|
HC POC UA DIPSTICK, MANUAL
|
Facility
|
IP
|
$12.48
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
30700013
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$11.23 |
| Rate for Payer: Aetna Commercial |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.19
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.61
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Core |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.36
|
|
|
HC POC UREA NITROGEN
|
Facility
|
IP
|
$15.77
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCN Commercial |
$12.19
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Nomi Health Commercial |
$12.93
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health HMO/PPO |
$13.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
HC POC UREA NITROGEN
|
Facility
|
OP
|
$15.77
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
30100698
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$14.19 |
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.93
|
| Rate for Payer: BCBS Complete |
$3.00
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| Rate for Payer: BCN Commercial |
$12.26
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Medicaid |
$3.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Nomi Health Commercial |
$12.93
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.25
|
| Rate for Payer: Priority Health HMO/PPO |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$3.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$13.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.94
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$3.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
|
|
HC POC URINE PREG TEST
|
Facility
|
OP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$6.54
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: BCCCP Commercial |
$8.61
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Mclaren Medicaid |
$6.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: Meridian Medicaid |
$6.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PACE Senior Care Partners |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Medicare |
$7.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Exchange |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.28
|
| Rate for Payer: UHCCP Medicaid |
$6.23
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC POC URINE PREG TEST
|
Facility
|
IP
|
$29.13
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
30000174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$26.22 |
| Rate for Payer: Aetna Commercial |
$24.76
|
| Rate for Payer: BCBS Trust/PPO |
$23.78
|
| Rate for Payer: BCN Commercial |
$22.51
|
| Rate for Payer: Cash Price |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.30
|
| Rate for Payer: Healthscope Commercial |
$26.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.93
|
| Rate for Payer: Priority Health HMO/PPO |
$25.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.63
|
| Rate for Payer: UHC Core |
$24.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.85
|
|
|
HC POC WET PREP
|
Facility
|
OP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.03
|
| Rate for Payer: BCBS Complete |
$4.42
|
| Rate for Payer: BCBS MAPPO |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$42.18
|
| Rate for Payer: BCN Commercial |
$39.89
|
| Rate for Payer: BCN Medicare Advantage |
$12.83
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.83
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Mclaren Medicaid |
$4.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.47
|
| Rate for Payer: Meridian Medicaid |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PACE Senior Care Partners |
$12.19
|
| Rate for Payer: PACE SWMI |
$12.83
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$12.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Medicare |
$12.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: Railroad Medicare Medicare |
$12.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.83
|
| Rate for Payer: UHC Exchange |
$12.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.83
|
| Rate for Payer: UHCCP Medicaid |
$4.21
|
| Rate for Payer: VA VA |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC POC WET PREP
|
Facility
|
IP
|
$51.31
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
30600342
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$46.18 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: BCBS Trust/PPO |
$41.88
|
| Rate for Payer: BCN Commercial |
$39.65
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cofinity Commercial |
$44.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.05
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.61
|
| Rate for Payer: Nomi Health Commercial |
$42.07
|
| Rate for Payer: PHP Commercial |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO |
$44.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.15
|
| Rate for Payer: UHC Core |
