|
HC UNILAT PERC IMPLANT NEUROSTIM ELTRD, SACRAL NERVE W/IMAG
|
Facility
|
IP
|
$9,466.31
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
76100247
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,773.50 |
| Max. Negotiated Rate |
$8,519.68 |
| Rate for Payer: Aetna Commercial |
$8,046.36
|
| Rate for Payer: BCBS Trust/PPO |
$7,315.56
|
| Rate for Payer: BCN Commercial |
$7,315.56
|
| Rate for Payer: Cash Price |
$7,573.05
|
| Rate for Payer: Cofinity Commercial |
$8,141.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,573.05
|
| Rate for Payer: Healthscope Commercial |
$8,519.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,099.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,046.36
|
| Rate for Payer: PHP Commercial |
$8,046.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,626.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,235.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,773.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,330.35
|
| Rate for Payer: UHC Core |
$7,904.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,099.73
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
OP
|
$1,103.27
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.71 |
| Max. Negotiated Rate |
$992.94 |
| Rate for Payer: Aetna Commercial |
$937.78
|
| Rate for Payer: Aetna Medicare |
$286.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$344.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$344.77
|
| Rate for Payer: BCBS Complete |
$137.25
|
| Rate for Payer: BCBS MAPPO |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$857.79
|
| Rate for Payer: BCN Commercial |
$857.79
|
| Rate for Payer: BCN Medicare Advantage |
$275.82
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cofinity Commercial |
$948.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.82
|
| Rate for Payer: Healthscope Commercial |
$992.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.45
|
| Rate for Payer: Mclaren Medicaid |
$130.71
|
| Rate for Payer: Meridian Medicaid |
$137.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$289.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.78
|
| Rate for Payer: PACE Senior Care Partners |
$262.03
|
| Rate for Payer: PACE SWMI |
$275.82
|
| Rate for Payer: PHP Commercial |
$937.78
|
| Rate for Payer: PHP Medicare Advantage |
$275.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$959.84
|
| Rate for Payer: Priority Health Medicare |
$275.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.88
|
| Rate for Payer: Railroad Medicare Medicare |
$275.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.88
|
| Rate for Payer: UHC Core |
$921.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.82
|
| Rate for Payer: UHC Medicare Advantage |
$284.09
|
| Rate for Payer: VA VA |
$275.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.45
|
|
|
HC UNLISTED FEMALE GENITAL SYSTEM
|
Facility
|
IP
|
$1,103.27
|
|
|
Service Code
|
CPT 58999
|
| Hospital Charge Code |
36100387
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$672.88 |
| Max. Negotiated Rate |
$992.94 |
| Rate for Payer: Aetna Commercial |
$937.78
|
| Rate for Payer: BCBS Trust/PPO |
$852.61
|
| Rate for Payer: BCN Commercial |
$852.61
|
| Rate for Payer: Cash Price |
$882.62
|
| Rate for Payer: Cofinity Commercial |
$948.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$882.62
|
| Rate for Payer: Healthscope Commercial |
$992.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$827.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$937.78
|
| Rate for Payer: PHP Commercial |
$937.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$959.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$672.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$970.88
|
| Rate for Payer: UHC Core |
$921.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$827.45
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
OP
|
$712.41
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Aetna Commercial |
$605.55
|
| Rate for Payer: Aetna Medicare |
$185.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.63
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$178.10
|
| Rate for Payer: BCBS Trust/PPO |
$553.90
|
| Rate for Payer: BCN Commercial |
$553.90
|
| Rate for Payer: BCN Medicare Advantage |
$178.10
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.10
|
| Rate for Payer: Healthscope Commercial |
$641.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.31
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.55
|
| Rate for Payer: PACE Senior Care Partners |
$169.20
|
| Rate for Payer: PACE SWMI |
$178.10
|
| Rate for Payer: PHP Commercial |
$605.55
|
| Rate for Payer: PHP Medicare Advantage |
$178.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.80
|
| Rate for Payer: Priority Health Medicare |
$178.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.50
|
| Rate for Payer: Railroad Medicare Medicare |
$178.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$626.92
|
| Rate for Payer: UHC Core |
$594.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.10
|
| Rate for Payer: UHC Medicare Advantage |
$183.45
|
| Rate for Payer: VA VA |
$178.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.31
|
|
|
HC UNLISTED PROCEDURE NERVOUS SYSTEM 64999
|
Facility
|
IP
|
$712.41
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
36100437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$434.50 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Aetna Commercial |
$605.55
|
| Rate for Payer: BCBS Trust/PPO |
$550.55
|
| Rate for Payer: BCN Commercial |
$550.55
|
