|
HC U.S. SKIN PREP PACK
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.57
|
| Rate for Payer: UHC Core |
$13.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
HC U.S. SKIN PREP PACK
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
27000163
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.18
|
| Rate for Payer: BCBS Complete |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$4.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.88
|
| Rate for Payer: BCN Commercial |
$12.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.14
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PACE Senior Care Partners |
$3.93
|
| Rate for Payer: PACE SWMI |
$4.14
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: PHP Medicare Advantage |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$4.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.57
|
| Rate for Payer: UHC Core |
$13.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$4.26
|
| Rate for Payer: VA VA |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.42
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
OP
|
$770.55
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Aetna Commercial |
$654.97
|
| Rate for Payer: Aetna Medicare |
$200.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$240.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$240.80
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$192.64
|
| Rate for Payer: BCBS Trust/PPO |
$599.10
|
| Rate for Payer: BCN Commercial |
$599.10
|
| Rate for Payer: BCN Medicare Advantage |
$192.64
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cofinity Commercial |
$662.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.64
|
| Rate for Payer: Healthscope Commercial |
$693.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$577.91
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.97
|
| Rate for Payer: PACE Senior Care Partners |
$183.01
|
| Rate for Payer: PACE SWMI |
$192.64
|
| Rate for Payer: PHP Commercial |
$654.97
|
| Rate for Payer: PHP Medicare Advantage |
$192.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$670.38
|
| Rate for Payer: Priority Health Medicare |
$192.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.96
|
| Rate for Payer: Railroad Medicare Medicare |
$192.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.08
|
| Rate for Payer: UHC Core |
$643.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.64
|
| Rate for Payer: UHC Medicare Advantage |
$198.42
|
| Rate for Payer: VA VA |
$192.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$577.91
|
|
|
HC US SOFT TISSUE HEAD NECK
|
Facility
|
IP
|
$770.55
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
40200006
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$469.96 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Aetna Commercial |
$654.97
|
| Rate for Payer: BCBS Trust/PPO |
$595.48
|
| Rate for Payer: BCN Commercial |
$595.48
|
| Rate for Payer: Cash Price |
$616.44
|
| Rate for Payer: Cofinity Commercial |
$662.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$616.44
|
| Rate for Payer: Healthscope Commercial |
$693.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$577.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$654.97
|
| Rate for Payer: PHP Commercial |
$654.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$670.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.08
|
| Rate for Payer: UHC Core |
$643.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$577.91
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
OP
|
$476.47
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Medicare |
$123.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.90
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$119.12
|
| Rate for Payer: BCBS Trust/PPO |
$370.46
|
| Rate for Payer: BCN Commercial |
$370.46
|
| Rate for Payer: BCN Medicare Advantage |
$119.12
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.12
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.35
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PACE Senior Care Partners |
$113.16
|
| Rate for Payer: PACE SWMI |
$119.12
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: PHP Medicare Advantage |
$119.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.53
|
| Rate for Payer: Priority Health Medicare |
$119.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.60
|
| Rate for Payer: Railroad Medicare Medicare |
$119.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.29
|
| Rate for Payer: UHC Core |
$397.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.12
|
| Rate for Payer: UHC Medicare Advantage |
$122.69
|
| Rate for Payer: VA VA |
$119.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.35
|
|
|
HC US SPINAL CANAL AND CONTENTS
|
Facility
|
IP
|
$476.47
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
40200014
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$290.60 |
| Max. Negotiated Rate |
$428.82 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: BCBS Trust/PPO |
$368.22
|
| Rate for Payer: BCN Commercial |
$368.22
|
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Cofinity Commercial |
$409.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.18
|
| Rate for Payer: Healthscope Commercial |
$428.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.00
|
| Rate for Payer: PHP Commercial |
$405.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.29
|
| Rate for Payer: UHC Core |
$397.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.35
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
OP
|
$667.08
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.43 |
| Max. Negotiated Rate |
$600.37 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: Aetna Medicare |
$173.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$208.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$208.46
|
| Rate for Payer: BCBS Complete |
$266.83
|
| Rate for Payer: BCBS MAPPO |
$166.77
|
| Rate for Payer: BCBS Trust/PPO |
$518.65
|
| Rate for Payer: BCN Commercial |
$518.65
|
| Rate for Payer: BCN Medicare Advantage |
$166.77
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.77
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PACE Senior Care Partners |
$158.43
|
| Rate for Payer: PACE SWMI |
$166.77
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: PHP Medicare Advantage |
$166.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.36
|
| Rate for Payer: Priority Health Medicare |
$166.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.85
|
| Rate for Payer: Railroad Medicare Medicare |
$166.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.03
|
| Rate for Payer: UHC Core |
$557.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.77
|
| Rate for Payer: UHC Medicare Advantage |
$171.77
|
| Rate for Payer: VA VA |
$166.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.31
|
|
|
HC US SURGERY INTRAOPERATIVE
|
Facility
|
IP
|
$667.08
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
40200050
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$406.85 |
| Max. Negotiated Rate |
$600.37 |
| Rate for Payer: Aetna Commercial |
$567.02
|
| Rate for Payer: BCBS Trust/PPO |
