|
HC SMRNP
|
Facility
|
OP
|
$35.87
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
30200435
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$32.28 |
| Rate for Payer: Aetna Commercial |
$30.49
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.21
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.49
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.90
|
| Rate for Payer: Mclaren Medicaid |
$6.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.49
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.21
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.57
|
| Rate for Payer: UHC Core |
$29.95
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.32
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.32
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.90
|
|
|
HC SNARE
|
Facility
|
OP
|
$1,315.02
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$1,183.52 |
| Rate for Payer: Aetna Commercial |
$1,117.77
|
| Rate for Payer: Aetna Medicare |
$341.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$410.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$410.94
|
| Rate for Payer: BCBS Complete |
$243.41
|
| Rate for Payer: BCBS MAPPO |
$328.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.08
|
| Rate for Payer: BCN Commercial |
$1,081.08
|
| Rate for Payer: BCN Medicare Advantage |
$328.75
|
| Rate for Payer: Cash Price |
$1,052.02
|
| Rate for Payer: Cofinity Commercial |
$1,130.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$328.75
|
| Rate for Payer: Healthscope Commercial |
$1,183.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.26
|
| Rate for Payer: Mclaren Medicaid |
$231.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.19
|
| Rate for Payer: Meridian Medicaid |
$243.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$361.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.77
|
| Rate for Payer: Nomi Health Commercial |
$1,078.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$986.26
|
| Rate for Payer: PACE Senior Care Partners |
$312.32
|
| Rate for Payer: PACE SWMI |
$328.75
|
| Rate for Payer: PHP Commercial |
$1,117.77
|
| Rate for Payer: PHP Medicare Advantage |
$328.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,144.07
|
| Rate for Payer: Priority Health Medicare |
$332.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$915.25
|
| Rate for Payer: Railroad Medicare Medicare |
$328.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.22
|
| Rate for Payer: UHC Core |
$1,098.04
|
| Rate for Payer: UHC Exchange |
$328.75
|
| Rate for Payer: UHC Medicaid |
$231.84
|
| Rate for Payer: UHC Medicare Advantage |
$328.75
|
| Rate for Payer: UHCCP Medicaid |
$231.84
|
| Rate for Payer: VA VA |
$328.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.26
|
|
|
HC SNARE
|
Facility
|
IP
|
$1,315.02
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$915.25 |
| Max. Negotiated Rate |
$1,183.52 |
| Rate for Payer: Aetna Commercial |
$1,117.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.08
|
| Rate for Payer: BCN Commercial |
$1,086.08
|
| Rate for Payer: Cash Price |
$1,052.02
|
| Rate for Payer: Cofinity Commercial |
$1,130.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,052.02
|
| Rate for Payer: Healthscope Commercial |
$1,183.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$986.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,117.77
|
| Rate for Payer: Nomi Health Commercial |
$1,078.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$986.26
|
| Rate for Payer: PHP Commercial |
$1,117.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,144.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$915.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,157.22
|
| Rate for Payer: UHC Core |
$1,098.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$986.26
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$17.96
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.74
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PACE Senior Care Partners |
$5.19
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Medicare |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Medicaid |
$3.85
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHCCP Medicaid |
$3.85
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$19.66 |
| Rate for Payer: Aetna Commercial |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.05
|
| Rate for Payer: BCN Commercial |
$18.05
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.39
|
| Rate for Payer: PHP Commercial |
$18.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.23
|
| Rate for Payer: UHC Core |
$18.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.39
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$21.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.63
|
| Rate for Payer: BCBS Complete |
$3.93
|
| Rate for Payer: BCBS MAPPO |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: BCN Medicare Advantage |
$5.31
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.31
