial |
$489.97
|
| Rate for Payer: BCBS Trust/PPO |
$470.54
|
| Rate for Payer: BCN Commercial |
$445.47
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$495.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Healthscope Commercial |
$518.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: PHP Commercial |
$489.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: Priority Health HMO/PPO |
$501.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.26
|
| Rate for Payer: UHC Core |
$481.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.32
|
|
|
HC EXTERNAL PACER
|
Facility
|
OP
|
$576.43
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
48000001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$136.90 |
| Max. Negotiated Rate |
$518.79 |
| Rate for Payer: Aetna Commercial |
$489.97
|
| Rate for Payer: Aetna Medicare |
$149.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.13
|
| Rate for Payer: BCBS Complete |
$486.76
|
| Rate for Payer: BCBS MAPPO |
$144.11
|
| Rate for Payer: BCBS Trust/PPO |
$473.88
|
| Rate for Payer: BCN Commercial |
$448.17
|
| Rate for Payer: BCN Medicare Advantage |
$144.11
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cash Price |
$461.14
|
| Rate for Payer: Cofinity Commercial |
$495.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.11
|
| Rate for Payer: Healthscope Commercial |
$518.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.32
|
| Rate for Payer: Mclaren Medicaid |
$463.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.31
|
| Rate for Payer: Meridian Medicaid |
$486.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.97
|
| Rate for Payer: Nomi Health Commercial |
$472.67
|
| Rate for Payer: PACE Senior Care Partners |
$136.90
|
| Rate for Payer: PACE SWMI |
$144.11
|
| Rate for Payer: PHP Commercial |
$489.97
|
| Rate for Payer: PHP Medicare Advantage |
$144.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.68
|
| Rate for Payer: Priority Health HMO/PPO |
$501.49
|
| Rate for Payer: Priority Health Medicare |
$145.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.21
|
| Rate for Payer: Railroad Medicare Medicare |
$144.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.26
|
| Rate for Payer: UHC Core |
$481.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.11
|
| Rate for Payer: UHC Exchange |
$144.11
|
| Rate for Payer: UHC Medicare Advantage |
$144.11
|
| Rate for Payer: UHCCP Medicaid |
$463.55
|
| Rate for Payer: VA VA |
$144.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.32
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,844.91 |
| Max. Negotiated Rate |
$2,554.49 |
| Rate for Payer: Aetna Commercial |
$2,412.57
|
| Rate for Payer: BCBS Trust/PPO |
$2,316.92
|
| Rate for Payer: BCN Commercial |
$2,193.45
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,440.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Healthscope Commercial |
$2,554.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,128.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: PHP Commercial |
$2,412.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: Priority Health HMO/PPO |
$2,469.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,901.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,497.72
|
| Rate for Payer: UHC Core |
$2,370.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,128.74
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$2,838.32
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
36100121
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$674.10 |
| Max. Negotiated Rate |
$2,554.49 |
| Rate for Payer: Aetna Commercial |
$2,412.57
|
| Rate for Payer: Aetna Medicare |
$737.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$886.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$886.98
|
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: BCBS MAPPO |
$709.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,333.38
|
| Rate for Payer: BCN Commercial |
$2,206.79
|
| Rate for Payer: BCN Medicare Advantage |
$709.58
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cash Price |
$2,270.66
|
| Rate for Payer: Cofinity Commercial |
$2,440.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,270.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.58
|
| Rate for Payer: Healthscope Commercial |
$2,554.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,128.74
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$745.06
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$816.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,412.57
|
| Rate for Payer: Nomi Health Commercial |
$2,327.42
|
| Rate for Payer: PACE Senior Care Partners |
$674.10
|
| Rate for Payer: PACE SWMI |
$709.58
|
| Rate for Payer: PHP Commercial |
$2,412.57
|
| Rate for Payer: PHP Medicare Advantage |
$709.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.91
|
| Rate for Payer: Priority Health HMO/PPO |
$2,469.34
|
| Rate for Payer: Priority Health Medicare |
$716.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,901.67
|
| Rate for Payer: Railroad Medicare Medicare |
$709.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,497.72
|
| Rate for Payer: UHC Core |
$2,370.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.58
|
| Rate for Payer: UHC Exchange |
$709.58
|
| Rate for Payer: UHC Medicare Advantage |
$709.58
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
| Rate for Payer: VA VA |
