|
HC ROPIVACAINE HYDROCHLORIDE 1 MG
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT J2795
|
| Hospital Charge Code |
63600236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.25
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.40
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.40
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.48
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.52
|
| Rate for Payer: UHC Core |
$3.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.03
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.00
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
OP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$176.26 |
| Rate for Payer: Aetna Commercial |
$166.46
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.20
|
| Rate for Payer: BCBS Complete |
$82.60
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCBS Trust/PPO |
$152.27
|
| Rate for Payer: BCN Commercial |
$152.27
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$168.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Healthscope Commercial |
$176.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.88
|
| Rate for Payer: Mclaren Medicaid |
$78.66
|
| Rate for Payer: Meridian Medicaid |
$82.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: PACE Senior Care Partners |
$46.51
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Commercial |
$166.46
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.38
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.44
|
| Rate for Payer: Railroad Medicare Medicare |
$48.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.34
|
| Rate for Payer: UHC Core |
$163.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Medicare Advantage |
$50.43
|
| Rate for Payer: VA VA |
$48.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.88
|
|
|
HC RO SUPERFICIAL AND/OR ORTHO
|
Facility
|
IP
|
$195.84
|
|
|
Service Code
|
CPT 77401
|
| Hospital Charge Code |
33300036
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$176.26 |
| Rate for Payer: Aetna Commercial |
$166.46
|
| Rate for Payer: BCBS Trust/PPO |
$151.35
|
| Rate for Payer: BCN Commercial |
$151.35
|
| Rate for Payer: Cash Price |
$156.67
|
| Rate for Payer: Cofinity Commercial |
$168.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.67
|
| Rate for Payer: Healthscope Commercial |
$176.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.46
|
| Rate for Payer: PHP Commercial |
$166.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.34
|
| Rate for Payer: UHC Core |
$163.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.88
|
|
|
HC ROTABLATOR BURR
|
Facility
|
OP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$974.38 |
| Max. Negotiated Rate |
$3,692.39 |
| Rate for Payer: Aetna Commercial |
$3,487.26
|
| Rate for Payer: Aetna Medicare |
$1,066.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,282.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,282.08
|
| Rate for Payer: BCBS Complete |
$1,641.06
|
| Rate for Payer: BCBS MAPPO |
$1,025.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,189.82
|
| Rate for Payer: BCN Commercial |
$3,189.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.66
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$3,528.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,282.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.66
|
| Rate for Payer: Healthscope Commercial |
$3,692.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,077.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,076.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,179.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: PACE Senior Care Partners |
$974.38
|
| Rate for Payer: PACE SWMI |
$1,025.66
|
| Rate for Payer: PHP Commercial |
$3,487.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,569.31
|
| Rate for Payer: Priority Health Medicare |
$1,025.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,502.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,025.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,610.34
|
| Rate for Payer: UHC Core |
$3,425.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,056.43
|
| Rate for Payer: VA VA |
$1,025.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,077.00
|
|
|
HC ROTABLATOR BURR
|
Facility
|
IP
|
$4,102.66
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27200069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,502.21 |
| Max. Negotiated Rate |
$3,692.39 |
| Rate for Payer: Aetna Commercial |
$3,487.26
|
| Rate for Payer: BCBS Trust/PPO |
$3,170.54
|
| Rate for Payer: BCN Commercial |
$3,170.54
|
| Rate for Payer: Cash Price |
$3,282.13
|
| Rate for Payer: Cofinity Commercial |
$3,528.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,282.13
|
| Rate for Payer: Healthscope Commercial |
$3,692.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,077.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,487.26
|
| Rate for Payer: PHP Commercial |
$3,487.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,871.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,569.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,502.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,610.34
|
| Rate for Payer: UHC Core |
$3,425.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,077.00
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
OP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$91.46
|
| Rate for Payer: Aetna Medicare |
$27.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.62
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCBS Trust/PPO |
