|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: BCBS Trust/PPO |
$36.64
|
| Rate for Payer: BCN Commercial |
$36.64
|
| Rate for Payer: Cash Price |
$35.49
|
| Rate for Payer: Cofinity Commercial |
$38.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.49
|
| Rate for Payer: Healthscope Commercial |
$39.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Nomi Health Commercial |
$36.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.27
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$38.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.04
|
| Rate for Payer: UHC Core |
$37.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.27
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$379.43 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: BCBS Trust/PPO |
$450.25
|
| Rate for Payer: BCN Commercial |
$450.25
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.74
|
| Rate for Payer: UHC Core |
$455.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.87
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$545.16
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.11 |
| Max. Negotiated Rate |
$490.64 |
| Rate for Payer: Aetna Commercial |
$463.39
|
| Rate for Payer: Aetna Medicare |
$141.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$170.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$170.36
|
| Rate for Payer: BCBS Complete |
$100.91
|
| Rate for Payer: BCBS MAPPO |
$136.29
|
| Rate for Payer: BCBS Trust/PPO |
$448.18
|
| Rate for Payer: BCN Commercial |
$448.18
|
| Rate for Payer: BCN Medicare Advantage |
$136.29
|
| Rate for Payer: Cash Price |
$436.13
|
| Rate for Payer: Cofinity Commercial |
$468.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.29
|
| Rate for Payer: Healthscope Commercial |
$490.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.87
|
| Rate for Payer: Mclaren Medicaid |
$96.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.10
|
| Rate for Payer: Meridian Medicaid |
$100.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.39
|
| Rate for Payer: Nomi Health Commercial |
$447.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$408.87
|
| Rate for Payer: PACE Senior Care Partners |
$129.48
|
| Rate for Payer: PACE SWMI |
$136.29
|
| Rate for Payer: PHP Commercial |
$463.39
|
| Rate for Payer: PHP Medicare Advantage |
$136.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$474.29
|
| Rate for Payer: Priority Health Medicare |
$137.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$379.43
|
| Rate for Payer: Railroad Medicare Medicare |
$136.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.74
|
| Rate for Payer: UHC Core |
$455.21
|
| Rate for Payer: UHC Exchange |
$136.29
|
| Rate for Payer: UHC Medicaid |
$96.11
|
| Rate for Payer: UHC Medicare Advantage |
$136.29
|
| Rate for Payer: UHCCP Medicaid |
$96.11
|
| Rate for Payer: VA VA |
$136.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.87
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.86 |
| Max. Negotiated Rate |
$167.74 |
| Rate for Payer: Aetna Commercial |
$158.42
|
| Rate for Payer: Aetna Medicare |
$48.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.24
|
| Rate for Payer: BCBS Complete |
$34.50
|
| Rate for Payer: BCBS MAPPO |
$46.59
|
| Rate for Payer: BCBS Trust/PPO |
$153.22
|
| Rate for Payer: BCN Commercial |
$153.22
|
| Rate for Payer: BCN Medicare Advantage |
$46.59
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Commercial |
$160.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.59
|
| Rate for Payer: Healthscope Commercial |
$167.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.78
|
| Rate for Payer: Mclaren Medicaid |
$32.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.92
|
| Rate for Payer: Meridian Medicaid |
$34.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Nomi Health Commercial |
$152.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: PACE Senior Care Partners |
$44.27
|
| Rate for Payer: PACE SWMI |
$46.59
|
| Rate for Payer: PHP Commercial |
$158.42
|
| Rate for Payer: PHP Medicare Advantage |
$46.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.15
|
| Rate for Payer: Priority Health Medicare |
$47.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.72
|
| Rate for Payer: Railroad Medicare Medicare |
$46.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.01
|
| Rate for Payer: UHC Core |
$155.63
|
| Rate for Payer: UHC Exchange |
$46.59
|
| Rate for Payer: UHC Medicaid |
$32.86
|
| Rate for Payer: UHC Medicare Advantage |
$46.59
|
| Rate for Payer: UHCCP Medicaid |
$32.86
|
| Rate for Payer: VA VA |
$46.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.78
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$186.38
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$167.74 |
| Rate for Payer: Aetna Commercial |
$158.42
|
| Rate for Payer: BCBS Trust/PPO |
$153.93
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cofinity Commercial |
$160.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.10
|
| Rate for Payer: Healthscope Commercial |
$167.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.42
|
| Rate for Payer: Nomi Health Commercial |
$152.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.78
|
| Rate for Payer: PHP Commercial |
$158.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$162.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.01
|