$42.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.48
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
IP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: BCBS Trust/PPO |
$223.80
|
| Rate for Payer: BCN Commercial |
$211.88
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health HMO/PPO |
$238.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.27
|
| Rate for Payer: UHC Core |
$228.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
HC POLARCATH N.O. CARTRIDGE
|
Facility
|
OP
|
$274.17
|
|
| Hospital Charge Code |
27200148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$246.75 |
| Rate for Payer: Aetna Commercial |
$233.04
|
| Rate for Payer: Aetna Medicare |
$71.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.68
|
| Rate for Payer: BCBS Complete |
$109.67
|
| Rate for Payer: BCBS MAPPO |
$68.54
|
| Rate for Payer: BCBS Trust/PPO |
$225.40
|
| Rate for Payer: BCN Commercial |
$213.17
|
| Rate for Payer: BCN Medicare Advantage |
$68.54
|
| Rate for Payer: Cash Price |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$235.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.04
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: PACE Senior Care Partners |
$65.12
|
| Rate for Payer: PACE SWMI |
$68.54
|
| Rate for Payer: PHP Commercial |
$233.04
|
| Rate for Payer: PHP Medicare Advantage |
$68.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.21
|
| Rate for Payer: Priority Health HMO/PPO |
$238.53
|
| Rate for Payer: Priority Health Medicare |
$69.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.69
|
| Rate for Payer: Railroad Medicare Medicare |
$68.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.27
|
| Rate for Payer: UHC Core |
$228.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.54
|
| Rate for Payer: UHC Exchange |
$68.54
|
| Rate for Payer: UHC Medicare Advantage |
$68.54
|
| Rate for Payer: VA VA |
$68.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.63
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
IP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: BCBS Trust/PPO |
$35.50
|
| Rate for Payer: BCN Commercial |
$33.61
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: Nomi Health Commercial |
$35.66
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health HMO/PPO |
$37.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.27
|
| Rate for Payer: UHC Core |
$36.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
HC POLIOVIRUS VACCINE, INACTIVATED (IPV) SUBQ/IM
|
Facility
|
OP
|
$43.49
|
|
|
Service Code
|
CPT 90713
|
| Hospital Charge Code |
63600082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$39.14 |
| Rate for Payer: Aetna Commercial |
$36.97
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.59
|
| Rate for Payer: BCBS Complete |
$17.40
|
| Rate for Payer: BCBS MAPPO |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$35.75
|
| Rate for Payer: BCN Commercial |
$33.81
|
| Rate for Payer: BCN Medicare Advantage |
$10.87
|
| Rate for Payer: Cash Price |
$34.79
|
| Rate for Payer: Cofinity Commercial |
$37.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.87
|
| Rate for Payer: Healthscope Commercial |
$39.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.97
|
| Rate for Payer: Nomi Health Commercial |
$35.66
|
| Rate for Payer: PACE Senior Care Partners |
$10.33
|
| Rate for Payer: PACE SWMI |
$10.87
|
| Rate for Payer: PHP Commercial |
$36.97
|
| Rate for Payer: PHP Medicare Advantage |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.27
|
| Rate for Payer: Priority Health HMO/PPO |
$37.84
|
| Rate for Payer: Priority Health Medicare |
$10.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.27
|
| Rate for Payer: UHC Core |
$36.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.87
|
| Rate for Payer: UHC Exchange |
$10.87
|
| Rate for Payer: UHC Medicare Advantage |
$10.87
|
| Rate for Payer: VA VA |
$10.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.62
|
|
|
HC POLYPECTOMY
|
Facility
|
OP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: Aetna Medicare |
$138.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.02
|
| Rate for Payer: BCBS Complete |
$213.79
|
| Rate for Payer: BCBS MAPPO |
$133.62
|
| Rate for Payer: BCBS Trust/PPO |
$439.39
|
| Rate for Payer: BCN Commercial |
$415.55
|
| Rate for Payer: BCN Medicare Advantage |
$133.62
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.62
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$153.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: Nomi Health Commercial |
$438.27
|
| Rate for Payer: PACE Senior Care Partners |
$126.94
|
| Rate for Payer: PACE SWMI |
$133.62
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: PHP Medicare Advantage |
$133.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health HMO/PPO |
$464.99
|
| Rate for Payer: Priority Health Medicare |
$134.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.09
|
| Rate for Payer: Railroad Medicare Medicare |