$83.66
|
| Rate for Payer: BCN Commercial |
$83.66
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$96.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.70
|
| Rate for Payer: Mclaren Medicaid |
$8.84
|
| Rate for Payer: Meridian Medicaid |
$9.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PACE Senior Care Partners |
$25.56
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Commercial |
$91.46
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.61
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.63
|
| Rate for Payer: Railroad Medicare Medicare |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.69
|
| Rate for Payer: UHC Core |
$89.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$27.71
|
| Rate for Payer: VA VA |
$26.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.70
|
|
|
HC ROTAVIRUS ANTIGEN
|
Facility
|
IP
|
$107.60
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
30600145
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$91.46
|
| Rate for Payer: BCBS Trust/PPO |
$83.15
|
| Rate for Payer: BCN Commercial |
$83.15
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cofinity Commercial |
$92.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.08
|
| Rate for Payer: Healthscope Commercial |
$96.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.46
|
| Rate for Payer: PHP Commercial |
$91.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.69
|
| Rate for Payer: UHC Core |
$89.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.70
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
OP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$157.53 |
| Rate for Payer: Aetna Commercial |
$148.78
|
| Rate for Payer: Aetna Medicare |
$45.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.70
|
| Rate for Payer: BCBS Complete |
$70.01
|
| Rate for Payer: BCBS MAPPO |
$43.76
|
| Rate for Payer: BCBS Trust/PPO |
$136.09
|
| Rate for Payer: BCN Commercial |
$136.09
|
| Rate for Payer: BCN Medicare Advantage |
$43.76
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$150.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.76
|
| Rate for Payer: Healthscope Commercial |
$157.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: PACE Senior Care Partners |
$41.57
|
| Rate for Payer: PACE SWMI |
$43.76
|
| Rate for Payer: PHP Commercial |
$148.78
|
| Rate for Payer: PHP Medicare Advantage |
$43.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.28
|
| Rate for Payer: Priority Health Medicare |
$43.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.75
|
| Rate for Payer: Railroad Medicare Medicare |
$43.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.03
|
| Rate for Payer: UHC Core |
$146.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.76
|
| Rate for Payer: UHC Medicare Advantage |
$45.07
|
| Rate for Payer: VA VA |
$43.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.27
|
|
|
HC ROTAVIRUS ATTEN 2 DOSE SCHED LIVE ORAL
|
Facility
|
IP
|
$175.03
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
63600121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$157.53 |
| Rate for Payer: Aetna Commercial |
$148.78
|
| Rate for Payer: BCBS Trust/PPO |
$135.26
|
| Rate for Payer: BCN Commercial |
$135.26
|
| Rate for Payer: Cash Price |
$140.02
|
| Rate for Payer: Cofinity Commercial |
$150.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.02
|
| Rate for Payer: Healthscope Commercial |
$157.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.78
|
| Rate for Payer: PHP Commercial |
$148.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.03
|
| Rate for Payer: UHC Core |
$146.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.27
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
IP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.29 |
| Max. Negotiated Rate |
$68.30 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: BCN Commercial |
$58.65
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.71
|
| Rate for Payer: Healthscope Commercial |
$68.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: PHP Commercial |
$64.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.78
|
| Rate for Payer: UHC Core |
$63.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE ORAL
|
Facility
|
OP
|
$75.89
|
|
|
Service Code
|
CPT 90680
|
| Hospital Charge Code |
63600076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$68.30 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Aetna Medicare |
$19.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.72
|
| Rate for Payer: BCBS Complete |
$30.36
|
| Rate for Payer: BCBS MAPPO |
$18.97
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCN Commercial |
$59.00
|
| Rate for Payer: BCN Medicare Advantage |
$18.97
|
| Rate for Payer: Cash Price |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$65.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.97
|
| Rate for Payer: Healthscope Commercial |
$68.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.51
|
| Rate for Payer: PACE Senior Care Partners |
$18.02
|
| Rate for Payer: PACE SWMI |
$18.97
|
| Rate for Payer: PHP Commercial |
$64.51
|
| Rate for Payer: PHP Medicare Advantage |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.02
|
| Rate for Payer: Priority Health Medicare |
$18.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.29
|
| Rate for Payer: Railroad Medicare Medicare |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.78
|
| Rate for Payer: UHC Core |
$63.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$19.54
|
| Rate for Payer: VA VA |