| Rate for Payer: Cash Price |
$569.93
|
| Rate for Payer: Cofinity Commercial |
$612.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$569.93
|
| Rate for Payer: Healthscope Commercial |
$641.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.55
|
| Rate for Payer: PHP Commercial |
$605.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$626.92
|
| Rate for Payer: UHC Core |
$594.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.31
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.44 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: BCBS Trust/PPO |
$502.32
|
| Rate for Payer: BCN Commercial |
$502.32
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.00
|
| Rate for Payer: UHC Core |
$542.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
HC UNLISTED PROCEDURE NOSE
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 30999
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.38 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.12
|
| Rate for Payer: BCBS Complete |
$168.25
|
| Rate for Payer: BCBS MAPPO |
$162.50
|
| Rate for Payer: BCBS Trust/PPO |
$505.38
|
| Rate for Payer: BCN Commercial |
$505.38
|
| Rate for Payer: BCN Medicare Advantage |
$162.50
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.50
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Mclaren Medicaid |
$160.23
|
| Rate for Payer: Meridian Medicaid |
$168.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$170.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PACE Senior Care Partners |
$154.38
|
| Rate for Payer: PACE SWMI |
$162.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: PHP Medicare Advantage |
$162.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.50
|
| Rate for Payer: Priority Health Medicare |
$162.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.44
|
| Rate for Payer: Railroad Medicare Medicare |
$162.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.00
|
| Rate for Payer: UHC Core |
$542.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.50
|
| Rate for Payer: UHC Medicare Advantage |
$167.38
|
| Rate for Payer: VA VA |
$162.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
OP
|
$2,847.42
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$2,562.68 |
| Rate for Payer: Aetna Commercial |
$2,420.31
|
| Rate for Payer: Aetna Medicare |
$740.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$889.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$889.82
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$711.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,213.87
|
| Rate for Payer: BCN Commercial |
$2,213.87
|
| Rate for Payer: BCN Medicare Advantage |
$711.86
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cofinity Commercial |
$2,448.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,277.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.86
|
| Rate for Payer: Healthscope Commercial |
$2,562.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,135.56
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$747.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$818.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,420.31
|
| Rate for Payer: PACE Senior Care Partners |
$676.26
|
| Rate for Payer: PACE SWMI |
$711.86
|
| Rate for Payer: PHP Commercial |
$2,420.31
|
| Rate for Payer: PHP Medicare Advantage |
$711.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,477.26
|
| Rate for Payer: Priority Health Medicare |
$711.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,736.64
|
| Rate for Payer: Railroad Medicare Medicare |
$711.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,505.73
|
| Rate for Payer: UHC Core |
$2,377.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.86
|
| Rate for Payer: UHC Medicare Advantage |
$733.21
|
| Rate for Payer: VA VA |
$711.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,135.56
|
|
|
HC UNLISTED PROCEDURE SPINE
|
Facility
|
IP
|
$2,847.42
|
|
|
Service Code
|
CPT 22899
|
| Hospital Charge Code |
36100036
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,736.64 |
| Max. Negotiated Rate |
$2,562.68 |
| Rate for Payer: Aetna Commercial |
$2,420.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,200.49
|
| Rate for Payer: BCN Commercial |
$2,200.49
|
| Rate for Payer: Cash Price |
$2,277.94
|
| Rate for Payer: Cofinity Commercial |
$2,448.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,277.94
|
| Rate for Payer: Healthscope Commercial |
$2,562.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,135.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,420.31
|
| Rate for Payer: PHP Commercial |
$2,420.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,993.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,477.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,736.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,505.73
|
| Rate for Payer: UHC Core |
$2,377.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,135.56
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
OP
|
$448.01
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$403.21 |
| Rate for Payer: Aetna Commercial |
$380.81
|
| Rate for Payer: Aetna Medicare |
$116.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.00
|
| Rate for Payer: BCBS Complete |
$162.43
|
| Rate for Payer: BCBS MAPPO |
$112.00
|
| Rate for Payer: BCBS Trust/PPO |
$348.33
|
| Rate for Payer: BCN Commercial |
$348.33
|
| Rate for Payer: BCN Medicare Advantage |
$112.00
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cofinity Commercial |
$385.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$403.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.01