$515.52
|
| Rate for Payer: BCN Commercial |
$515.52
|
| Rate for Payer: Cash Price |
$533.66
|
| Rate for Payer: Cofinity Commercial |
$573.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$533.66
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$500.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$567.02
|
| Rate for Payer: PHP Commercial |
$567.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.03
|
| Rate for Payer: UHC Core |
$557.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$500.31
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$99.41 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: BCBS Trust/PPO |
$125.97
|
| Rate for Payer: BCN Commercial |
$125.97
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.44
|
| Rate for Payer: UHC Core |
$136.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.25
|
|
|
HC USTEKINUMAB AND AB
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
30100673
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Aetna Commercial |
$138.55
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.94
|
| Rate for Payer: BCBS Complete |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$40.75
|
| Rate for Payer: BCBS Trust/PPO |
$126.73
|
| Rate for Payer: BCN Commercial |
$126.73
|
| Rate for Payer: BCN Medicare Advantage |
$40.75
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$140.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.75
|
| Rate for Payer: Healthscope Commercial |
$146.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.25
|
| Rate for Payer: Mclaren Medicaid |
$12.75
|
| Rate for Payer: Meridian Medicaid |
$13.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.55
|
| Rate for Payer: PACE Senior Care Partners |
$38.71
|
| Rate for Payer: PACE SWMI |
$40.75
|
| Rate for Payer: PHP Commercial |
$138.55
|
| Rate for Payer: PHP Medicare Advantage |
$40.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.81
|
| Rate for Payer: Priority Health Medicare |
$40.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.41
|
| Rate for Payer: Railroad Medicare Medicare |
$40.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.44
|
| Rate for Payer: UHC Core |
$136.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.75
|
| Rate for Payer: UHC Medicare Advantage |
$41.97
|
| Rate for Payer: VA VA |
$40.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.25
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$42.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.62
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$40.50
|
| Rate for Payer: BCBS Trust/PPO |
$125.96
|
| Rate for Payer: BCN Commercial |
$125.96
|
| Rate for Payer: BCN Medicare Advantage |
$40.50
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.50
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PACE Senior Care Partners |
$38.48
|
| Rate for Payer: PACE SWMI |
$40.50
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: PHP Medicare Advantage |
$40.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.94
|
| Rate for Payer: Priority Health Medicare |
$40.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.80
|
| Rate for Payer: Railroad Medicare Medicare |
$40.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.56
|
| Rate for Payer: UHC Core |
$135.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.50
|
| Rate for Payer: UHC Medicare Advantage |
$41.72
|
| Rate for Payer: VA VA |
$40.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC USTEKINUMAB AND AB CMPT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100674
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: BCBS Trust/PPO |
$125.19
|
| Rate for Payer: BCN Commercial |
$125.19
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.56
|
| Rate for Payer: UHC Core |
$135.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.27 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: BCBS Trust/PPO |
$114.37
|
| Rate for Payer: BCN Commercial |
$114.37
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
30100708
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.25
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS MAPPO |
$37.00
|
| Rate for Payer: BCBS Trust/PPO |
$115.07
|
| Rate for Payer: BCN Commercial |
$115.07
|
| Rate for Payer: BCN Medicare Advantage |
$37.00
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.00
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Mclaren Medicaid |
$10.42
|
| Rate for Payer: Meridian Medicaid |
$10.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PACE Senior Care Partners |
$35.15
|
| Rate for Payer: PACE SWMI |
$37.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: PHP Medicare Advantage |
$37.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.76
|
| Rate for Payer: Priority Health Medicare |
$37.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.24
|
| Rate for Payer: UHC Core |
$123.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.00
|
| Rate for Payer: UHC Medicare Advantage |
$38.11
|
| Rate for Payer: VA VA |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB CMPT
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Medicare |
$42.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.62
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS MAPPO |
$40.50
|
| Rate for Payer: BCBS Trust/PPO |
$125.96
|
| Rate for Payer: BCN Commercial |
$125.96
|
| Rate for Payer: BCN Medicare Advantage |
$40.50
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.50
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Mclaren Medicaid |
$13.76
|
| Rate for Payer: Meridian Medicaid |
$14.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PACE Senior Care Partners |
$38.48
|
| Rate for Payer: PACE SWMI |
$40.50
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: PHP Medicare Advantage |
$40.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.94
|
| Rate for Payer: Priority Health Medicare |
$40.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.80
|
| Rate for Payer: Railroad Medicare Medicare |
$40.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.56
|
| Rate for Payer: UHC Core |
$135.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.50
|
| Rate for Payer: UHC Medicare Advantage |
$41.72
|
| Rate for Payer: VA VA |
$40.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC USTEKINUMAB AND ANTI-USTEK AB CMPT
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
30100709
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: BCBS Trust/PPO |
$125.19
|
| Rate for Payer: BCN Commercial |
$125.19
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.60
|
| Rate for Payer: Healthscope Commercial |
$145.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.70
|
| Rate for Payer: PHP Commercial |
$137.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.56
|
| Rate for Payer: UHC Core |
$135.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.50
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
IP
|
$500.38
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: BCBS Trust/PPO |
$386.69
|
| Rate for Payer: BCN Commercial |
$386.69
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC US TRANSPLANTED KIDNEY
|
Facility
|
