|
HC GASTROSCOPY
|
Facility
|
OP
|
$1,962.15
|
|
| Hospital Charge Code |
36000047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$466.01 |
| Max. Negotiated Rate |
$1,765.93 |
| Rate for Payer: Aetna Commercial |
$1,667.83
|
| Rate for Payer: Aetna Medicare |
$510.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$613.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$613.17
|
| Rate for Payer: BCBS Complete |
$784.86
|
| Rate for Payer: BCBS MAPPO |
$490.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,613.08
|
| Rate for Payer: BCN Commercial |
$1,525.57
|
| Rate for Payer: BCN Medicare Advantage |
$490.54
|
| Rate for Payer: Cash Price |
$1,569.72
|
| Rate for Payer: Cofinity Commercial |
$1,687.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,569.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.54
|
| Rate for Payer: Healthscope Commercial |
$1,765.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,471.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,667.83
|
| Rate for Payer: Nomi Health Commercial |
$1,608.96
|
| Rate for Payer: PACE Senior Care Partners |
$466.01
|
| Rate for Payer: PACE SWMI |
$490.54
|
| Rate for Payer: PHP Commercial |
$1,667.83
|
| Rate for Payer: PHP Medicare Advantage |
$490.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,275.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,707.07
|
| Rate for Payer: Priority Health Medicare |
$495.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,314.64
|
| Rate for Payer: Railroad Medicare Medicare |
$490.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.69
|
| Rate for Payer: UHC Core |
$1,638.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.54
|
| Rate for Payer: UHC Exchange |
$490.54
|
| Rate for Payer: UHC Medicare Advantage |
$490.54
|
| Rate for Payer: VA VA |
$490.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,471.61
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
OP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.05 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna Medicare |
$20.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.07
|
| Rate for Payer: BCBS Complete |
$32.09
|
| Rate for Payer: BCBS MAPPO |
$20.05
|
| Rate for Payer: BCBS Trust/PPO |
$65.95
|
| Rate for Payer: BCN Commercial |
$62.37
|
| Rate for Payer: BCN Medicare Advantage |
$20.05
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.05
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: Nomi Health Commercial |
$65.78
|
| Rate for Payer: PACE Senior Care Partners |
$19.05
|
| Rate for Payer: PACE SWMI |
$20.05
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: PHP Medicare Advantage |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health HMO/PPO |
$69.79
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.75
|
| Rate for Payer: Railroad Medicare Medicare |
$20.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.59
|
| Rate for Payer: UHC Core |
$66.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.05
|
| Rate for Payer: UHC Exchange |
$20.05
|
| Rate for Payer: UHC Medicare Advantage |
$20.05
|
| Rate for Payer: VA VA |
$20.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.16
|
|
|
HC GEL SKIN/WOUND ANTIMICROBIAL ANASEPT
|
Facility
|
IP
|
$80.22
|
|
| Hospital Charge Code |
27000708
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: BCBS Trust/PPO |
$65.48
|
| Rate for Payer: BCN Commercial |
$61.99
|
| Rate for Payer: Cash Price |
$64.18
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.18
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.19
|
| Rate for Payer: Nomi Health Commercial |
$65.78
|
| Rate for Payer: PHP Commercial |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.14
|
| Rate for Payer: Priority Health HMO/PPO |
$69.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.59
|
| Rate for Payer: UHC Core |
$66.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.16
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GELSYN-3 FOR INTRA-ARTICULAR INJ, 0.1 MG
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J7328
|
| Hospital Charge Code |
63600259
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO |
$0.01
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.01
|
| Rate for Payer: Railroad Medicare Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
| Rate for Payer: VA VA |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
OP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$35.61 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.85
|
| Rate for Payer: BCBS Complete |
$59.97
|
| Rate for Payer: BCBS MAPPO |
$37.48
|
| Rate for Payer: BCBS Trust/PPO |
$123.25
|
| Rate for Payer: BCN Commercial |
$116.56
|
| Rate for Payer: BCN Medicare Advantage |
$37.48
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: Nomi Health Commercial |
$122.93
|
| Rate for Payer: PACE Senior Care Partners |
$35.61
|
| Rate for Payer: PACE SWMI |
$37.48
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: PHP Medicare Advantage |
$37.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health HMO/PPO |
$130.43
|
| Rate for Payer: Priority Health Medicare |
$37.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.45
|
| Rate for Payer: Railroad Medicare Medicare |
$37.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.93
|
| Rate for Payer: UHC Core |
$125.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.48
|