| Rate for Payer: UHC Core |
$155.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.78
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$28.05
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.96
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna Commercial |
$28.87
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.29
|
| Rate for Payer: BCBS MAPPO |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$27.92
|
| Rate for Payer: BCN Commercial |
$27.92
|
| Rate for Payer: BCN Medicare Advantage |
$8.49
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Cofinity Commercial |
$29.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.47
|
| Rate for Payer: Mclaren Medicaid |
$5.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.91
|
| Rate for Payer: Meridian Medicaid |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.87
|
| Rate for Payer: Nomi Health Commercial |
$27.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.47
|
| Rate for Payer: PACE Senior Care Partners |
$8.07
|
| Rate for Payer: PACE SWMI |
$8.49
|
| Rate for Payer: PHP Commercial |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.55
|
| Rate for Payer: Priority Health Medicare |
$8.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.88
|
| Rate for Payer: UHC Core |
$28.36
|
| Rate for Payer: UHC Exchange |
$8.49
|
| Rate for Payer: UHC Medicaid |
$5.99
|
| Rate for Payer: UHC Medicare Advantage |
$8.49
|
| Rate for Payer: UHCCP Medicaid |
$5.99
|
| Rate for Payer: VA VA |
$8.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.47
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.08
|
| Rate for Payer: BCBS Complete |
$5.97
|
| Rate for Payer: BCBS MAPPO |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.51
|
| Rate for Payer: BCN Commercial |
$26.51
|
| Rate for Payer: BCN Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Mclaren Medicaid |
$5.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Meridian Medicaid |
$5.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PACE Senior Care Partners |
$7.66
|
| Rate for Payer: PACE SWMI |
$8.06
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: PHP Medicare Advantage |
$8.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$8.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.45
|
| Rate for Payer: Railroad Medicare Medicare |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: UHC Exchange |
$8.06
|
| Rate for Payer: UHC Medicaid |
$5.69
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: UHCCP Medicaid |
$5.69
|
| Rate for Payer: VA VA |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$32.25
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$29.02 |
| Rate for Payer: Aetna Commercial |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$26.64
|
| Rate for Payer: BCN Commercial |
$26.64
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$27.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.80
|
| Rate for Payer: Healthscope Commercial |
$29.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.41
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.19
|
| Rate for Payer: PHP Commercial |
$27.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.38
|
| Rate for Payer: UHC Core |
$26.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.19
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$189.82 |
| Max. Negotiated Rate |
$245.46 |
| Rate for Payer: Aetna Commercial |
$231.82
|
| Rate for Payer: BCBS Trust/PPO |
$225.25
|
| Rate for Payer: BCN Commercial |
$225.25
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Commercial |
$234.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Healthscope Commercial |
$245.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Nomi Health Commercial |
$223.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: PHP Commercial |
$231.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.00
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.55
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$272.73
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$245.46 |
| Rate for Payer: Aetna Commercial |
$231.82
|
| Rate for Payer: Aetna Medicare |
$70.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.23
|
| Rate for Payer: BCBS Complete |
$50.48
|
| Rate for Payer: BCBS MAPPO |
$68.18
|
| Rate for Payer: BCBS Trust/PPO |
$224.21
|
| Rate for Payer: BCN Commercial |
$224.21
|
| Rate for Payer: BCN Medicare Advantage |
$68.18
|
| Rate for Payer: Cash Price |
$218.18
|
| Rate for Payer: Cofinity Commercial |
$234.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.18
|
| Rate for Payer: Healthscope Commercial |
$245.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.55
|
| Rate for Payer: Mclaren Medicaid |
$48.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.59
|
| Rate for Payer: Meridian Medicaid |
$50.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.82
|
| Rate for Payer: Nomi Health Commercial |
$223.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.55
|
| Rate for Payer: PACE Senior Care Partners |
$64.77
|
| Rate for Payer: PACE SWMI |
$68.18
|
| Rate for Payer: PHP Commercial |
$231.82
|
| Rate for Payer: PHP Medicare Advantage |
$68.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$237.28
|
| Rate for Payer: Priority Health Medicare |
$68.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.82
|
| Rate for Payer: Railroad Medicare Medicare |