$133.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.33
|
| Rate for Payer: UHC Core |
$446.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.62
|
| Rate for Payer: UHC Exchange |
$133.62
|
| Rate for Payer: UHC Medicare Advantage |
$133.62
|
| Rate for Payer: VA VA |
$133.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.85
|
|
|
HC POLYPECTOMY
|
Facility
|
IP
|
$534.47
|
|
| Hospital Charge Code |
36000080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.41 |
| Max. Negotiated Rate |
$481.02 |
| Rate for Payer: Aetna Commercial |
$454.30
|
| Rate for Payer: BCBS Trust/PPO |
$436.29
|
| Rate for Payer: BCN Commercial |
$413.04
|
| Rate for Payer: Cash Price |
$427.58
|
| Rate for Payer: Cofinity Commercial |
$459.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.58
|
| Rate for Payer: Healthscope Commercial |
$481.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$400.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.30
|
| Rate for Payer: Nomi Health Commercial |
$438.27
|
| Rate for Payer: PHP Commercial |
$454.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.41
|
| Rate for Payer: Priority Health HMO/PPO |
$464.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.33
|
| Rate for Payer: UHC Core |
$446.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$400.85
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
OP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.40 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: Aetna Medicare |
$47.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.10
|
| Rate for Payer: BCBS Complete |
$73.09
|
| Rate for Payer: BCBS MAPPO |
$45.68
|
| Rate for Payer: BCBS Trust/PPO |
$150.22
|
| Rate for Payer: BCN Commercial |
$142.07
|
| Rate for Payer: BCN Medicare Advantage |
$45.68
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: Nomi Health Commercial |
$149.84
|
| Rate for Payer: PACE Senior Care Partners |
$43.40
|
| Rate for Payer: PACE SWMI |
$45.68
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: PHP Medicare Advantage |
$45.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health HMO/PPO |
$158.98
|
| Rate for Payer: Priority Health Medicare |
$46.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.43
|
| Rate for Payer: Railroad Medicare Medicare |
$45.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.80
|
| Rate for Payer: UHC Core |
$152.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.68
|
| Rate for Payer: UHC Exchange |
$45.68
|
| Rate for Payer: UHC Medicare Advantage |
$45.68
|
| Rate for Payer: VA VA |
$45.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.05
|
|
|
HC POLYPECTOMY ADDL 45 MIN OR MORE
|
Facility
|
IP
|
$182.73
|
|
| Hospital Charge Code |
36000004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.77 |
| Max. Negotiated Rate |
$164.46 |
| Rate for Payer: Aetna Commercial |
$155.32
|
| Rate for Payer: BCBS Trust/PPO |
$149.16
|
| Rate for Payer: BCN Commercial |
$141.21
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$157.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.18
|
| Rate for Payer: Healthscope Commercial |
$164.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.32
|
| Rate for Payer: Nomi Health Commercial |
$149.84
|
| Rate for Payer: PHP Commercial |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.77
|
| Rate for Payer: Priority Health HMO/PPO |
$158.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.80
|
| Rate for Payer: UHC Core |
$152.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.05
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
OP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: Aetna Medicare |
$8.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.40
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: BCBS MAPPO |
$8.32
|
| Rate for Payer: BCBS Trust/PPO |
$27.37
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Medicare Advantage |
$8.32
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Mclaren Medicaid |
$10.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.74
|
| Rate for Payer: Meridian Medicaid |
$11.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.91
|
| Rate for Payer: PACE SWMI |
$8.32
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$28.96
|
| Rate for Payer: Priority Health Medicare |
$8.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.30
|
| Rate for Payer: Railroad Medicare Medicare |
$8.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.30
|
| Rate for Payer: UHC Core |
$27.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.32
|
| Rate for Payer: UHC Exchange |
$8.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.32
|
| Rate for Payer: UHCCP Medicaid |
$10.64
|
| Rate for Payer: VA VA |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
HC PORPHYRIN URINE QUANTITATIVE
|
Facility
|
IP
|
$33.29
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
30100395
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$29.96 |
| Rate for Payer: Aetna Commercial |
$28.30