$18.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.92
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$37.76 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna Commercial |
$434.37
|
| Rate for Payer: Aetna Medicare |
$41.34
|
| Rate for Payer: Aetna Medicare |
$132.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.69
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS MAPPO |
$39.75
|
| Rate for Payer: BCBS MAPPO |
$127.76
|
| Rate for Payer: BCBS Trust/PPO |
$397.32
|
| Rate for Payer: BCBS Trust/PPO |
$123.62
|
| Rate for Payer: BCN Commercial |
$397.32
|
| Rate for Payer: BCN Commercial |
$123.62
|
| Rate for Payer: BCN Medicare Advantage |
$127.76
|
| Rate for Payer: BCN Medicare Advantage |
$39.75
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.75
|
| Rate for Payer: Healthscope Commercial |
$459.92
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.26
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: PACE Senior Care Partners |
$121.37
|
| Rate for Payer: PACE Senior Care Partners |
$37.76
|
| Rate for Payer: PACE SWMI |
$127.76
|
| Rate for Payer: PACE SWMI |
$39.75
|
| Rate for Payer: PHP Commercial |
$434.37
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: PHP Medicare Advantage |
$127.76
|
| Rate for Payer: PHP Medicare Advantage |
$39.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.59
|
| Rate for Payer: Priority Health Medicare |
$39.75
|
| Rate for Payer: Priority Health Medicare |
$127.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.67
|
| Rate for Payer: Railroad Medicare Medicare |
$127.76
|
| Rate for Payer: Railroad Medicare Medicare |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.70
|
| Rate for Payer: UHC Core |
$426.70
|
| Rate for Payer: UHC Core |
$132.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.75
|
| Rate for Payer: UHC Medicare Advantage |
$40.94
|
| Rate for Payer: UHC Medicare Advantage |
$131.59
|
| Rate for Payer: VA VA |
$39.75
|
| Rate for Payer: VA VA |
$127.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.26
|
|
|
HC RO TREATMENT DEVICE INTERMED
|
Facility
|
IP
|
$511.02
|
|
|
Service Code
|
CPT 77333
|
| Hospital Charge Code |
33300037
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$311.67 |
| Max. Negotiated Rate |
$459.92 |
| Rate for Payer: Aetna Commercial |
$434.37
|
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: BCBS Trust/PPO |
$122.88
|
| Rate for Payer: BCBS Trust/PPO |
$394.92
|
| Rate for Payer: BCN Commercial |
$122.88
|
| Rate for Payer: BCN Commercial |
$394.92
|
| Rate for Payer: Cash Price |
$408.82
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Healthscope Commercial |
$459.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.37
|
| Rate for Payer: PHP Commercial |
$434.37
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.70
|
| Rate for Payer: UHC Core |
$426.70
|
| Rate for Payer: UHC Core |
$132.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.26
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
OP
|
$405.96
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$365.36 |
| Rate for Payer: Aetna Commercial |
$345.07
|
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna Medicare |
$88.14
|
| Rate for Payer: Aetna Medicare |
$105.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.94
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS Complete |
$93.46
|
| Rate for Payer: BCBS MAPPO |
$84.75
|
| Rate for Payer: BCBS MAPPO |
$101.49
|
| Rate for Payer: BCBS Trust/PPO |
$263.57
|
| Rate for Payer: BCBS Trust/PPO |
$315.63
|
| Rate for Payer: BCN Commercial |
$263.57
|
| Rate for Payer: BCN Commercial |
$315.63
|
| Rate for Payer: BCN Medicare Advantage |
$84.75
|
| Rate for Payer: BCN Medicare Advantage |
$101.49
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.49
|
| Rate for Payer: Healthscope Commercial |
$365.36
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.47
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Mclaren Medicaid |
$89.01
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Medicaid |
$93.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$106.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: PACE Senior Care Partners |
$96.42
|
| Rate for Payer: PACE Senior Care Partners |
$80.51
|
| Rate for Payer: PACE SWMI |
$101.49
|
| Rate for Payer: PACE SWMI |
$84.75
|
| Rate for Payer: PHP Commercial |
$345.07
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: PHP Medicare Advantage |
$101.49
|
| Rate for Payer: PHP Medicare Advantage |
$84.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.19
|
| Rate for Payer: Priority Health Medicare |
$101.49
|
| Rate for Payer: Priority Health Medicare |
$84.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.60
|
| Rate for Payer: Railroad Medicare Medicare |
$101.49
|
| Rate for Payer: Railroad Medicare Medicare |
$84.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.32
|
| Rate for Payer: UHC Core |
$338.98
|
| Rate for Payer: UHC Core |
$283.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.49
|
| Rate for Payer: UHC Medicare Advantage |
$87.29
|
| Rate for Payer: UHC Medicare Advantage |
$104.53
|
| Rate for Payer: VA VA |
$84.75
|
| Rate for Payer: VA VA |
$101.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.47
|
|
|
HC RO TREATMENT DEVICE SIMPLE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 77332
|
| Hospital Charge Code |
33300038
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$206.76 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna Commercial |
$345.07
|
| Rate for Payer: BCBS Trust/PPO |