|
| Rate for Payer: Mclaren Medicaid |
$154.70
|
| Rate for Payer: Meridian Medicaid |
$162.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.81
|
| Rate for Payer: PACE Senior Care Partners |
$106.40
|
| Rate for Payer: PACE SWMI |
$112.00
|
| Rate for Payer: PHP Commercial |
$380.81
|
| Rate for Payer: PHP Medicare Advantage |
$112.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.77
|
| Rate for Payer: Priority Health Medicare |
$112.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.24
|
| Rate for Payer: Railroad Medicare Medicare |
$112.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.25
|
| Rate for Payer: UHC Core |
$374.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.00
|
| Rate for Payer: UHC Medicare Advantage |
$115.36
|
| Rate for Payer: VA VA |
$112.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.01
|
|
|
HC UNLISTED PROC HAND OR FINGER
|
Facility
|
IP
|
$448.01
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
36100518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.24 |
| Max. Negotiated Rate |
$403.21 |
| Rate for Payer: Aetna Commercial |
$380.81
|
| Rate for Payer: BCBS Trust/PPO |
$346.22
|
| Rate for Payer: BCN Commercial |
$346.22
|
| Rate for Payer: Cash Price |
$358.41
|
| Rate for Payer: Cofinity Commercial |
$385.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.41
|
| Rate for Payer: Healthscope Commercial |
$403.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.81
|
| Rate for Payer: PHP Commercial |
$380.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.25
|
| Rate for Payer: UHC Core |
$374.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.01
|
|
|
HC UNNA BOOT
|
Facility
|
OP
|
$360.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$324.05 |
| Rate for Payer: Aetna Commercial |
$306.05
|
| Rate for Payer: Aetna Medicare |
$93.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.52
|
| Rate for Payer: BCBS Complete |
$108.53
|
| Rate for Payer: BCBS MAPPO |
$90.02
|
| Rate for Payer: BCBS Trust/PPO |
$279.95
|
| Rate for Payer: BCN Commercial |
$279.95
|
| Rate for Payer: BCN Medicare Advantage |
$90.02
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cofinity Commercial |
$309.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.02
|
| Rate for Payer: Healthscope Commercial |
$324.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.04
|
| Rate for Payer: Mclaren Medicaid |
$103.36
|
| Rate for Payer: Meridian Medicaid |
$108.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.05
|
| Rate for Payer: PACE Senior Care Partners |
$85.51
|
| Rate for Payer: PACE SWMI |
$90.02
|
| Rate for Payer: PHP Commercial |
$306.05
|
| Rate for Payer: PHP Medicare Advantage |
$90.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.25
|
| Rate for Payer: Priority Health Medicare |
$90.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.60
|
| Rate for Payer: Railroad Medicare Medicare |
$90.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.85
|
| Rate for Payer: UHC Core |
$300.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.02
|
| Rate for Payer: UHC Medicare Advantage |
$92.72
|
| Rate for Payer: VA VA |
$90.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.04
|
|
|
HC UNNA BOOT
|
Facility
|
IP
|
$360.06
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$324.05 |
| Rate for Payer: Aetna Commercial |
$306.05
|
| Rate for Payer: BCBS Trust/PPO |
$278.25
|
| Rate for Payer: BCN Commercial |
$278.25
|
| Rate for Payer: Cash Price |
$288.05
|
| Rate for Payer: Cofinity Commercial |
$309.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.05
|
| Rate for Payer: Healthscope Commercial |
$324.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.05
|
| Rate for Payer: PHP Commercial |
$306.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.85
|
| Rate for Payer: UHC Core |
$300.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.04
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
OP
|
$8,845.22
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,100.74 |
| Max. Negotiated Rate |
$7,960.70 |
| Rate for Payer: Aetna Commercial |
$7,518.44
|
| Rate for Payer: Aetna Medicare |
$2,299.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,764.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,764.13
|
| Rate for Payer: BCBS Complete |
$7,355.10
|
| Rate for Payer: BCBS MAPPO |
$2,211.30
|
| Rate for Payer: BCBS Trust/PPO |
$6,877.16
|
| Rate for Payer: BCN Commercial |
$6,877.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,211.30
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cofinity Commercial |
$7,606.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,076.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,211.30
|
| Rate for Payer: Healthscope Commercial |
$7,960.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,633.92
|
| Rate for Payer: Mclaren Medicaid |
$7,004.86
|
| Rate for Payer: Meridian Medicaid |
$7,355.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,321.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,543.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,518.44
|
| Rate for Payer: PACE Senior Care Partners |
$2,100.74
|
| Rate for Payer: PACE SWMI |
$2,211.30
|
| Rate for Payer: PHP Commercial |
$7,518.44
|
| Rate for Payer: PHP Medicare Advantage |
$2,211.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,004.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,191.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,695.34
|
| Rate for Payer: Priority Health Medicare |