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: BCN Commercial |
$25.73
|
| Rate for Payer: Cash Price |
$26.63
|
| Rate for Payer: Cofinity Commercial |
$28.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.63
|
| Rate for Payer: Healthscope Commercial |
$29.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.30
|
| Rate for Payer: Nomi Health Commercial |
$27.30
|
| Rate for Payer: PHP Commercial |
$28.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$28.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.30
|
| Rate for Payer: UHC Core |
$27.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.97
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
OP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.88
|
| Rate for Payer: BCBS Complete |
$6.41
|
| Rate for Payer: BCBS MAPPO |
$7.90
|
| Rate for Payer: BCBS Trust/PPO |
$25.99
|
| Rate for Payer: BCN Commercial |
$24.58
|
| Rate for Payer: BCN Medicare Advantage |
$7.90
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Mclaren Medicaid |
$6.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.30
|
| Rate for Payer: Meridian Medicaid |
$6.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.90
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.90
|
| Rate for Payer: UHC Exchange |
$7.90
|
| Rate for Payer: UHC Medicare Advantage |
$7.90
|
| Rate for Payer: UHCCP Medicaid |
$6.10
|
| Rate for Payer: VA VA |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC PORPHYRIN URINE QUANTITATIVE C
|
Facility
|
IP
|
$31.62
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
30100394
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Aetna Commercial |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.81
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: Cash Price |
$25.30
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.30
|
| Rate for Payer: Healthscope Commercial |
$28.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.88
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: PHP Commercial |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.55
|
| Rate for Payer: Priority Health HMO/PPO |
$27.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Core |
$26.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.72
|
|
|
HC PORTAL FILMS
|
Facility
|
OP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$63.50 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: Aetna Medicare |
$69.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.56
|
| Rate for Payer: BCBS Complete |
$106.95
|
| Rate for Payer: BCBS MAPPO |
$66.84
|
| Rate for Payer: BCBS Trust/PPO |
$219.81
|
| Rate for Payer: BCN Commercial |
$207.89
|
| Rate for Payer: BCN Medicare Advantage |
$66.84
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.84
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: PACE Senior Care Partners |
$63.50
|
| Rate for Payer: PACE SWMI |
$66.84
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: PHP Medicare Advantage |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health HMO/PPO |
$232.62
|
| Rate for Payer: Priority Health Medicare |
$67.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.14
|
| Rate for Payer: Railroad Medicare Medicare |
$66.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.29
|
| Rate for Payer: UHC Core |
$223.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.84
|
| Rate for Payer: UHC Exchange |
$66.84
|
| Rate for Payer: UHC Medicare Advantage |
$66.84
|
| Rate for Payer: VA VA |
$66.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
|
|
HC PORTAL FILMS
|
Facility
|
IP
|
$267.38
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$240.64 |
| Rate for Payer: Aetna Commercial |
$227.27
|
| Rate for Payer: BCBS Trust/PPO |
$218.26
|
| Rate for Payer: BCN Commercial |
$206.63
|
| Rate for Payer: Cash Price |
$213.90
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.90
|
| Rate for Payer: Healthscope Commercial |
$240.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.27
|
| Rate for Payer: Nomi Health Commercial |
$219.25
|
| Rate for Payer: PHP Commercial |
$227.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.80
|
| Rate for Payer: Priority Health HMO/PPO |
$232.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.29
|
| Rate for Payer: UHC Core |
$223.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.54
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
IP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$498.14 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: BCBS Trust/PPO |
$451.81
|
| Rate for Payer: BCN Commercial |
$427.74
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Healthscope Commercial |
$498.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PHP Commercial |
$470.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health HMO/PPO |
$481.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.07
|
| Rate for Payer: UHC Core |
$462.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.12
|
|
|
HC PORT PLAN, TOTAL BODY