$68.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.00
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$68.18
|
| Rate for Payer: UHC Medicaid |
$48.08
|
| Rate for Payer: UHC Medicare Advantage |
$68.18
|
| Rate for Payer: UHCCP Medicaid |
$48.08
|
| Rate for Payer: VA VA |
$68.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.55
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.53 |
| Max. Negotiated Rate |
$508.10 |
| Rate for Payer: Aetna Commercial |
$479.88
|
| Rate for Payer: Aetna Medicare |
$146.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.43
|
| Rate for Payer: BCBS Complete |
$104.50
|
| Rate for Payer: BCBS MAPPO |
$141.14
|
| Rate for Payer: BCBS Trust/PPO |
$464.12
|
| Rate for Payer: BCN Commercial |
$464.12
|
| Rate for Payer: BCN Medicare Advantage |
$141.14
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Commercial |
$485.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.14
|
| Rate for Payer: Healthscope Commercial |
$508.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.42
|
| Rate for Payer: Mclaren Medicaid |
$99.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.20
|
| Rate for Payer: Meridian Medicaid |
$104.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Nomi Health Commercial |
$462.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: PACE Senior Care Partners |
$134.08
|
| Rate for Payer: PACE SWMI |
$141.14
|
| Rate for Payer: PHP Commercial |
$479.88
|
| Rate for Payer: PHP Medicare Advantage |
$141.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$491.17
|
| Rate for Payer: Priority Health Medicare |
$142.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.93
|
| Rate for Payer: Railroad Medicare Medicare |
$141.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.81
|
| Rate for Payer: UHC Core |
$471.41
|
| Rate for Payer: UHC Exchange |
$141.14
|
| Rate for Payer: UHC Medicaid |
$99.53
|
| Rate for Payer: UHC Medicare Advantage |
$141.14
|
| Rate for Payer: UHCCP Medicaid |
$99.53
|
| Rate for Payer: VA VA |
$141.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.42
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$564.56
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$392.93 |
| Max. Negotiated Rate |
$508.10 |
| Rate for Payer: Aetna Commercial |
$479.88
|
| Rate for Payer: BCBS Trust/PPO |
$466.27
|
| Rate for Payer: BCN Commercial |
$466.27
|
| Rate for Payer: Cash Price |
$451.65
|
| Rate for Payer: Cofinity Commercial |
$485.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$451.65
|
| Rate for Payer: Healthscope Commercial |
$508.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.88
|
| Rate for Payer: Nomi Health Commercial |
$462.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.42
|
| Rate for Payer: PHP Commercial |
$479.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$491.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$392.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.81
|
| Rate for Payer: UHC Core |
$471.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.42
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,194.29 |
| Max. Negotiated Rate |
$1,544.35 |
| Rate for Payer: Aetna Commercial |
$1,458.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.19
|
| Rate for Payer: BCN Commercial |
$1,417.19
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Commercial |
$1,475.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Healthscope Commercial |
$1,544.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,286.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Nomi Health Commercial |
$1,407.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: PHP Commercial |
$1,458.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,492.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,194.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,510.03
|
| Rate for Payer: UHC Core |
$1,432.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,286.95
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,715.94
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$302.52 |
| Max. Negotiated Rate |
$1,544.35 |
| Rate for Payer: Aetna Commercial |
$1,458.55
|
| Rate for Payer: Aetna Medicare |
$446.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$536.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$536.23
|
| Rate for Payer: BCBS Complete |
$317.62
|
| Rate for Payer: BCBS MAPPO |
$428.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,410.67
|
| Rate for Payer: BCN Commercial |
$1,410.67
|
| Rate for Payer: BCN Medicare Advantage |
$428.99
|
| Rate for Payer: Cash Price |
$1,372.75
|
| Rate for Payer: Cofinity Commercial |
$1,475.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,372.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.99
|
| Rate for Payer: Healthscope Commercial |
$1,544.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,286.95
|
| Rate for Payer: Mclaren Medicaid |
$302.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$450.43
|
| Rate for Payer: Meridian Medicaid |
$317.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$493.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$471.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,458.55
|
| Rate for Payer: Nomi Health Commercial |
$1,407.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,286.95
|
| Rate for Payer: PACE Senior Care Partners |
$407.54
|