| Rate for Payer: VA VA |
$37.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.44
|
|
|
HC GEN ANES ADDL 15 MIN
|
Facility
|
IP
|
$149.92
|
|
| Hospital Charge Code |
37000001
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$134.93 |
| Rate for Payer: Aetna Commercial |
$127.43
|
| Rate for Payer: BCBS Trust/PPO |
$122.38
|
| Rate for Payer: BCN Commercial |
$115.86
|
| Rate for Payer: Cash Price |
$119.94
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.94
|
| Rate for Payer: Healthscope Commercial |
$134.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.43
|
| Rate for Payer: Nomi Health Commercial |
$122.93
|
| Rate for Payer: PHP Commercial |
$127.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.45
|
| Rate for Payer: Priority Health HMO/PPO |
$130.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.93
|
| Rate for Payer: UHC Core |
$125.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.44
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
IP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$383.32 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: BCBS Trust/PPO |
$481.39
|
| Rate for Payer: BCN Commercial |
$455.74
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: Nomi Health Commercial |
$483.57
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health HMO/PPO |
$513.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.95
|
| Rate for Payer: UHC Core |
$492.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.29
|
|
|
HC GEN ANES INIT 30 MIN
|
Facility
|
OP
|
$589.72
|
|
| Hospital Charge Code |
37000002
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$140.06 |
| Max. Negotiated Rate |
$530.75 |
| Rate for Payer: Aetna Commercial |
$501.26
|
| Rate for Payer: Aetna Medicare |
$153.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$184.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$184.29
|
| Rate for Payer: BCBS Complete |
$235.89
|
| Rate for Payer: BCBS MAPPO |
$147.43
|
| Rate for Payer: BCBS Trust/PPO |
$484.81
|
| Rate for Payer: BCN Commercial |
$458.51
|
| Rate for Payer: BCN Medicare Advantage |
$147.43
|
| Rate for Payer: Cash Price |
$471.78
|
| Rate for Payer: Cofinity Commercial |
$507.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$471.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.43
|
| Rate for Payer: Healthscope Commercial |
$530.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$442.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.26
|
| Rate for Payer: Nomi Health Commercial |
$483.57
|
| Rate for Payer: PACE Senior Care Partners |
$140.06
|
| Rate for Payer: PACE SWMI |
$147.43
|
| Rate for Payer: PHP Commercial |
$501.26
|
| Rate for Payer: PHP Medicare Advantage |
$147.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.32
|
| Rate for Payer: Priority Health HMO/PPO |
$513.06
|
| Rate for Payer: Priority Health Medicare |
$148.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$395.11
|
| Rate for Payer: Railroad Medicare Medicare |
$147.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.95
|
| Rate for Payer: UHC Core |
$492.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.43
|
| Rate for Payer: UHC Exchange |
$147.43
|
| Rate for Payer: UHC Medicare Advantage |
$147.43
|
| Rate for Payer: VA VA |
$147.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$442.29
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
IP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$13.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC GENERAL ANESTHESIA PER MINUTE
|
Facility
|
OP
|
$16.00
|
|
| Hospital Charge Code |
37000024
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$13.60
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$14.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: PACE Senior Care Partners |
$3.80
|
| Rate for Payer: PACE SWMI |
$4.00
|
| Rate for Payer: PHP Commercial |
$13.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO |
$13.92
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Core |
$13.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.00
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UHC Medicare Advantage |
$4.00
|
| Rate for Payer: VA VA |
$4.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.00
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Aetna Commercial |
$196.11
|
| Rate for Payer: Aetna Medicare |
$59.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.10
|
| Rate for Payer: BCBS Complete |
$92.29
|
| Rate for Payer: BCBS MAPPO |
$57.68
|
| Rate for Payer: BCBS Trust/PPO |
$189.67
|
| Rate for Payer: BCN Commercial |
$179.38
|
| Rate for Payer: BCN Medicare Advantage |
$57.68
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$198.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.68
|
| Rate for Payer: Healthscope Commercial |
$207.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: Nomi Health Commercial |
$189.19
|
| Rate for Payer: PACE Senior Care Partners |
$54.80
|
| Rate for Payer: PACE SWMI |
$57.68
|
| Rate for Payer: PHP Commercial |
$196.11
|
| Rate for Payer: PHP Medicare Advantage |
$57.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: Priority Health HMO/PPO |
$200.73
|
| Rate for Payer: Priority Health Medicare |
$58.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.58
|
| Rate for Payer: Railroad Medicare Medicare |
$57.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.03
|
