|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$268.65
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$63.80 |
| Max. Negotiated Rate |
$241.78 |
| Rate for Payer: Aetna Commercial |
$228.35
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.95
|
| Rate for Payer: BCBS Complete |
$107.46
|
| Rate for Payer: BCBS MAPPO |
$67.16
|
| Rate for Payer: BCBS Trust/PPO |
$208.88
|
| Rate for Payer: BCN Commercial |
$208.88
|
| Rate for Payer: BCN Medicare Advantage |
$67.16
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cofinity Commercial |
$231.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.16
|
| Rate for Payer: Healthscope Commercial |
$241.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.35
|
| Rate for Payer: PACE Senior Care Partners |
$63.80
|
| Rate for Payer: PACE SWMI |
$67.16
|
| Rate for Payer: PHP Commercial |
$228.35
|
| Rate for Payer: PHP Medicare Advantage |
$67.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.73
|
| Rate for Payer: Priority Health Medicare |
$67.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.85
|
| Rate for Payer: Railroad Medicare Medicare |
$67.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.41
|
| Rate for Payer: UHC Core |
$224.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.16
|
| Rate for Payer: UHC Medicare Advantage |
$69.18
|
| Rate for Payer: VA VA |
$67.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.49
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$268.65
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$163.85 |
| Max. Negotiated Rate |
$241.78 |
| Rate for Payer: Aetna Commercial |
$228.35
|
| Rate for Payer: BCBS Trust/PPO |
$207.61
|
| Rate for Payer: BCN Commercial |
$207.61
|
| Rate for Payer: Cash Price |
$214.92
|
| Rate for Payer: Cofinity Commercial |
$231.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.92
|
| Rate for Payer: Healthscope Commercial |
$241.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.35
|
| Rate for Payer: PHP Commercial |
$228.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.41
|
| Rate for Payer: UHC Core |
$224.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.49
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$869.14 |
| Max. Negotiated Rate |
$1,282.55 |
| Rate for Payer: Aetna Commercial |
$1,211.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,101.29
|
| Rate for Payer: BCN Commercial |
$1,101.29
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,225.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Commercial |
$1,282.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,068.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: PHP Commercial |
$1,211.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$869.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,254.05
|
| Rate for Payer: UHC Core |
$1,189.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,068.80
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,425.06
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$338.45 |
| Max. Negotiated Rate |
$1,282.55 |
| Rate for Payer: Aetna Commercial |
$1,211.30
|
| Rate for Payer: Aetna Medicare |
$370.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$445.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$445.33
|
| Rate for Payer: BCBS Complete |
$570.02
|
| Rate for Payer: BCBS MAPPO |
$356.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.98
|
| Rate for Payer: BCN Commercial |
$1,107.98
|
| Rate for Payer: BCN Medicare Advantage |
$356.26
|
| Rate for Payer: Cash Price |
$1,140.05
|
| Rate for Payer: Cofinity Commercial |
$1,225.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,140.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.26
|
| Rate for Payer: Healthscope Commercial |
$1,282.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,068.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$409.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,211.30
|
| Rate for Payer: PACE Senior Care Partners |
$338.45
|
| Rate for Payer: PACE SWMI |
$356.26
|
| Rate for Payer: PHP Commercial |
$1,211.30
|
| Rate for Payer: PHP Medicare Advantage |
$356.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.80
|
| Rate for Payer: Priority Health Medicare |
$356.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$869.14
|
| Rate for Payer: Railroad Medicare Medicare |
$356.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,254.05
|
| Rate for Payer: UHC Core |
$1,189.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$356.26
|
| Rate for Payer: UHC Medicare Advantage |
$366.95
|
| Rate for Payer: VA VA |
$356.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,068.80
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.13 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: BCBS Trust/PPO |
$195.30
|
| Rate for Payer: BCN Commercial |
$195.30
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Healthscope Commercial |
$227.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: PHP Commercial |
$214.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.39
|
| Rate for Payer: UHC Core |
$211.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.54
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$252.72
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.02 |
| Max. Negotiated Rate |
$227.45 |
| Rate for Payer: Aetna Commercial |
$214.81
|
| Rate for Payer: Aetna Medicare |