$709.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,128.74
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
IP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.95 |
| Max. Negotiated Rate |
$351.62 |
| Rate for Payer: Aetna Commercial |
$332.09
|
| Rate for Payer: BCBS Trust/PPO |
$318.92
|
| Rate for Payer: BCN Commercial |
$301.93
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$335.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Healthscope Commercial |
$351.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: PHP Commercial |
$332.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: Priority Health HMO/PPO |
$339.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.81
|
| Rate for Payer: UHC Core |
$326.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.02
|
|
|
HC EXTRAORAL INC AND DRAIN ABSC, CYST, HEMATOMA FLOOR OF MOUTH SUBLING
|
Facility
|
OP
|
$390.69
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
76100137
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.79 |
| Max. Negotiated Rate |
$378.80 |
| Rate for Payer: Aetna Commercial |
$332.09
|
| Rate for Payer: Aetna Medicare |
$101.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.09
|
| Rate for Payer: BCBS Complete |
$378.80
|
| Rate for Payer: BCBS MAPPO |
$97.67
|
| Rate for Payer: BCBS Trust/PPO |
$321.19
|
| Rate for Payer: BCN Commercial |
$303.76
|
| Rate for Payer: BCN Medicare Advantage |
$97.67
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cash Price |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$335.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.67
|
| Rate for Payer: Healthscope Commercial |
$351.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$293.02
|
| Rate for Payer: Mclaren Medicaid |
$360.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.56
|
| Rate for Payer: Meridian Medicaid |
$378.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.09
|
| Rate for Payer: Nomi Health Commercial |
$320.37
|
| Rate for Payer: PACE Senior Care Partners |
$92.79
|
| Rate for Payer: PACE SWMI |
$97.67
|
| Rate for Payer: PHP Commercial |
$332.09
|
| Rate for Payer: PHP Medicare Advantage |
$97.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.95
|
| Rate for Payer: Priority Health HMO/PPO |
$339.90
|
| Rate for Payer: Priority Health Medicare |
$98.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.76
|
| Rate for Payer: Railroad Medicare Medicare |
$97.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$343.81
|
| Rate for Payer: UHC Core |
$326.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.67
|
| Rate for Payer: UHC Exchange |
$97.67
|
| Rate for Payer: UHC Medicare Advantage |
$97.67
|
| Rate for Payer: UHCCP Medicaid |
$360.74
|
| Rate for Payer: VA VA |
$97.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$293.02
|
|
|
HC EZPAP SUPPLY
|
Facility
|
IP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.19 |
| Max. Negotiated Rate |
$115.19 |
| Rate for Payer: Aetna Commercial |
$108.79
|
| Rate for Payer: BCBS Trust/PPO |
$104.48
|
| Rate for Payer: BCN Commercial |
$98.91
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$110.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Healthscope Commercial |
$115.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PHP Commercial |
$108.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: Priority Health HMO/PPO |
$111.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.63
|
| Rate for Payer: UHC Core |
$106.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.99
|
|
|
HC EZPAP SUPPLY
|
Facility
|
OP
|
$127.99
|
|
| Hospital Charge Code |
27000072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$115.19 |
| Rate for Payer: Aetna Commercial |
$108.79
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$105.22
|
| Rate for Payer: BCN Commercial |
$99.51
|
| Rate for Payer: BCN Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$102.39
|
| Rate for Payer: Cofinity Commercial |
$110.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$115.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.79
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PACE Senior Care Partners |
$30.40
|
| Rate for Payer: PACE SWMI |
$32.00
|
| Rate for Payer: PHP Commercial |
$108.79
|
| Rate for Payer: PHP Medicare Advantage |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.19
|
| Rate for Payer: Priority Health HMO/PPO |
$111.35
|
| Rate for Payer: Priority Health Medicare |
$32.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.75
|
| Rate for Payer: Railroad Medicare Medicare |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.63
|
| Rate for Payer: UHC Core |
$106.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.00
|
| Rate for Payer: UHC Exchange |
$32.00
|
| Rate for Payer: UHC Medicare Advantage |
$32.00
|
| Rate for Payer: VA VA |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.99
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
OP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$115.13 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.03
|
| Rate for Payer: Aetna Medicare |
$126.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.48
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS MAPPO |
$121.18
|
| Rate for Payer: BCBS Trust/PPO |
$398.50
|
| Rate for Payer: BCN Commercial |
$376.89
|
| Rate for Payer: BCN Medicare Advantage |
$121.18
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.18