| Rate for Payer: UHC Core |
$192.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.68
|
| Rate for Payer: UHC Exchange |
$57.68
|
| Rate for Payer: UHC Medicare Advantage |
$57.68
|
| Rate for Payer: VA VA |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.04
|
|
|
HC GENERAL HEALTH PANEL
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT 80050
|
| Hospital Charge Code |
30100011
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Aetna Commercial |
$196.11
|
| Rate for Payer: BCBS Trust/PPO |
$188.34
|
| Rate for Payer: BCN Commercial |
$178.30
|
| Rate for Payer: Cash Price |
$184.58
|
| Rate for Payer: Cofinity Commercial |
$198.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.58
|
| Rate for Payer: Healthscope Commercial |
$207.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.11
|
| Rate for Payer: Nomi Health Commercial |
$189.19
|
| Rate for Payer: PHP Commercial |
$196.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.97
|
| Rate for Payer: Priority Health HMO/PPO |
$200.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.03
|
| Rate for Payer: UHC Core |
$192.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.04
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
OP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$110.71 |
| Rate for Payer: Aetna Commercial |
$104.56
|
| Rate for Payer: Aetna Medicare |
$31.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.44
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS MAPPO |
$30.75
|
| Rate for Payer: BCBS Trust/PPO |
$101.13
|
| Rate for Payer: BCN Commercial |
$95.64
|
| Rate for Payer: BCN Medicare Advantage |
$30.75
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$105.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.75
|
| Rate for Payer: Healthscope Commercial |
$110.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.26
|
| Rate for Payer: Mclaren Medicaid |
$11.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.29
|
| Rate for Payer: Meridian Medicaid |
$12.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: PACE Senior Care Partners |
$29.21
|
| Rate for Payer: PACE SWMI |
$30.75
|
| Rate for Payer: PHP Commercial |
$104.56
|
| Rate for Payer: PHP Medicare Advantage |
$30.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health HMO/PPO |
$107.02
|
| Rate for Payer: Priority Health Medicare |
$31.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.42
|
| Rate for Payer: Railroad Medicare Medicare |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.25
|
| Rate for Payer: UHC Core |
$102.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.75
|
| Rate for Payer: UHC Exchange |
$30.75
|
| Rate for Payer: UHC Medicare Advantage |
$30.75
|
| Rate for Payer: UHCCP Medicaid |
$11.84
|
| Rate for Payer: VA VA |
$30.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.26
|
|
|
HC GENTAMICIN LEVEL
|
Facility
|
IP
|
$123.01
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
30100030
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$110.71 |
| Rate for Payer: Aetna Commercial |
$104.56
|
| Rate for Payer: BCBS Trust/PPO |
$100.41
|
| Rate for Payer: BCN Commercial |
$95.06
|
| Rate for Payer: Cash Price |
$98.41
|
| Rate for Payer: Cofinity Commercial |
$105.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.41
|
| Rate for Payer: Healthscope Commercial |
$110.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.56
|
| Rate for Payer: Nomi Health Commercial |
$100.87
|
| Rate for Payer: PHP Commercial |
$104.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.96
|
| Rate for Payer: Priority Health HMO/PPO |
$107.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.25
|
| Rate for Payer: UHC Core |
$102.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.26
|
|
|
HC GGTP
|
Facility
|
IP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: BCBS Trust/PPO |
$56.62
|
| Rate for Payer: BCN Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC GGTP
|
Facility
|
OP
|
$69.36
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
30100229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$62.42 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.68
|
| Rate for Payer: BCBS Complete |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$57.02
|
| Rate for Payer: BCN Commercial |
$53.93
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cash Price |
$55.49
|
| Rate for Payer: Cofinity Commercial |
$59.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.02
|
| Rate for Payer: Mclaren Medicaid |
$5.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.96
|
| Rate for Payer: Nomi Health Commercial |
$56.88
|
| Rate for Payer: PACE Senior Care Partners |
$16.47
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$58.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.08
|
| Rate for Payer: Priority Health HMO/PPO |
$60.34
|
| Rate for Payer: Priority Health Medicare |
$17.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.47
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.04
|
| Rate for Payer: UHC Core |
$57.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.34
|
| Rate for Payer: UHC Exchange |
$17.34
|
| Rate for Payer: UHC Medicare Advantage |
$17.34
|
| Rate for Payer: UHCCP Medicaid |
$5.21
|
| Rate for Payer: VA VA |
$17.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.02
|
|
|
HC GIARDIA SCREEN
|
Facility
|
OP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.31