$2,211.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,394.70
|
| Rate for Payer: Railroad Medicare Medicare |
$2,211.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,783.79
|
| Rate for Payer: UHC Core |
$7,385.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,211.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,277.64
|
| Rate for Payer: VA VA |
$2,211.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,633.92
|
|
|
HC UPGRADE PACEMAKER
|
Facility
|
IP
|
$8,845.22
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
36100063
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,394.70 |
| Max. Negotiated Rate |
$7,960.70 |
| Rate for Payer: Aetna Commercial |
$7,518.44
|
| Rate for Payer: BCBS Trust/PPO |
$6,835.59
|
| Rate for Payer: BCN Commercial |
$6,835.59
|
| Rate for Payer: Cash Price |
$7,076.18
|
| Rate for Payer: Cofinity Commercial |
$7,606.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,076.18
|
| Rate for Payer: Healthscope Commercial |
$7,960.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,633.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,518.44
|
| Rate for Payer: PHP Commercial |
$7,518.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,191.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,695.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,394.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,783.79
|
| Rate for Payer: UHC Core |
$7,385.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,633.92
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
OP
|
$4,556.67
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,082.21 |
| Max. Negotiated Rate |
$7,355.10 |
| Rate for Payer: Aetna Commercial |
$3,873.17
|
| Rate for Payer: Aetna Medicare |
$1,184.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,423.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,423.96
|
| Rate for Payer: BCBS Complete |
$7,355.10
|
| Rate for Payer: BCBS MAPPO |
$1,139.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,542.81
|
| Rate for Payer: BCN Commercial |
$3,542.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,139.17
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cofinity Commercial |
$3,918.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,139.17
|
| Rate for Payer: Healthscope Commercial |
$4,101.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.50
|
| Rate for Payer: Mclaren Medicaid |
$7,004.86
|
| Rate for Payer: Meridian Medicaid |
$7,355.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,196.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,310.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,873.17
|
| Rate for Payer: PACE Senior Care Partners |
$1,082.21
|
| Rate for Payer: PACE SWMI |
$1,139.17
|
| Rate for Payer: PHP Commercial |
$3,873.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,139.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,004.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,189.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,964.30
|
| Rate for Payer: Priority Health Medicare |
$1,139.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,779.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,139.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,009.87
|
| Rate for Payer: UHC Core |
$3,804.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,139.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,173.34
|
| Rate for Payer: VA VA |
$1,139.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.50
|
|
|
HC UPGRADE TO BI-V PACEMAKER/ICD
|
Facility
|
IP
|
$4,556.67
|
|
|
Service Code
|
CPT 33224
|
| Hospital Charge Code |
36100069
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,779.11 |
| Max. Negotiated Rate |
$4,101.00 |
| Rate for Payer: Aetna Commercial |
$3,873.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,521.39
|
| Rate for Payer: BCN Commercial |
$3,521.39
|
| Rate for Payer: Cash Price |
$3,645.34
|
| Rate for Payer: Cofinity Commercial |
$3,918.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,645.34
|
| Rate for Payer: Healthscope Commercial |
$4,101.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,417.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,873.17
|
| Rate for Payer: PHP Commercial |
$3,873.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,189.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,964.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,779.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,009.87
|
| Rate for Payer: UHC Core |
$3,804.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,417.50
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
OP
|
$20.40
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS MAPPO |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.86
|
| Rate for Payer: BCN Commercial |
$15.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.10
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Mclaren Medicaid |
$2.92
|
| Rate for Payer: Meridian Medicaid |
$3.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.10
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Medicare |
$5.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: VA VA |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC UREA NITROGEN BUN
|
Facility
|
IP
|
$20.40
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100450
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$18.36 |
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: Cash Price |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.34
|
| Rate for Payer: PHP Commercial |
$17.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.95
