|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
IP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.11 |
| Max. Negotiated Rate |
$246.62 |
| Rate for Payer: Aetna Commercial |
$232.92
|
| Rate for Payer: BCBS Trust/PPO |
$223.68
|
| Rate for Payer: BCN Commercial |
$211.76
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$235.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$224.70
|
| Rate for Payer: PHP Commercial |
$232.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: Priority Health HMO/PPO |
$238.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.14
|
| Rate for Payer: UHC Core |
$228.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.51
|
|
|
HC OB SURGERY ADDL 15 MIN
|
Facility
|
OP
|
$274.02
|
|
| Hospital Charge Code |
36000104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$65.08 |
| Max. Negotiated Rate |
$246.62 |
| Rate for Payer: Aetna Commercial |
$232.92
|
| Rate for Payer: Aetna Medicare |
$71.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.63
|
| Rate for Payer: BCBS Complete |
$109.61
|
| Rate for Payer: BCBS MAPPO |
$68.50
|
| Rate for Payer: BCBS Trust/PPO |
$225.27
|
| Rate for Payer: BCN Commercial |
$213.05
|
| Rate for Payer: BCN Medicare Advantage |
$68.50
|
| Rate for Payer: Cash Price |
$219.22
|
| Rate for Payer: Cofinity Commercial |
$235.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.50
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.92
|
| Rate for Payer: Nomi Health Commercial |
$224.70
|
| Rate for Payer: PACE Senior Care Partners |
$65.08
|
| Rate for Payer: PACE SWMI |
$68.50
|
| Rate for Payer: PHP Commercial |
$232.92
|
| Rate for Payer: PHP Medicare Advantage |
$68.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.11
|
| Rate for Payer: Priority Health HMO/PPO |
$238.40
|
| Rate for Payer: Priority Health Medicare |
$69.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.59
|
| Rate for Payer: Railroad Medicare Medicare |
$68.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.14
|
| Rate for Payer: UHC Core |
$228.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.50
|
| Rate for Payer: UHC Exchange |
$68.50
|
| Rate for Payer: UHC Medicare Advantage |
$68.50
|
| Rate for Payer: VA VA |
$68.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.51
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
OP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.22 |
| Max. Negotiated Rate |
$1,308.20 |
| Rate for Payer: Aetna Commercial |
$1,235.53
|
| Rate for Payer: Aetna Medicare |
$377.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$454.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$454.24
|
| Rate for Payer: BCBS Complete |
$581.42
|
| Rate for Payer: BCBS MAPPO |
$363.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.97
|
| Rate for Payer: BCN Commercial |
$1,130.14
|
| Rate for Payer: BCN Medicare Advantage |
$363.39
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,250.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.39
|
| Rate for Payer: Healthscope Commercial |
$1,308.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$417.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: Nomi Health Commercial |
$1,191.92
|
| Rate for Payer: PACE Senior Care Partners |
$345.22
|
| Rate for Payer: PACE SWMI |
$363.39
|
| Rate for Payer: PHP Commercial |
$1,235.53
|
| Rate for Payer: PHP Medicare Advantage |
$363.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1,264.60
|
| Rate for Payer: Priority Health Medicare |
$367.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$973.89
|
| Rate for Payer: Railroad Medicare Medicare |
$363.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,279.13
|
| Rate for Payer: UHC Core |
$1,213.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.39
|
| Rate for Payer: UHC Exchange |
$363.39
|
| Rate for Payer: UHC Medicare Advantage |
$363.39
|
| Rate for Payer: VA VA |
$363.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.17
|
|
|
HC OB SURGERY INITIAL 30 MIN
|
Facility
|
IP
|
$1,453.56
|
|
| Hospital Charge Code |
36000077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$944.81 |
| Max. Negotiated Rate |
$1,308.20 |
| Rate for Payer: Aetna Commercial |
$1,235.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.54
|
| Rate for Payer: BCN Commercial |
$1,123.31
|
| Rate for Payer: Cash Price |
$1,162.85
|
| Rate for Payer: Cofinity Commercial |
$1,250.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.85
|
| Rate for Payer: Healthscope Commercial |
$1,308.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,090.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.53
|
| Rate for Payer: Nomi Health Commercial |
$1,191.92
|
| Rate for Payer: PHP Commercial |
$1,235.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.81
|
| Rate for Payer: Priority Health HMO/PPO |
$1,264.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$973.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,279.13
|
| Rate for Payer: UHC Core |
$1,213.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,090.17
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
IP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.55 |
| Max. Negotiated Rate |
$231.99 |
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: BCBS Trust/PPO |
$210.42
|
| Rate for Payer: BCN Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$221.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Healthscope Commercial |
$231.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.37