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Mclaren Medicaid |
$3.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Meridian Medicaid |
$3.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.04
|
| Rate for Payer: PACE SWMI |
$5.31
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Medicare |
$5.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: UHC Exchange |
$5.31
|
| Rate for Payer: UHC Medicaid |
$3.74
|
| Rate for Payer: UHC Medicare Advantage |
$5.31
|
| Rate for Payer: UHCCP Medicaid |
$3.74
|
| Rate for Payer: VA VA |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC SODIUM LEVEL
|
Facility
|
IP
|
$21.23
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$18.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.98
|
| Rate for Payer: Healthscope Commercial |
$19.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.92
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.68
|
| Rate for Payer: UHC Core |
$17.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.92
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
IP
|
$22.07
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.36 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCN Commercial |
$18.23
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$18.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.42
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.55
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
OP
|
$22.07
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$19.86 |
| Rate for Payer: Aetna Commercial |
$18.76
|
| Rate for Payer: Aetna Medicare |
$5.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.90
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS MAPPO |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$18.14
|
| Rate for Payer: BCN Commercial |
$18.14
|
| Rate for Payer: BCN Medicare Advantage |
$5.52
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.52
|
| Rate for Payer: Healthscope Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.55
|
| Rate for Payer: Mclaren Medicaid |
$3.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.79
|
| Rate for Payer: Meridian Medicaid |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.76
|
| Rate for Payer: Nomi Health Commercial |
$18.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.55
|
| Rate for Payer: PACE Senior Care Partners |
$5.24
|
| Rate for Payer: PACE SWMI |
$5.52
|
| Rate for Payer: PHP Commercial |
$18.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.20
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.42
|
| Rate for Payer: UHC Core |
$18.43
|
| Rate for Payer: UHC Exchange |
$5.52
|
| Rate for Payer: UHC Medicaid |
$3.89
|
| Rate for Payer: UHC Medicare Advantage |
$5.52
|
| Rate for Payer: UHCCP Medicaid |
$3.89
|
| Rate for Payer: VA VA |
$5.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.55
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$35.89
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.51
|
| Rate for Payer: Aetna Medicare |
$9.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.22
|
| Rate for Payer: BCBS Complete |
$6.64
|
| Rate for Payer: BCBS MAPPO |
$8.97
|
| Rate for Payer: BCBS Trust/PPO |
$29.51
|
| Rate for Payer: BCN Commercial |
$29.51
|
| Rate for Payer: BCN Medicare Advantage |
$8.97
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Commercial |
$30.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.97
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.92
|
| Rate for Payer: Mclaren Medicaid |
$6.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.42
|
| Rate for Payer: Meridian Medicaid |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Nomi Health Commercial |
$29.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: PACE Senior Care Partners |
$8.52
|
| Rate for Payer: PACE SWMI |
$8.97
|
| Rate for Payer: PHP Commercial |
$30.51
|
| Rate for Payer: PHP Medicare Advantage |
$8.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.22
|
| Rate for Payer: Priority Health Medicare |
$9.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.58
|
| Rate for Payer: UHC Core |
$29.97
|
| Rate for Payer: UHC Exchange |
$8.97
|
| Rate for Payer: UHC Medicaid |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$8.97
|
| Rate for Payer: UHCCP Medicaid |
$6.33
|
| Rate for Payer: VA VA |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.92
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$35.89
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna Commercial |
$30.51
|
| Rate for Payer: BCBS Trust/PPO |
$29.64
|
| Rate for Payer: BCN Commercial |
$29.64
|
| Rate for Payer: Cash Price |
$28.71
|
| Rate for Payer: Cofinity Commercial |
$30.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.71
|
| Rate for Payer: Healthscope Commercial |
$32.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.51
|
| Rate for Payer: Nomi Health Commercial |
$29.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.92
|