|
Facility
|
OP
|
$553.49
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$498.14 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Aetna Medicare |
$143.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$172.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$172.97
|
| Rate for Payer: BCBS Complete |
$272.30
|
| Rate for Payer: BCBS MAPPO |
$138.37
|
| Rate for Payer: BCBS Trust/PPO |
$455.02
|
| Rate for Payer: BCN Commercial |
$430.34
|
| Rate for Payer: BCN Medicare Advantage |
$138.37
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cash Price |
$442.79
|
| Rate for Payer: Cofinity Commercial |
$476.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$442.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.37
|
| Rate for Payer: Healthscope Commercial |
$498.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$415.12
|
| Rate for Payer: Mclaren Medicaid |
$259.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.29
|
| Rate for Payer: Meridian Medicaid |
$272.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$159.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.47
|
| Rate for Payer: Nomi Health Commercial |
$453.86
|
| Rate for Payer: PACE Senior Care Partners |
$131.45
|
| Rate for Payer: PACE SWMI |
$138.37
|
| Rate for Payer: PHP Commercial |
$470.47
|
| Rate for Payer: PHP Medicare Advantage |
$138.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.77
|
| Rate for Payer: Priority Health HMO/PPO |
$481.54
|
| Rate for Payer: Priority Health Medicare |
$139.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$370.84
|
| Rate for Payer: Railroad Medicare Medicare |
$138.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.07
|
| Rate for Payer: UHC Core |
$462.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.37
|
| Rate for Payer: UHC Exchange |
$138.37
|
| Rate for Payer: UHC Medicare Advantage |
$138.37
|
| Rate for Payer: UHCCP Medicaid |
$259.32
|
| Rate for Payer: VA VA |
$138.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$415.12
|
|
|
HC POSLUMA PER MCI
|
Facility
|
OP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$386.92 |
| Max. Negotiated Rate |
$1,466.22 |
| Rate for Payer: Aetna Commercial |
$1,384.76
|
| Rate for Payer: Aetna Medicare |
$423.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$509.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$509.10
|
| Rate for Payer: BCBS Complete |
$494.75
|
| Rate for Payer: BCBS MAPPO |
$407.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.31
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$407.28
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,401.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.28
|
| Rate for Payer: Healthscope Commercial |
$1,466.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,221.85
|
| Rate for Payer: Mclaren Medicaid |
$471.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.65
|
| Rate for Payer: Meridian Medicaid |
$494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$468.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: PACE Senior Care Partners |
$386.92
|
| Rate for Payer: PACE SWMI |
$407.28
|
| Rate for Payer: PHP Commercial |
$1,384.76
|
| Rate for Payer: PHP Medicare Advantage |
$407.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,417.34
|
| Rate for Payer: Priority Health Medicare |
$411.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.52
|
| Rate for Payer: Railroad Medicare Medicare |
$407.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,433.63
|
| Rate for Payer: UHC Core |
$1,360.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.28
|
| Rate for Payer: UHC Exchange |
$407.28
|
| Rate for Payer: UHC Medicare Advantage |
$407.28
|
| Rate for Payer: UHCCP Medicaid |
$471.16
|
| Rate for Payer: VA VA |
$407.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,221.85
|
|
|
HC POSLUMA PER MCI
|
Facility
|
IP
|
$1,629.13
|
|
|
Service Code
|
HCPCS A9608
|
| Hospital Charge Code |
34300038
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,058.93 |
| Max. Negotiated Rate |
$1,466.22 |
| Rate for Payer: Aetna Commercial |
$1,384.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,329.86
|
| Rate for Payer: BCN Commercial |
$1,258.99
|
| Rate for Payer: Cash Price |
$1,303.30
|
| Rate for Payer: Cofinity Commercial |
$1,401.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,303.30
|
| Rate for Payer: Healthscope Commercial |
$1,466.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,221.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.76
|
| Rate for Payer: Nomi Health Commercial |
$1,335.89
|
| Rate for Payer: PHP Commercial |
$1,384.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.93
|
| Rate for Payer: Priority Health HMO/PPO |
$1,417.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,091.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,433.63
|
| Rate for Payer: UHC Core |
$1,360.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,221.85
|
|