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: Priority Health HMO/PPO |
$224.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.84
|
| Rate for Payer: UHC Core |
$215.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.33
|
|
|
HC OB VAC DEL KIT DISP (OB)
|
Facility
|
OP
|
$257.77
|
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$231.99 |
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: Aetna Medicare |
$67.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.55
|
| Rate for Payer: BCBS Complete |
$103.11
|
| Rate for Payer: BCBS MAPPO |
$64.44
|
| Rate for Payer: BCBS Trust/PPO |
$211.91
|
| Rate for Payer: BCN Commercial |
$200.42
|
| Rate for Payer: BCN Medicare Advantage |
$64.44
|
| Rate for Payer: Cash Price |
$206.22
|
| Rate for Payer: Cofinity Commercial |
$221.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.44
|
| Rate for Payer: Healthscope Commercial |
$231.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.10
|
| Rate for Payer: Nomi Health Commercial |
$211.37
|
| Rate for Payer: PACE Senior Care Partners |
$61.22
|
| Rate for Payer: PACE SWMI |
$64.44
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: PHP Medicare Advantage |
$64.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.55
|
| Rate for Payer: Priority Health HMO/PPO |
$224.26
|
| Rate for Payer: Priority Health Medicare |
$65.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.71
|
| Rate for Payer: Railroad Medicare Medicare |
$64.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.84
|
| Rate for Payer: UHC Core |
$215.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.44
|
| Rate for Payer: UHC Exchange |
$64.44
|
| Rate for Payer: UHC Medicare Advantage |
$64.44
|
| Rate for Payer: VA VA |
$64.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.33
|
|
|
HC OCCLUSION CATH
|
Facility
|
IP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,090.51 |
| Max. Negotiated Rate |
$4,279.17 |
| Rate for Payer: Aetna Commercial |
$4,041.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,881.20
|
| Rate for Payer: BCN Commercial |
$3,674.38
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$4,088.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Healthscope Commercial |
$4,279.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,565.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: Nomi Health Commercial |
$3,898.80
|
| Rate for Payer: PHP Commercial |
$4,041.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: Priority Health HMO/PPO |
$4,136.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,185.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,184.07
|
| Rate for Payer: UHC Core |
$3,970.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,565.97
|
|
|
HC OCCLUSION CATH
|
Facility
|
OP
|
$4,754.63
|
|
|
Service Code
|
HCPCS C2628
|
| Hospital Charge Code |
27200344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,129.22 |
| Max. Negotiated Rate |
$4,279.17 |
| Rate for Payer: Aetna Commercial |
$4,041.44
|
| Rate for Payer: Aetna Medicare |
$1,236.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,485.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,485.82
|
| Rate for Payer: BCBS Complete |
$1,901.85
|
| Rate for Payer: BCBS MAPPO |
$1,188.66
|
| Rate for Payer: BCBS Trust/PPO |
$3,908.78
|
| Rate for Payer: BCN Commercial |
$3,696.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,188.66
|
| Rate for Payer: Cash Price |
$3,803.70
|
| Rate for Payer: Cofinity Commercial |
$4,088.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,188.66
|
| Rate for Payer: Healthscope Commercial |
$4,279.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,565.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,248.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,366.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,041.44
|
| Rate for Payer: Nomi Health Commercial |
$3,898.80
|
| Rate for Payer: PACE Senior Care Partners |
$1,129.22
|
| Rate for Payer: PACE SWMI |
$1,188.66
|
| Rate for Payer: PHP Commercial |
$4,041.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,188.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.51
|
| Rate for Payer: Priority Health HMO/PPO |
$4,136.53
|
| Rate for Payer: Priority Health Medicare |
$1,200.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,185.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,188.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,184.07
|
| Rate for Payer: UHC Core |
$3,970.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,188.66
|
| Rate for Payer: UHC Exchange |
$1,188.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,188.66
|
| Rate for Payer: VA VA |
$1,188.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,565.97
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
OP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna Commercial |
$26.09
|
| Rate for Payer: Aetna Medicare |
$7.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.59
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$7.67
|
| Rate for Payer: BCBS Trust/PPO |
$25.24
|
| Rate for Payer: BCN Commercial |
$23.87
|
| Rate for Payer: BCN Medicare Advantage |
$7.67
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.67
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.02
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.06
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$25.17
|
| Rate for Payer: PACE Senior Care Partners |
$7.29
|
| Rate for Payer: PACE SWMI |
$7.67
|
| Rate for Payer: PHP Commercial |