$261.98
|
| Rate for Payer: BCBS Trust/PPO |
$313.73
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: BCN Commercial |
$261.98
|
| Rate for Payer: Cash Price |
$324.77
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Cofinity Commercial |
$349.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Healthscope Commercial |
$365.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$345.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.15
|
| Rate for Payer: PHP Commercial |
$345.07
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.32
|
| Rate for Payer: UHC Core |
$283.06
|
| Rate for Payer: UHC Core |
$338.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.47
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$523.90 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: BCBS Trust/PPO |
$663.84
|
| Rate for Payer: BCBS Trust/PPO |
$531.28
|
| Rate for Payer: BCN Commercial |
$663.84
|
| Rate for Payer: BCN Commercial |
$531.28
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$419.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.98
|
| Rate for Payer: UHC Core |
$574.05
|
| Rate for Payer: UHC Core |
$717.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
|
HC RO TRTMNT >1 MEV COMPLEX
|
Facility
|
OP
|
$687.48
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
33300049
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$163.28 |
| Max. Negotiated Rate |
$618.73 |
| Rate for Payer: Aetna Commercial |
$584.36
|
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Medicare |
$178.74
|
| Rate for Payer: Aetna Medicare |
$223.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.84
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCBS MAPPO |
$171.87
|
| Rate for Payer: BCBS Trust/PPO |
$534.52
|
| Rate for Payer: BCBS Trust/PPO |
$667.87
|
| Rate for Payer: BCN Commercial |
$534.52
|
| Rate for Payer: BCN Commercial |
$667.87
|
| Rate for Payer: BCN Medicare Advantage |
$171.87
|
| Rate for Payer: BCN Medicare Advantage |
$214.75
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$549.98
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cofinity Commercial |
$591.23
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$549.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.87
|
| Rate for Payer: Healthscope Commercial |
$618.73
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$515.61
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$584.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: PACE Senior Care Partners |
$204.01
|
| Rate for Payer: PACE Senior Care Partners |
$163.28
|
| Rate for Payer: PACE SWMI |
$214.75
|
| Rate for Payer: PACE SWMI |
$171.87
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: PHP Commercial |
$584.36
|
| Rate for Payer: PHP Medicare Advantage |
$171.87
|
| Rate for Payer: PHP Medicare Advantage |
$214.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$481.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$598.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.33
|
| Rate for Payer: Priority Health Medicare |
$214.75
|
| Rate for Payer: Priority Health Medicare |
$171.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$419.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.90
|
| Rate for Payer: Railroad Medicare Medicare |
$171.87
|
| Rate for Payer: Railroad Medicare Medicare |
$214.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.92
|
| Rate for Payer: UHC Core |
$574.05
|
| Rate for Payer: UHC Core |
$717.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Medicare Advantage |
$177.03
|
| Rate for Payer: UHC Medicare Advantage |
$221.19
|
| Rate for Payer: VA VA |
$171.87
|
| Rate for Payer: VA VA |
$214.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$515.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
IP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$252.05 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: BCBS Trust/PPO |
$319.38
|
| Rate for Payer: BCN Commercial |
$319.38
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.68
|
| Rate for Payer: UHC Core |
$345.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
|
HC RO TRTMNT > 1 MEV INTERMEDIATE
|
Facility
|
OP
|
$413.27
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
33300052
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$98.15 |
| Max. Negotiated Rate |
$371.94 |
| Rate for Payer: Aetna Commercial |
$351.28
|
| Rate for Payer: Aetna Medicare |
$107.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.15
|
| Rate for Payer: BCBS Complete |
$185.11
|
| Rate for Payer: BCBS MAPPO |
$103.32
|
| Rate for Payer: BCBS Trust/PPO |
$321.32
|
| Rate for Payer: BCN Commercial |
$321.32
|
| Rate for Payer: BCN Medicare Advantage |
$103.32
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cash Price |
$330.62
|
| Rate for Payer: Cofinity Commercial |
$355.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.32
|
| Rate for Payer: Healthscope Commercial |
$371.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.95
|
| Rate for Payer: Mclaren Medicaid |
$176.29
|
| Rate for Payer: Meridian Medicaid |
$185.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$351.28
|
| Rate for Payer: PACE Senior Care Partners |
$98.15
|
| Rate for Payer: PACE SWMI |
$103.32
|
| Rate for Payer: PHP Commercial |
$351.28
|
| Rate for Payer: PHP Medicare Advantage |
$103.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.54
|
| Rate for Payer: Priority Health Medicare |
$103.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.05
|
| Rate for Payer: Railroad Medicare Medicare |