$65.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.98
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$63.18
|
| Rate for Payer: BCBS Trust/PPO |
$196.49
|
| Rate for Payer: BCN Commercial |
$196.49
|
| Rate for Payer: BCN Medicare Advantage |
$63.18
|
| Rate for Payer: Cash Price |
$202.18
|
| Rate for Payer: Cofinity Commercial |
$217.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.18
|
| Rate for Payer: Healthscope Commercial |
$227.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.81
|
| Rate for Payer: PACE Senior Care Partners |
$60.02
|
| Rate for Payer: PACE SWMI |
$63.18
|
| Rate for Payer: PHP Commercial |
$214.81
|
| Rate for Payer: PHP Medicare Advantage |
$63.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.87
|
| Rate for Payer: Priority Health Medicare |
$63.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.13
|
| Rate for Payer: Railroad Medicare Medicare |
$63.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.39
|
| Rate for Payer: UHC Core |
$211.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.18
|
| Rate for Payer: UHC Medicare Advantage |
$65.08
|
| Rate for Payer: VA VA |
$63.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.54
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,842.99 |
| Max. Negotiated Rate |
$4,195.26 |
| Rate for Payer: Aetna Commercial |
$3,962.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,602.33
|
| Rate for Payer: BCN Commercial |
$3,602.33
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$4,008.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Healthscope Commercial |
$4,195.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: PHP Commercial |
$3,962.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,055.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,842.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,102.03
|
| Rate for Payer: UHC Core |
$3,892.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.05
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,661.40
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.08 |
| Max. Negotiated Rate |
$4,195.26 |
| Rate for Payer: Aetna Commercial |
$3,962.19
|
| Rate for Payer: Aetna Medicare |
$1,211.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,456.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,456.69
|
| Rate for Payer: BCBS Complete |
$1,864.56
|
| Rate for Payer: BCBS MAPPO |
$1,165.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,624.24
|
| Rate for Payer: BCN Commercial |
$3,624.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,165.35
|
| Rate for Payer: Cash Price |
$3,729.12
|
| Rate for Payer: Cofinity Commercial |
$4,008.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,729.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,165.35
|
| Rate for Payer: Healthscope Commercial |
$4,195.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,223.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,340.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,962.19
|
| Rate for Payer: PACE Senior Care Partners |
$1,107.08
|
| Rate for Payer: PACE SWMI |
$1,165.35
|
| Rate for Payer: PHP Commercial |
$3,962.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,165.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,262.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,055.42
|
| Rate for Payer: Priority Health Medicare |
$1,165.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,842.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1,165.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,102.03
|
| Rate for Payer: UHC Core |
$3,892.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,165.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,200.31
|
| Rate for Payer: VA VA |
$1,165.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.05
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.41
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$23.40
|
| Rate for Payer: BCN Commercial |
$23.40
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$27.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.58
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Meridian Medicaid |
$4.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: PACE Senior Care Partners |
$7.15
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$25.58
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.19
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: Railroad Medicare Medicare |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.49
|
| Rate for Payer: UHC Core |
$25.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.75
|
| Rate for Payer: VA VA |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.58
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.10
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$23.26
|
| Rate for Payer: Cash Price |
$24.08
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$27.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.58
|
| Rate for Payer: PHP Commercial |
$25.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.49
|
| Rate for Payer: UHC Core |
$25.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.58
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,542.86 |
| Max. Negotiated Rate |
$2,276.73 |
| Rate for Payer: Aetna Commercial |
$2,150.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,954.95
|
| Rate for Payer: BCN Commercial |
$1,954.95
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Healthscope Commercial |