OP
|
$500.38
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
40200013
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.12 |
| Max. Negotiated Rate |
$450.34 |
| Rate for Payer: Aetna Commercial |
$425.32
|
| Rate for Payer: Aetna Medicare |
$130.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.37
|
| Rate for Payer: BCBS Complete |
$75.72
|
| Rate for Payer: BCBS MAPPO |
$125.10
|
| Rate for Payer: BCBS Trust/PPO |
$389.05
|
| Rate for Payer: BCN Commercial |
$389.05
|
| Rate for Payer: BCN Medicare Advantage |
$125.10
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cofinity Commercial |
$430.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.10
|
| Rate for Payer: Healthscope Commercial |
$450.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.28
|
| Rate for Payer: Mclaren Medicaid |
$72.12
|
| Rate for Payer: Meridian Medicaid |
$75.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$425.32
|
| Rate for Payer: PACE Senior Care Partners |
$118.84
|
| Rate for Payer: PACE SWMI |
$125.10
|
| Rate for Payer: PHP Commercial |
$425.32
|
| Rate for Payer: PHP Medicare Advantage |
$125.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.33
|
| Rate for Payer: Priority Health Medicare |
$125.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.18
|
| Rate for Payer: Railroad Medicare Medicare |
$125.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.33
|
| Rate for Payer: UHC Core |
$417.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.10
|
| Rate for Payer: UHC Medicare Advantage |
$128.85
|
| Rate for Payer: VA VA |
$125.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.28
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,876.25 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: Aetna Medicare |
$2,054.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,468.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,468.75
|
| Rate for Payer: BCBS Complete |
$2,217.64
|
| Rate for Payer: BCBS MAPPO |
$1,975.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,142.25
|
| Rate for Payer: BCN Commercial |
$6,142.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,975.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,320.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,975.00
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,925.00
|
| Rate for Payer: Mclaren Medicaid |
$2,112.04
|
| Rate for Payer: Meridian Medicaid |
$2,217.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,073.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,271.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PACE Senior Care Partners |
$1,876.25
|
| Rate for Payer: PACE SWMI |
$1,975.00
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,975.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,112.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,873.00
|
| Rate for Payer: Priority Health Medicare |
$1,975.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,818.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1,975.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,952.00
|
| Rate for Payer: UHC Core |
$6,596.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,975.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,034.25
|
| Rate for Payer: VA VA |
$1,975.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,925.00
|
|
|
HC UVULECTOMY EXCISION UVULA
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
CPT 42140
|
| Hospital Charge Code |
76100468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,818.21 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$6,715.00
|
| Rate for Payer: BCBS Trust/PPO |
$6,105.12
|
| Rate for Payer: BCN Commercial |
$6,105.12
|
| Rate for Payer: Cash Price |
$6,320.00
|
| Rate for Payer: Cofinity Commercial |
$6,794.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,320.00
|
| Rate for Payer: Healthscope Commercial |
$7,110.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,925.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,715.00
|
| Rate for Payer: PHP Commercial |
$6,715.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,530.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,873.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,818.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,952.00
|
| Rate for Payer: UHC Core |
$6,596.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,925.00
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$15.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.75
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.65
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.45
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC V5011 FITTING ORIENTATION CHECKING OF HEARING AID
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT V5011
|
| Hospital Charge Code |
47000008
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: BCBS Trust/PPO |
$46.37
|
| Rate for Payer: BCN Commercial |
$46.37
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.00
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.80
|
| Rate for Payer: UHC Core |
$50.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.00
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: BCBS Trust/PPO |
$367.08
|
| Rate for Payer: BCN Commercial |
$367.08
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC V5160 DISPENSING FEE BINAURAL
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT V5160
|
| Hospital Charge Code |
47000006
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$112.81 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.44
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$118.75
|
| Rate for Payer: BCBS Trust/PPO |
$369.31
|
| Rate for Payer: BCN Commercial |
$369.31
|
| Rate for Payer: BCN Medicare Advantage |
$118.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.75
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PACE Senior Care Partners |
$112.81
|
| Rate for Payer: PACE SWMI |
$118.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: PHP Medicare Advantage |
$118.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.25
|
| Rate for Payer: Priority Health Medicare |
$118.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.70
|
| Rate for Payer: Railroad Medicare Medicare |
$118.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.75
|
| Rate for Payer: UHC Medicare Advantage |
$122.31
|
| Rate for Payer: VA VA |
$118.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
HC V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT V5241
|
| Hospital Charge Code |
47000004
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$167.72 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$233.75
|
| Rate for Payer: BCBS Trust/PPO |
$212.52
|
| Rate for Payer: BCN Commercial |
$212.52
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$236.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.00
|
| Rate for Payer: Healthscope Commercial |
$247.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.75
|
| Rate for Payer: PHP Commercial |
$233.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.00
|
| Rate for Payer: UHC Core |
$229.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.25
|
|