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS MAPPO |
$11.45
|
| Rate for Payer: BCBS Trust/PPO |
$37.64
|
| Rate for Payer: BCN Commercial |
$35.59
|
| Rate for Payer: BCN Medicare Advantage |
$11.45
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.45
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Mclaren Medicaid |
$8.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.02
|
| Rate for Payer: Meridian Medicaid |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PACE Senior Care Partners |
$10.87
|
| Rate for Payer: PACE SWMI |
$11.45
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: PHP Medicare Advantage |
$11.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Medicare |
$11.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.45
|
| Rate for Payer: UHC Exchange |
$11.45
|
| Rate for Payer: UHC Medicare Advantage |
$11.45
|
| Rate for Payer: UHCCP Medicaid |
$8.66
|
| Rate for Payer: VA VA |
$11.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC GIARDIA SCREEN
|
Facility
|
IP
|
$45.78
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
30600119
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Aetna Commercial |
$38.91
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCN Commercial |
$35.38
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cofinity Commercial |
$39.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.62
|
| Rate for Payer: Healthscope Commercial |
$41.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.91
|
| Rate for Payer: Nomi Health Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$38.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.76
|
| Rate for Payer: Priority Health HMO/PPO |
$39.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.29
|
| Rate for Payer: UHC Core |
$38.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.34
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
IP
|
$1,796.43
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,167.68 |
| Max. Negotiated Rate |
$1,616.79 |
| Rate for Payer: Aetna Commercial |
$1,526.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,466.43
|
| Rate for Payer: BCN Commercial |
$1,388.28
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cofinity Commercial |
$1,544.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,437.14
|
| Rate for Payer: Healthscope Commercial |
$1,616.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,347.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.97
|
| Rate for Payer: Nomi Health Commercial |
$1,473.07
|
| Rate for Payer: PHP Commercial |
$1,526.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,562.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,203.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,580.86
|
| Rate for Payer: UHC Core |
$1,500.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,347.32
|
|
|
HC GI CONVERT G TO GJ TUBE W
|
Facility
|
OP
|
$1,796.43
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
36100228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$426.65 |
| Max. Negotiated Rate |
$1,616.79 |
| Rate for Payer: Aetna Commercial |
$1,526.97
|
| Rate for Payer: Aetna Medicare |
$467.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$561.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$561.38
|
| Rate for Payer: BCBS Complete |
$1,440.19
|
| Rate for Payer: BCBS MAPPO |
$449.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.85
|
| Rate for Payer: BCN Commercial |
$1,396.72
|
| Rate for Payer: BCN Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cash Price |
$1,437.14
|
| Rate for Payer: Cofinity Commercial |
$1,544.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,437.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.11
|
| Rate for Payer: Healthscope Commercial |
$1,616.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,347.32
|
| Rate for Payer: Mclaren Medicaid |
$1,371.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.56
|
| Rate for Payer: Meridian Medicaid |
$1,440.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$516.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,526.97
|
| Rate for Payer: Nomi Health Commercial |
$1,473.07
|
| Rate for Payer: PACE Senior Care Partners |
$426.65
|
| Rate for Payer: PACE SWMI |
$449.11
|
| Rate for Payer: PHP Commercial |
$1,526.97
|
| Rate for Payer: PHP Medicare Advantage |
$449.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,371.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,562.89
|
| Rate for Payer: Priority Health Medicare |
$453.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,203.61
|
| Rate for Payer: Railroad Medicare Medicare |
$449.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,580.86
|
| Rate for Payer: UHC Core |
$1,500.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.11
|
| Rate for Payer: UHC Exchange |
$449.11
|
| Rate for Payer: UHC Medicare Advantage |
$449.11
|
| Rate for Payer: UHCCP Medicaid |
$1,371.52
|
| Rate for Payer: VA VA |
$449.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,347.32
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
OP
|
$1,811.10
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$430.14 |
| Max. Negotiated Rate |
$1,629.99 |
| Rate for Payer: Aetna Commercial |
$1,539.43
|
| Rate for Payer: Aetna Medicare |
$470.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$565.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$565.97