$26.09
|
| Rate for Payer: PHP Medicare Advantage |
$7.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: Priority Health HMO/PPO |
$26.71
|
| Rate for Payer: Priority Health Medicare |
$7.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.57
|
| Rate for Payer: Railroad Medicare Medicare |
$7.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$25.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.67
|
| Rate for Payer: UHC Exchange |
$7.67
|
| Rate for Payer: UHC Medicare Advantage |
$7.67
|
| Rate for Payer: UHCCP Medicaid |
$3.85
|
| Rate for Payer: VA VA |
$7.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
|
HC OCCULT BLOOD OTHER SOURCES
|
Facility
|
IP
|
$30.70
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
30100122
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$27.63 |
| Rate for Payer: Aetna Commercial |
$26.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.06
|
| Rate for Payer: BCN Commercial |
$23.72
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Cofinity Commercial |
$26.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.56
|
| Rate for Payer: Healthscope Commercial |
$27.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$25.17
|
| Rate for Payer: PHP Commercial |
$26.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.95
|
| Rate for Payer: Priority Health HMO/PPO |
$26.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.02
|
| Rate for Payer: UHC Core |
$25.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.02
|
|
|
HC OCT CATHETER
|
Facility
|
OP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.82 |
| Max. Negotiated Rate |
$2,322.26 |
| Rate for Payer: Aetna Commercial |
$2,193.25
|
| Rate for Payer: Aetna Medicare |
$670.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$806.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$806.34
|
| Rate for Payer: BCBS Complete |
$1,032.12
|
| Rate for Payer: BCBS MAPPO |
$645.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,121.26
|
| Rate for Payer: BCN Commercial |
$2,006.18
|
| Rate for Payer: BCN Medicare Advantage |
$645.07
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$645.07
|
| Rate for Payer: Healthscope Commercial |
$2,322.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: PACE Senior Care Partners |
$612.82
|
| Rate for Payer: PACE SWMI |
$645.07
|
| Rate for Payer: PHP Commercial |
$2,193.25
|
| Rate for Payer: PHP Medicare Advantage |
$645.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health HMO/PPO |
$2,244.85
|
| Rate for Payer: Priority Health Medicare |
$651.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,728.79
|
| Rate for Payer: Railroad Medicare Medicare |
$645.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,270.66
|
| Rate for Payer: UHC Core |
$2,154.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$645.07
|
| Rate for Payer: UHC Exchange |
$645.07
|
| Rate for Payer: UHC Medicare Advantage |
$645.07
|
| Rate for Payer: VA VA |
$645.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.22
|
|
|
HC OCT CATHETER
|
Facility
|
IP
|
$2,580.29
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
27200243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,677.19 |
| Max. Negotiated Rate |
$2,322.26 |
| Rate for Payer: Aetna Commercial |
$2,193.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.29
|
| Rate for Payer: BCN Commercial |
$1,994.05
|
| Rate for Payer: Cash Price |
$2,064.23
|
| Rate for Payer: Cofinity Commercial |
$2,219.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.23
|
| Rate for Payer: Healthscope Commercial |
$2,322.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,193.25
|
| Rate for Payer: Nomi Health Commercial |
$2,115.84
|
| Rate for Payer: PHP Commercial |
$2,193.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.19
|
| Rate for Payer: Priority Health HMO/PPO |
$2,244.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,728.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,270.66
|
| Rate for Payer: UHC Core |
$2,154.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.22
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
IP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: BCBS Trust/PPO |
$37.47
|
| Rate for Payer: BCN Commercial |
$35.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC OCTOPUS SET CARDIOPLEGIA
|
Facility
|
OP
|
$45.90
|
|
| Hospital Charge Code |
27000106
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna Commercial |
$39.02
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.34
|
| Rate for Payer: BCBS Complete |
$18.36
|
| Rate for Payer: BCBS MAPPO |
$11.47
|
| Rate for Payer: BCBS Trust/PPO |
$37.73
|
| Rate for Payer: BCN Commercial |
$35.69
|
| Rate for Payer: BCN Medicare Advantage |
$11.47
|
| Rate for Payer: Cash Price |
$36.72
|
| Rate for Payer: Cofinity Commercial |
$39.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$41.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.02
|
| Rate for Payer: Nomi Health Commercial |
$37.64
|
| Rate for Payer: PACE Senior Care Partners |
$10.90
|
| Rate for Payer: PACE SWMI |
$11.47
|
| Rate for Payer: PHP Commercial |
$39.02
|
| Rate for Payer: PHP Medicare Advantage |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.84
|
| Rate for Payer: Priority Health HMO/PPO |
$39.93
|
| Rate for Payer: Priority Health Medicare |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.75
|
| Rate for Payer: Railroad Medicare Medicare |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.39