$2,276.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,897.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: PHP Commercial |
$2,150.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,542.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.14
|
| Rate for Payer: UHC Core |
$2,112.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,897.28
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,529.70
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.80 |
| Max. Negotiated Rate |
$2,276.73 |
| Rate for Payer: Aetna Commercial |
$2,150.24
|
| Rate for Payer: Aetna Medicare |
$657.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$790.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$790.53
|
| Rate for Payer: BCBS Complete |
$1,011.88
|
| Rate for Payer: BCBS MAPPO |
$632.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,966.84
|
| Rate for Payer: BCN Commercial |
$1,966.84
|
| Rate for Payer: BCN Medicare Advantage |
$632.42
|
| Rate for Payer: Cash Price |
$2,023.76
|
| Rate for Payer: Cofinity Commercial |
$2,175.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,023.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.42
|
| Rate for Payer: Healthscope Commercial |
$2,276.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,897.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$664.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$727.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,150.24
|
| Rate for Payer: PACE Senior Care Partners |
$600.80
|
| Rate for Payer: PACE SWMI |
$632.42
|
| Rate for Payer: PHP Commercial |
$2,150.24
|
| Rate for Payer: PHP Medicare Advantage |
$632.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,770.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.84
|
| Rate for Payer: Priority Health Medicare |
$632.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,542.86
|
| Rate for Payer: Railroad Medicare Medicare |
$632.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,226.14
|
| Rate for Payer: UHC Core |
$2,112.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.42
|
| Rate for Payer: UHC Medicare Advantage |
$651.40
|
| Rate for Payer: VA VA |
$632.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,897.28
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.06
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.99
|
| Rate for Payer: BCN Commercial |
$34.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PACE Senior Care Partners |
$10.69
|
| Rate for Payer: PACE SWMI |
$11.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Medicare |
$11.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.25
|
| Rate for Payer: UHC Medicare Advantage |
$11.59
|
| Rate for Payer: VA VA |
$11.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.00
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.78
|
| Rate for Payer: BCN Commercial |
$34.78
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.60
|
| Rate for Payer: UHC Core |
$37.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: BCBS Trust/PPO |
$39.41
|
| Rate for Payer: BCN Commercial |
$39.41
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$13.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.94
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$12.75
|
| Rate for Payer: BCBS Trust/PPO |
$39.65
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.75
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.75
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: PACE Senior Care Partners |
$12.11
|
| Rate for Payer: PACE SWMI |
$12.75
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.37
|
| Rate for Payer: Priority Health Medicare |
$12.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.88
|
| Rate for Payer: UHC Core |
$42.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.75
|
| Rate for Payer: UHC Medicare Advantage |
$13.13
|
| Rate for Payer: VA VA |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCN Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.00
|
| Rate for Payer: UHC Core |
$35.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$10.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.14
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS MAPPO |
$10.51
|
| Rate for Payer: BCBS Trust/PPO |
$32.69
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: BCN Medicare Advantage |
$10.51
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.51
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Mclaren Medicaid |
$20.21
|
| Rate for Payer: Meridian Medicaid |
$21.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.51
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$10.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.00
|
| Rate for Payer: UHC Core |
$35.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.51
|
| Rate for Payer: UHC Medicare Advantage |
$10.83
|
| Rate for Payer: VA VA |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCN Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.00
|
| Rate for Payer: UHC Core |
$35.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$42.04
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$35.73
|
| Rate for Payer: Aetna Medicare |
$10.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.14
|
| Rate for Payer: BCBS Complete |
$21.22
|
| Rate for Payer: BCBS MAPPO |
$10.51
|
| Rate for Payer: BCBS Trust/PPO |
$32.69