| Rate for Payer: PACE SWMI |
$428.99
|
| Rate for Payer: PHP Commercial |
$1,458.55
|
| Rate for Payer: PHP Medicare Advantage |
$428.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,492.87
|
| Rate for Payer: Priority Health Medicare |
$433.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,194.29
|
| Rate for Payer: Railroad Medicare Medicare |
$428.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,510.03
|
| Rate for Payer: UHC Core |
$1,432.81
|
| Rate for Payer: UHC Exchange |
$428.99
|
| Rate for Payer: UHC Medicaid |
$302.52
|
| Rate for Payer: UHC Medicare Advantage |
$428.99
|
| Rate for Payer: UHCCP Medicaid |
$302.52
|
| Rate for Payer: VA VA |
$428.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,286.95
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
IP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$49.24 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: BCBS Trust/PPO |
$58.43
|
| Rate for Payer: BCN Commercial |
$58.43
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC POST MASTECTOMY SLEEVE A
|
Facility
|
OP
|
$70.75
|
|
| Hospital Charge Code |
96000049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$63.67 |
| Rate for Payer: Aetna Commercial |
$60.14
|
| Rate for Payer: Aetna Medicare |
$18.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.11
|
| Rate for Payer: BCBS Complete |
$13.10
|
| Rate for Payer: BCBS MAPPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$58.16
|
| Rate for Payer: BCN Commercial |
$58.16
|
| Rate for Payer: BCN Medicare Advantage |
$17.69
|
| Rate for Payer: Cash Price |
$56.60
|
| Rate for Payer: Cofinity Commercial |
$60.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.69
|
| Rate for Payer: Healthscope Commercial |
$63.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.06
|
| Rate for Payer: Mclaren Medicaid |
$12.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.57
|
| Rate for Payer: Meridian Medicaid |
$13.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$58.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.06
|
| Rate for Payer: PACE Senior Care Partners |
$16.80
|
| Rate for Payer: PACE SWMI |
$17.69
|
| Rate for Payer: PHP Commercial |
$60.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.55
|
| Rate for Payer: Priority Health Medicare |
$17.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.24
|
| Rate for Payer: Railroad Medicare Medicare |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.26
|
| Rate for Payer: UHC Core |
$59.08
|
| Rate for Payer: UHC Exchange |
$17.69
|
| Rate for Payer: UHC Medicaid |
$12.47
|
| Rate for Payer: UHC Medicare Advantage |
$17.69
|
| Rate for Payer: UHCCP Medicaid |
$12.47
|
| Rate for Payer: VA VA |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.06
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
OP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: Aetna Medicare |
$21.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.01
|
| Rate for Payer: BCBS Complete |
$15.41
|
| Rate for Payer: BCBS MAPPO |
$20.81
|
| Rate for Payer: BCBS Trust/PPO |
$68.42
|
| Rate for Payer: BCN Commercial |
$68.42
|
| Rate for Payer: BCN Medicare Advantage |
$20.81
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Mclaren Medicaid |
$14.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.85
|
| Rate for Payer: Meridian Medicaid |
$15.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PACE Senior Care Partners |
$19.77
|
| Rate for Payer: PACE SWMI |
$20.81
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Medicare |
$21.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$20.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: UHC Exchange |
$20.81
|
| Rate for Payer: UHC Medicaid |
$14.67
|
| Rate for Payer: UHC Medicare Advantage |
$20.81
|
| Rate for Payer: UHCCP Medicaid |
$14.67
|
| Rate for Payer: VA VA |
$20.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC POST MASTECTOMY SLEEVE B
|
Facility
|
IP
|
$83.23
|
|
| Hospital Charge Code |
96000050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$57.93 |
| Max. Negotiated Rate |
$74.91 |
| Rate for Payer: Aetna Commercial |
$70.75
|
| Rate for Payer: BCBS Trust/PPO |
$68.74
|
| Rate for Payer: BCN Commercial |
$68.74
|
| Rate for Payer: Cash Price |
$66.58
|
| Rate for Payer: Cofinity Commercial |
$71.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.58
|
| Rate for Payer: Healthscope Commercial |
$74.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.75
|
| Rate for Payer: Nomi Health Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.42
|
| Rate for Payer: PHP Commercial |
$70.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.24
|
| Rate for Payer: UHC Core |
$69.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.42
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
IP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$156.41 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: BCBS Trust/PPO |
$185.60
|
| Rate for Payer: BCN Commercial |
$185.60
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC POST MASTECTOMY SLEEVE C
|
Facility
|
OP
|
$224.73
|
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$202.26 |
| Rate for Payer: Aetna Commercial |
$191.02
|
| Rate for Payer: Aetna Medicare |
$58.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.23
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$56.18
|
| Rate for Payer: BCBS Trust/PPO |