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.47
|
| Rate for Payer: UHC Exchange |
$11.47
|
| Rate for Payer: UHC Medicare Advantage |
$11.47
|
| Rate for Payer: VA VA |
$11.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.42
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.26
|
| Rate for Payer: BCBS Complete |
$20.81
|
| Rate for Payer: BCBS MAPPO |
$13.01
|
| Rate for Payer: BCBS Trust/PPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$40.45
|
| Rate for Payer: BCN Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PACE Senior Care Partners |
$12.35
|
| Rate for Payer: PACE SWMI |
$13.01
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Medicare |
$13.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.01
|
| Rate for Payer: UHC Exchange |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$13.01
|
| Rate for Payer: VA VA |
$13.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC OCULAR INSTRMNT SCREEN BILAT
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
CPT 99174
|
| Hospital Charge Code |
51000105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$46.82 |
| Rate for Payer: Aetna Commercial |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$42.46
|
| Rate for Payer: BCN Commercial |
$40.20
|
| Rate for Payer: Cash Price |
$41.62
|
| Rate for Payer: Cofinity Commercial |
$44.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.62
|
| Rate for Payer: Healthscope Commercial |
$46.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.22
|
| Rate for Payer: Nomi Health Commercial |
$42.66
|
| Rate for Payer: PHP Commercial |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.81
|
| Rate for Payer: Priority Health HMO/PPO |
$45.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.78
|
| Rate for Payer: UHC Core |
$43.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.02
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100371
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$11.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.00
|
| Rate for Payer: BCBS Complete |
$20.79
|
| Rate for Payer: BCBS MAPPO |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.83
|
| Rate for Payer: BCN Commercial |
$34.83
|
| Rate for Payer: BCN Medicare Advantage |
$11.20
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Mclaren Medicaid |
$19.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.76
|
| Rate for Payer: Meridian Medicaid |
$20.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Senior Care Partners |
$10.64
|
| Rate for Payer: PACE SWMI |
$11.20
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$11.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.20
|
| Rate for Payer: UHC Exchange |
$11.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$19.80
|
| Rate for Payer: VA VA |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
OP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: Aetna Medicare |
$11.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.00
|
| Rate for Payer: BCBS Complete |
$20.79
|
| Rate for Payer: BCBS MAPPO |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$36.83
|
| Rate for Payer: BCN Commercial |
$34.83
|
| Rate for Payer: BCN Medicare Advantage |
$11.20
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.20
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Mclaren Medicaid |
$19.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.76
|
| Rate for Payer: Meridian Medicaid |
$20.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PACE Senior Care Partners |
$10.64
|
| Rate for Payer: PACE SWMI |
$11.20
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$11.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.20
|
| Rate for Payer: UHC Exchange |
$11.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.20
|
| Rate for Payer: UHCCP Medicaid |
$19.80
|
| Rate for Payer: VA VA |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OLIGOCLONAL BANDS CMPT
|
Facility
|
IP
|
$44.80
|
|
|
Service Code
|
CPT 83916
|
| Hospital Charge Code |
30100551
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$40.32 |
| Rate for Payer: Aetna Commercial |
$38.08
|
| Rate for Payer: BCBS Trust/PPO |
$36.57
|
| Rate for Payer: BCN Commercial |
$34.62
|
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$38.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$40.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.08
|
| Rate for Payer: Nomi Health Commercial |
$36.74
|
| Rate for Payer: PHP Commercial |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.12
|
| Rate for Payer: Priority Health HMO/PPO |
$38.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.42
|
| Rate for Payer: UHC Core |
$37.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.60
|
|
|
HC OMMAYA
|
Facility
|
IP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$250.07 |
| Max. Negotiated Rate |
$346.26 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: BCBS Trust/PPO |
$314.06
|
| Rate for Payer: BCN Commercial |
$297.32
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$330.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Healthscope Commercial |
$346.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: PHP Commercial |
$327.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.56
|
| Rate for Payer: UHC Core |
$321.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.55
|
|
|
HC OMMAYA
|
Facility
|
OP
|
$384.73
|
|
|
Service Code
|
CPT 96542
|
| Hospital Charge Code |
33500005
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$91.37 |