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: PACE Senior Care Partners |
$115.13
|
| Rate for Payer: PACE SWMI |
$121.18
|
| Rate for Payer: PHP Commercial |
$412.03
|
| Rate for Payer: PHP Medicare Advantage |
$121.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: Priority Health HMO/PPO |
$421.72
|
| Rate for Payer: Priority Health Medicare |
$122.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.78
|
| Rate for Payer: Railroad Medicare Medicare |
$121.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.57
|
| Rate for Payer: UHC Core |
$404.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.18
|
| Rate for Payer: UHC Exchange |
$121.18
|
| Rate for Payer: UHC Medicare Advantage |
$121.18
|
| Rate for Payer: VA VA |
$121.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
HC F-18 SODIUM FLUORIDE <=30MCI
|
Facility
|
IP
|
$484.74
|
|
|
Service Code
|
HCPCS A9580
|
| Hospital Charge Code |
34300028
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.03
|
| Rate for Payer: BCBS Trust/PPO |
$395.69
|
| Rate for Payer: BCN Commercial |
$374.61
|
| Rate for Payer: Cash Price |
$387.79
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.79
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.03
|
| Rate for Payer: Nomi Health Commercial |
$397.49
|
| Rate for Payer: PHP Commercial |
$412.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.08
|
| Rate for Payer: Priority Health HMO/PPO |
$421.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.57
|
| Rate for Payer: UHC Core |
$404.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
HC F232 OVALBUMIN
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: BCBS Trust/PPO |
$23.94
|
| Rate for Payer: BCN Commercial |
$22.67
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC F232 OVALBUMIN
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200439
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$24.11
|
| Rate for Payer: BCN Commercial |
$22.80
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PACE Senior Care Partners |
$6.97
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.65
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC F233 OVOMUCOID
|
Facility
|
OP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$24.11
|
| Rate for Payer: BCN Commercial |
$22.80
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PACE Senior Care Partners |
$6.97
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO |
$25.52
|
| Rate for Payer: Priority Health Medicare |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.65
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$7.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC F233 OVOMUCOID
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200440
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna Commercial |
$24.93
|
| Rate for Payer: BCBS Trust/PPO |
$23.94
|
| Rate for Payer: BCN Commercial |
$22.67
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$25.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$26.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: PHP Commercial |
$24.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: Priority Health HMO/PPO |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.81
|
| Rate for Payer: UHC Core |
$24.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.00
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.84
|
| Rate for Payer: BCBS Complete |
$13.61
|
| Rate for Payer: BCBS MAPPO |
$7.87
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$24.48
|
| Rate for Payer: BCN Medicare Advantage |
$7.87
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.87
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Mclaren Medicaid |
$12.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$13.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PACE Senior Care Partners |
$7.48
|
| Rate for Payer: PACE SWMI |
$7.87
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: PHP Medicare Advantage |
$7.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO |
$27.40
|
| Rate for Payer: Priority Health Medicare |
$7.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.10
|
| Rate for Payer: Railroad Medicare Medicare |
$7.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.71
|
| Rate for Payer: UHC Core |
$26.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.87
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.87
|
| Rate for Payer: UHCCP Medicaid |
$12.96
|
| Rate for Payer: VA VA |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
HC F352 RARA H8 PR-10 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200450
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.71
|
| Rate for Payer: BCN Commercial |
$24.34
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO |
$27.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.71
|
| Rate for Payer: UHC Core |
$26.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
HC F422 RARA H1 PEANUT
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
30200446
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.71
|
| Rate for Payer: BCN Commercial |
$24.34
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.77
|
| Rate for Payer: Nomi Health Commercial |
$25.82
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health HMO/PPO |
$27.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.71
|
| Rate for Payer: UHC Core |
$26.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