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: BCN Medicare Advantage |
$10.51
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Cofinity Commercial |
$36.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.51
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.53
|
| Rate for Payer: Mclaren Medicaid |
$20.21
|
| Rate for Payer: Meridian Medicaid |
$21.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.73
|
| Rate for Payer: PACE Senior Care Partners |
$9.98
|
| Rate for Payer: PACE SWMI |
$10.51
|
| Rate for Payer: PHP Commercial |
$35.73
|
| Rate for Payer: PHP Medicare Advantage |
$10.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.57
|
| Rate for Payer: Priority Health Medicare |
$10.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.64
|
| Rate for Payer: Railroad Medicare Medicare |
$10.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.00
|
| Rate for Payer: UHC Core |
$35.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.51
|
| Rate for Payer: UHC Medicare Advantage |
$10.83
|
| Rate for Payer: VA VA |
$10.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.53
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$89.58 |
| Max. Negotiated Rate |
$339.47 |
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: Aetna Medicare |
$98.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$117.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$117.87
|
| Rate for Payer: BCBS Complete |
$233.27
|
| Rate for Payer: BCBS MAPPO |
$94.30
|
| Rate for Payer: BCBS Trust/PPO |
$293.27
|
| Rate for Payer: BCN Commercial |
$293.27
|
| Rate for Payer: BCN Medicare Advantage |
$94.30
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.30
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.89
|
| Rate for Payer: Mclaren Medicaid |
$222.16
|
| Rate for Payer: Meridian Medicaid |
$233.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PACE Senior Care Partners |
$89.58
|
| Rate for Payer: PACE SWMI |
$94.30
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: PHP Medicare Advantage |
$94.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$222.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.16
|
| Rate for Payer: Priority Health Medicare |
$94.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.05
|
| Rate for Payer: Railroad Medicare Medicare |
$94.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.93
|
| Rate for Payer: UHC Core |
$314.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.30
|
| Rate for Payer: UHC Medicare Advantage |
$97.13
|
| Rate for Payer: VA VA |
$94.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.89
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$377.19
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$230.05 |
| Max. Negotiated Rate |
$339.47 |
| Rate for Payer: Aetna Commercial |
$320.61
|
| Rate for Payer: BCBS Trust/PPO |
$291.49
|
| Rate for Payer: BCN Commercial |
$291.49
|
| Rate for Payer: Cash Price |
$301.75
|
| Rate for Payer: Cofinity Commercial |
$324.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.75
|
| Rate for Payer: Healthscope Commercial |
$339.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$320.61
|
| Rate for Payer: PHP Commercial |
$320.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$264.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.93
|
| Rate for Payer: UHC Core |
$314.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.89
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.56
|
| Rate for Payer: UHC Core |
$1.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.77
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.71
|
| Rate for Payer: BCBS MAPPO |
$0.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.38
|
| Rate for Payer: BCN Commercial |
$1.38
|
| Rate for Payer: BCN Medicare Advantage |
$0.44
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Cofinity Commercial |
$1.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$1.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.50
|
| Rate for Payer: PACE Senior Care Partners |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.44
|
| Rate for Payer: PHP Commercial |
$1.50
|
| Rate for Payer: PHP Medicare Advantage |
$0.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.54
|
| Rate for Payer: Priority Health Medicare |
$0.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.56
|
| Rate for Payer: UHC Core |
$1.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.46
|
| Rate for Payer: VA VA |
$0.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.33
|
|
|
HC OPEN HEART PLATELET MAPPING
|
Facility
|
IP
|
$925.49
|
|
| Hospital Charge Code |
27000388
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$564.46 |
| Max. Negotiated Rate |
$832.94 |
| Rate for Payer: Aetna Commercial |
$786.67
|
| Rate for Payer: BCBS Trust/PPO |
$715.22
|
| Rate for Payer: BCN Commercial |
$715.22
|
| Rate for Payer: Cash Price |
$740.39
|
| Rate for Payer: Cofinity Commercial |
$795.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.39
|
| Rate for Payer: Healthscope Commercial |
$832.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$694.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$786.67
|
| Rate for Payer: PHP Commercial |
$786.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$564.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.43
|
| Rate for Payer: UHC Core |
$772.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$694.12
|
|