| Max. Negotiated Rate |
$346.26 |
| Rate for Payer: Aetna Commercial |
$327.02
|
| Rate for Payer: Aetna Medicare |
$100.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.23
|
| Rate for Payer: BCBS Complete |
$251.82
|
| Rate for Payer: BCBS MAPPO |
$96.18
|
| Rate for Payer: BCBS Trust/PPO |
$316.29
|
| Rate for Payer: BCN Commercial |
$299.13
|
| Rate for Payer: BCN Medicare Advantage |
$96.18
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cash Price |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$330.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.18
|
| Rate for Payer: Healthscope Commercial |
$346.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.55
|
| Rate for Payer: Mclaren Medicaid |
$239.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.99
|
| Rate for Payer: Meridian Medicaid |
$251.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.02
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: PACE Senior Care Partners |
$91.37
|
| Rate for Payer: PACE SWMI |
$96.18
|
| Rate for Payer: PHP Commercial |
$327.02
|
| Rate for Payer: PHP Medicare Advantage |
$96.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.07
|
| Rate for Payer: Priority Health HMO/PPO |
$334.72
|
| Rate for Payer: Priority Health Medicare |
$97.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.77
|
| Rate for Payer: Railroad Medicare Medicare |
$96.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.56
|
| Rate for Payer: UHC Core |
$321.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.18
|
| Rate for Payer: UHC Exchange |
$96.18
|
| Rate for Payer: UHC Medicare Advantage |
$96.18
|
| Rate for Payer: UHCCP Medicaid |
$239.81
|
| Rate for Payer: VA VA |
$96.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.55
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
OP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: Aetna Medicare |
$0.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.57
|
| Rate for Payer: BCBS Complete |
$0.72
|
| Rate for Payer: BCBS MAPPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$1.49
|
| Rate for Payer: BCN Commercial |
$1.41
|
| Rate for Payer: BCN Medicare Advantage |
$0.45
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.45
|
| Rate for Payer: Healthscope Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.43
|
| Rate for Payer: PACE SWMI |
$0.45
|
| Rate for Payer: PHP Commercial |
$1.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1.57
|
| Rate for Payer: Priority Health Medicare |
$0.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.21
|
| Rate for Payer: Railroad Medicare Medicare |
$0.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.59
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.45
|
| Rate for Payer: UHC Exchange |
$0.45
|
| Rate for Payer: UHC Medicare Advantage |
$0.45
|
| Rate for Payer: VA VA |
$0.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.36
|
|
|
HC OMNIPAQUE 300 PER ML
|
Facility
|
IP
|
$1.81
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
63600017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.63 |
| Rate for Payer: Aetna Commercial |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.48
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.54
|
| Rate for Payer: Nomi Health Commercial |
$1.48
|
| Rate for Payer: PHP Commercial |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO |
$1.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.59
|
| Rate for Payer: UHC Core |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.36
|
|
|
HC OPEN HEART OFF BYPASS
|
Facility
|
OP
|
$5,803.80
|
|
| Hospital Charge Code |
27000702
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,378.40 |
| Max. Negotiated Rate |
$5,223.42 |
| Rate for Payer: Aetna Commercial |
$4,933.23
|
| Rate for Payer: Aetna Medicare |
$1,508.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,813.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,813.69
|
| Rate for Payer: BCBS Complete |
$2,321.52
|
| Rate for Payer: BCBS MAPPO |
$1,450.95
|
| Rate for Payer: BCBS Trust/PPO |
$4,771.30
|
| Rate for Payer: BCN Commercial |
$4,512.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,450.95
|
| Rate for Payer: Cash Price |
$4,643.04
|
| Rate for Payer: Cofinity Commercial |
$4,991.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,643.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,450.95
|
| Rate for Payer: Healthscope Commercial |
$5,223.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,352.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,668.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,933.23
|
| Rate for Payer: Nomi Health Commercial |
$4,759.12
|
| Rate for Payer: PACE Senior Care Partners |
$1,378.40
|
| Rate for Payer: PACE SWMI |
$1,450.95
|
| Rate for Payer: PHP Commercial |
$4,933.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,450.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,772.47
|
| Rate for Payer: Priority Health HMO/PPO |
$5,049.31
|
| Rate for Payer: Priority Health Medicare |
$1,465.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,888.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,450.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,107.34
|
| Rate for Payer: UHC Core |
$4,846.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,450.95
|
| Rate for Payer: UHC Exchange |
$1,450.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,450.95
|
| Rate for Payer: VA VA |
$1,450.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,352.85
|
|