|
| Rate for Payer: BCBS Complete |
$724.44
|
| Rate for Payer: BCBS MAPPO |
$452.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,488.91
|
| Rate for Payer: BCN Commercial |
$1,408.13
|
| Rate for Payer: BCN Medicare Advantage |
$452.77
|
| Rate for Payer: Cash Price |
$1,448.88
|
| Rate for Payer: Cofinity Commercial |
$1,557.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.77
|
| Rate for Payer: Healthscope Commercial |
$1,629.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$520.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.43
|
| Rate for Payer: Nomi Health Commercial |
$1,485.10
|
| Rate for Payer: PACE Senior Care Partners |
$430.14
|
| Rate for Payer: PACE SWMI |
$452.77
|
| Rate for Payer: PHP Commercial |
$1,539.43
|
| Rate for Payer: PHP Medicare Advantage |
$452.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,575.66
|
| Rate for Payer: Priority Health Medicare |
$457.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,213.44
|
| Rate for Payer: Railroad Medicare Medicare |
$452.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,593.77
|
| Rate for Payer: UHC Core |
$1,512.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.77
|
| Rate for Payer: UHC Exchange |
$452.77
|
| Rate for Payer: UHC Medicare Advantage |
$452.77
|
| Rate for Payer: VA VA |
$452.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.33
|
|
|
HC GI FOREIGN BODY REMOVAL
|
Facility
|
IP
|
$1,811.10
|
|
| Hospital Charge Code |
36000049
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,177.21 |
| Max. Negotiated Rate |
$1,629.99 |
| Rate for Payer: Aetna Commercial |
$1,539.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.40
|
| Rate for Payer: BCN Commercial |
$1,399.62
|
| Rate for Payer: Cash Price |
$1,448.88
|
| Rate for Payer: Cofinity Commercial |
$1,557.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,448.88
|
| Rate for Payer: Healthscope Commercial |
$1,629.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,358.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,539.43
|
| Rate for Payer: Nomi Health Commercial |
$1,485.10
|
| Rate for Payer: PHP Commercial |
$1,539.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,177.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1,575.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,593.77
|
| Rate for Payer: UHC Core |
$1,512.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,358.33
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
IP
|
$1,267.94
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$824.16 |
| Max. Negotiated Rate |
$1,141.15 |
| Rate for Payer: Aetna Commercial |
$1,077.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.02
|
| Rate for Payer: BCN Commercial |
$979.86
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cofinity Commercial |
$1,090.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.35
|
| Rate for Payer: Healthscope Commercial |
$1,141.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.75
|
| Rate for Payer: Nomi Health Commercial |
$1,039.71
|
| Rate for Payer: PHP Commercial |
$1,077.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,103.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.79
|
| Rate for Payer: UHC Core |
$1,058.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.96
|
|
|
HC GI GASTRIC TUBE REPOSITION
|
Facility
|
OP
|
$1,267.94
|
|
|
Service Code
|
CPT 43761
|
| Hospital Charge Code |
36100192
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.84 |
| Max. Negotiated Rate |
$1,141.15 |
| Rate for Payer: Aetna Commercial |
$1,077.75
|
| Rate for Payer: Aetna Medicare |
$329.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$396.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$396.23
|
| Rate for Payer: BCBS Complete |
$184.65
|
| Rate for Payer: BCBS MAPPO |
$316.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,042.37
|
| Rate for Payer: BCN Commercial |
$985.82
|
| Rate for Payer: BCN Medicare Advantage |
$316.99
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cash Price |
$1,014.35
|
| Rate for Payer: Cofinity Commercial |
$1,090.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.99
|
| Rate for Payer: Healthscope Commercial |
$1,141.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.96
|
| Rate for Payer: Mclaren Medicaid |
$175.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.83
|
| Rate for Payer: Meridian Medicaid |
$184.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$364.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.75
|
| Rate for Payer: Nomi Health Commercial |
$1,039.71
|
| Rate for Payer: PACE Senior Care Partners |
$301.14
|
| Rate for Payer: PACE SWMI |
$316.99
|
| Rate for Payer: PHP Commercial |
$1,077.75
|
| Rate for Payer: PHP Medicare Advantage |
$316.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,103.11
|
| Rate for Payer: Priority Health Medicare |
$320.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$849.52
|
| Rate for Payer: Railroad Medicare Medicare |
$316.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,115.79
|
| Rate for Payer: UHC Core |
$1,058.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.99
|
| Rate for Payer: UHC Exchange |
$316.99
|
| Rate for Payer: UHC Medicare Advantage |
$316.99
|
| Rate for Payer: UHCCP Medicaid |
$175.84
|
| Rate for Payer: VA VA |
$316.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.96
|
|