$184.75
|
| Rate for Payer: BCN Commercial |
$184.75
|
| Rate for Payer: BCN Medicare Advantage |
$56.18
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cofinity Commercial |
$193.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.18
|
| Rate for Payer: Healthscope Commercial |
$202.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.55
|
| Rate for Payer: Mclaren Medicaid |
$39.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.99
|
| Rate for Payer: Meridian Medicaid |
$41.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$61.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.02
|
| Rate for Payer: Nomi Health Commercial |
$184.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.55
|
| Rate for Payer: PACE Senior Care Partners |
$53.37
|
| Rate for Payer: PACE SWMI |
$56.18
|
| Rate for Payer: PHP Commercial |
$191.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$195.52
|
| Rate for Payer: Priority Health Medicare |
$56.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.41
|
| Rate for Payer: Railroad Medicare Medicare |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.76
|
| Rate for Payer: UHC Core |
$187.65
|
| Rate for Payer: UHC Exchange |
$56.18
|
| Rate for Payer: UHC Medicaid |
$39.62
|
| Rate for Payer: UHC Medicare Advantage |
$56.18
|
| Rate for Payer: UHCCP Medicaid |
$39.62
|
| Rate for Payer: VA VA |
$56.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.55
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
OP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.12 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Aetna Commercial |
$217.55
|
| Rate for Payer: Aetna Medicare |
$66.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.98
|
| Rate for Payer: BCBS Complete |
$47.37
|
| Rate for Payer: BCBS MAPPO |
$63.98
|
| Rate for Payer: BCBS Trust/PPO |
$210.41
|
| Rate for Payer: BCN Commercial |
$210.41
|
| Rate for Payer: BCN Medicare Advantage |
$63.98
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Commercial |
$220.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.98
|
| Rate for Payer: Healthscope Commercial |
$230.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.96
|
| Rate for Payer: Mclaren Medicaid |
$45.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.18
|
| Rate for Payer: Meridian Medicaid |
$47.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$70.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Nomi Health Commercial |
$209.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: PACE Senior Care Partners |
$60.79
|
| Rate for Payer: PACE SWMI |
$63.98
|
| Rate for Payer: PHP Commercial |
$217.55
|
| Rate for Payer: PHP Medicare Advantage |
$63.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.67
|
| Rate for Payer: Priority Health Medicare |
$64.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.13
|
| Rate for Payer: Railroad Medicare Medicare |
$63.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.23
|
| Rate for Payer: UHC Core |
$213.71
|
| Rate for Payer: UHC Exchange |
$63.98
|
| Rate for Payer: UHC Medicaid |
$45.12
|
| Rate for Payer: UHC Medicare Advantage |
$63.98
|
| Rate for Payer: UHCCP Medicaid |
$45.12
|
| Rate for Payer: VA VA |
$63.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.96
|
|
|
HC POST MASTECTOMY SLEEVE D
|
Facility
|
IP
|
$255.94
|
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$178.13 |
| Max. Negotiated Rate |
$230.35 |
| Rate for Payer: Aetna Commercial |
$217.55
|
| Rate for Payer: BCBS Trust/PPO |
$211.38
|
| Rate for Payer: BCN Commercial |
$211.38
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cofinity Commercial |
$220.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$230.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.55
|
| Rate for Payer: Nomi Health Commercial |
$209.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.96
|
| Rate for Payer: PHP Commercial |
$217.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$222.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.23
|
| Rate for Payer: UHC Core |
$213.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.96
|
|
|
HC POST-OP
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.76
|
| Rate for Payer: BCBS Complete |
$3.41
|
| Rate for Payer: BCBS MAPPO |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$15.15
|
| Rate for Payer: BCN Medicare Advantage |
$4.61
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Mclaren Medicaid |
$3.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.84
|
| Rate for Payer: Meridian Medicaid |
$3.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.38
|
| Rate for Payer: PACE SWMI |
$4.61
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Medicare Advantage |
$4.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health Medicare |
$4.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$15.39
|
| Rate for Payer: UHC Exchange |
$4.61
|
| Rate for Payer: UHC Medicaid |
$3.25
|
| Rate for Payer: UHC Medicare Advantage |
$4.61
|
| Rate for Payer: UHCCP Medicaid |
$3.25
|
| Rate for Payer: VA VA |
$4.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
HC POST-OP
|
Facility
|
IP
|
$18.43
|
|
| Hospital Charge Code |
27000136
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: BCBS Trust/PPO |
$15.22
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$15.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