$103.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.68
|
| Rate for Payer: UHC Core |
$345.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.32
|
| Rate for Payer: UHC Medicare Advantage |
$106.42
|
| Rate for Payer: VA VA |
$103.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.95
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
OP
|
$226.71
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$204.04 |
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Medicare |
$223.34
|
| Rate for Payer: Aetna Medicare |
$58.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$268.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$268.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.85
|
| Rate for Payer: BCBS Complete |
$82.60
|
| Rate for Payer: BCBS Complete |
$82.60
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCBS MAPPO |
$56.68
|
| Rate for Payer: BCBS Trust/PPO |
$176.27
|
| Rate for Payer: BCBS Trust/PPO |
$667.87
|
| Rate for Payer: BCN Commercial |
$667.87
|
| Rate for Payer: BCN Commercial |
$176.27
|
| Rate for Payer: BCN Medicare Advantage |
$56.68
|
| Rate for Payer: BCN Medicare Advantage |
$214.75
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Cofinity Commercial |
$194.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.68
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Healthscope Commercial |
$204.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
| Rate for Payer: Mclaren Medicaid |
$78.66
|
| Rate for Payer: Mclaren Medicaid |
$78.66
|
| Rate for Payer: Meridian Medicaid |
$82.60
|
| Rate for Payer: Meridian Medicaid |
$82.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: PACE Senior Care Partners |
$53.84
|
| Rate for Payer: PACE Senior Care Partners |
$204.01
|
| Rate for Payer: PACE SWMI |
$56.68
|
| Rate for Payer: PACE SWMI |
$214.75
|
| Rate for Payer: PHP Commercial |
$192.70
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: PHP Medicare Advantage |
$214.75
|
| Rate for Payer: PHP Medicare Advantage |
$56.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.33
|
| Rate for Payer: Priority Health Medicare |
$56.68
|
| Rate for Payer: Priority Health Medicare |
$214.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.90
|
| Rate for Payer: Railroad Medicare Medicare |
$214.75
|
| Rate for Payer: Railroad Medicare Medicare |
$56.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.50
|
| Rate for Payer: UHC Core |
$717.26
|
| Rate for Payer: UHC Core |
$189.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.68
|
| Rate for Payer: UHC Medicare Advantage |
$58.38
|
| Rate for Payer: UHC Medicare Advantage |
$221.19
|
| Rate for Payer: VA VA |
$56.68
|
| Rate for Payer: VA VA |
$214.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
|
HC RO TRTMNT >1 MEV SIMPLE
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
33300048
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$523.90 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Aetna Commercial |
$730.15
|
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$663.84
|
| Rate for Payer: BCBS Trust/PPO |
$175.20
|
| Rate for Payer: BCN Commercial |
$175.20
|
| Rate for Payer: BCN Commercial |
$663.84
|
| Rate for Payer: Cash Price |
$687.20
|
| Rate for Payer: Cash Price |
$181.37
|
| Rate for Payer: Cofinity Commercial |
$194.97
|
| Rate for Payer: Cofinity Commercial |
$738.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$687.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.37
|
| Rate for Payer: Healthscope Commercial |
$773.10
|
| Rate for Payer: Healthscope Commercial |
$204.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$644.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$730.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.70
|
| Rate for Payer: PHP Commercial |
$192.70
|
| Rate for Payer: PHP Commercial |
$730.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$747.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.50
|
| Rate for Payer: UHC Core |
$189.30
|
| Rate for Payer: UHC Core |
$717.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$644.25
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
OP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.78
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Medicare |
$6.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC ROUGH MARSH ELDER IGE
|
Facility
|
IP
|
$24.89
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200058
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$21.16
|
| Rate for Payer: BCBS Trust/PPO |
$19.23
|
| Rate for Payer: BCN Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$22.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.16
|
| Rate for Payer: PHP Commercial |
$21.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$20.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.67
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.71
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
HC RPR (SYPHILIS SEROLOGY) SERUM
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
30200213
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$6.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Mclaren Medicaid |
$3.15
|
| Rate for Payer: Meridian Medicaid |
$3.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.18
|
| Rate for Payer: Priority Health Medicare |
$6.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.55
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.44
|
| Rate for Payer: UHC Core |
$21.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.57
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