|
| Rate for Payer: UHC Core |
$17.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.30
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
IP
|
$38.66
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: BCBS Trust/PPO |
$29.88
|
| Rate for Payer: BCN Commercial |
$29.88
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.86
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC UREA NITROGEN BUN URINE
|
Facility
|
OP
|
$38.66
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
30100451
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$34.79 |
| Rate for Payer: Aetna Commercial |
$32.86
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.08
|
| Rate for Payer: BCBS Complete |
$4.31
|
| Rate for Payer: BCBS MAPPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$30.06
|
| Rate for Payer: BCN Commercial |
$30.06
|
| Rate for Payer: BCN Medicare Advantage |
$9.66
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.66
|
| Rate for Payer: Healthscope Commercial |
$34.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.00
|
| Rate for Payer: Mclaren Medicaid |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$4.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.86
|
| Rate for Payer: PACE Senior Care Partners |
$9.18
|
| Rate for Payer: PACE SWMI |
$9.66
|
| Rate for Payer: PHP Commercial |
$32.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.63
|
| Rate for Payer: Priority Health Medicare |
$9.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.58
|
| Rate for Payer: Railroad Medicare Medicare |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.02
|
| Rate for Payer: UHC Core |
$32.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.66
|
| Rate for Payer: UHC Medicare Advantage |
$9.95
|
| Rate for Payer: VA VA |
$9.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.00
|
|
|
HC UREAPLASMA PCR
|
Facility
|
OP
|
$84.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.01 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.33
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$21.07
|
| Rate for Payer: BCBS Trust/PPO |
$65.52
|
| Rate for Payer: BCN Commercial |
$65.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.07
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.07
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.63
|
| Rate for Payer: PACE Senior Care Partners |
$20.01
|
| Rate for Payer: PACE SWMI |
$21.07
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: PHP Medicare Advantage |
$21.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.31
|
| Rate for Payer: Priority Health Medicare |
$21.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.40
|
| Rate for Payer: Railroad Medicare Medicare |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.07
|
| Rate for Payer: UHC Medicare Advantage |
$21.70
|
| Rate for Payer: VA VA |
$21.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC UREAPLASMA PCR
|
Facility
|
IP
|
$84.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: BCBS Trust/PPO |
$65.12
|
| Rate for Payer: BCN Commercial |
$65.12
|
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Cofinity Commercial |
$72.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.42
|
| Rate for Payer: Healthscope Commercial |
$75.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.63
|
| Rate for Payer: PHP Commercial |
$71.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.16
|
| Rate for Payer: UHC Core |
$70.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.20
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
IP
|
$58.77
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: BCBS Trust/PPO |
$45.42
|
| Rate for Payer: BCN Commercial |
$45.42
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.02
|
| Rate for Payer: Healthscope Commercial |
$52.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.95
|
| Rate for Payer: PHP Commercial |
$49.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.72
|
| Rate for Payer: UHC Core |
$49.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.08
|
|
|
HC UREAPLASMA PCR CMPT
|
Facility
|
OP
|
$58.77
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
30600302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$52.89 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Aetna Medicare |
$15.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.37
|
| Rate for Payer: BCBS Complete |
$27.19
|
| Rate for Payer: BCBS MAPPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$45.69
|
| Rate for Payer: BCN Commercial |
$45.69
|
| Rate for Payer: BCN Medicare Advantage |
$14.69
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cash Price |
$47.02
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$52.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.08
|
| Rate for Payer: Mclaren Medicaid |
$25.90
|
| Rate for Payer: Meridian Medicaid |
$27.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.95
|
| Rate for Payer: PACE Senior Care Partners |
$13.96
|
| Rate for Payer: PACE SWMI |
$14.69
|
| Rate for Payer: PHP Commercial |
$49.95
|
| Rate for Payer: PHP Medicare Advantage |
$14.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.13
|
| Rate for Payer: Priority Health Medicare |
$14.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.84
|
| Rate for Payer: Railroad Medicare Medicare |
$14.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.72
|
| Rate for Payer: UHC Core |
$49.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.69
|
| Rate for Payer: UHC Medicare Advantage |
$15.13
|
| Rate for Payer: VA VA |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.08
|
|