| Rate for Payer: PHP Commercial |
$30.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$31.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.58
|
| Rate for Payer: UHC Core |
$29.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.92
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$199.09
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$179.18 |
| Rate for Payer: Aetna Commercial |
$169.23
|
| Rate for Payer: Aetna Medicare |
$51.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.22
|
| Rate for Payer: BCBS Complete |
$36.85
|
| Rate for Payer: BCBS MAPPO |
$49.77
|
| Rate for Payer: BCBS Trust/PPO |
$163.67
|
| Rate for Payer: BCN Commercial |
$163.67
|
| Rate for Payer: BCN Medicare Advantage |
$49.77
|
| Rate for Payer: Cash Price |
$159.27
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.77
|
| Rate for Payer: Healthscope Commercial |
$179.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.32
|
| Rate for Payer: Mclaren Medicaid |
$35.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.26
|
| Rate for Payer: Meridian Medicaid |
$36.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.23
|
| Rate for Payer: Nomi Health Commercial |
$163.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.32
|
| Rate for Payer: PACE Senior Care Partners |
$47.28
|
| Rate for Payer: PACE SWMI |
$49.77
|
| Rate for Payer: PHP Commercial |
$169.23
|
| Rate for Payer: PHP Medicare Advantage |
$49.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.21
|
| Rate for Payer: Priority Health Medicare |
$50.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.57
|
| Rate for Payer: Railroad Medicare Medicare |
$49.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.20
|
| Rate for Payer: UHC Core |
$166.24
|
| Rate for Payer: UHC Exchange |
$49.77
|
| Rate for Payer: UHC Medicaid |
$35.10
|
| Rate for Payer: UHC Medicare Advantage |
$49.77
|
| Rate for Payer: UHCCP Medicaid |
$35.10
|
| Rate for Payer: VA VA |
$49.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.32
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$199.09
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$138.57 |
| Max. Negotiated Rate |
$179.18 |
| Rate for Payer: Aetna Commercial |
$169.23
|
| Rate for Payer: BCBS Trust/PPO |
$164.43
|
| Rate for Payer: BCN Commercial |
$164.43
|
| Rate for Payer: Cash Price |
$159.27
|
| Rate for Payer: Cofinity Commercial |
$171.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.27
|
| Rate for Payer: Healthscope Commercial |
$179.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.23
|
| Rate for Payer: Nomi Health Commercial |
$163.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.32
|
| Rate for Payer: PHP Commercial |
$169.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$173.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.20
|
| Rate for Payer: UHC Core |
$166.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.32
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$164.77
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$114.68 |
| Max. Negotiated Rate |
$148.29 |
| Rate for Payer: Aetna Commercial |
$140.05
|
| Rate for Payer: BCBS Trust/PPO |
$136.08
|
| Rate for Payer: BCN Commercial |
$136.08
|
| Rate for Payer: Cash Price |
$131.82
|
| Rate for Payer: Cofinity Commercial |
$141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.82
|
| Rate for Payer: Healthscope Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.05
|
| Rate for Payer: Nomi Health Commercial |
$135.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.58
|
| Rate for Payer: PHP Commercial |
$140.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.00
|
| Rate for Payer: UHC Core |
$137.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.58
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$164.77
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$148.29 |
| Rate for Payer: Aetna Commercial |
$140.05
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.49
|
| Rate for Payer: BCBS Complete |
$30.50
|
| Rate for Payer: BCBS MAPPO |
$41.19
|
| Rate for Payer: BCBS Trust/PPO |
$135.46
|
| Rate for Payer: BCN Commercial |
$135.46
|
| Rate for Payer: BCN Medicare Advantage |
$41.19
|
| Rate for Payer: Cash Price |
$131.82
|
| Rate for Payer: Cofinity Commercial |
$141.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.19
|
| Rate for Payer: Healthscope Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.58
|
| Rate for Payer: Mclaren Medicaid |
$29.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.25
|
| Rate for Payer: Meridian Medicaid |
$30.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.05
|
| Rate for Payer: Nomi Health Commercial |
$135.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.58
|
| Rate for Payer: PACE Senior Care Partners |
$39.13
|
| Rate for Payer: PACE SWMI |
$41.19
|
| Rate for Payer: PHP Commercial |
$140.05
|
| Rate for Payer: PHP Medicare Advantage |
$41.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$143.35
|
| Rate for Payer: Priority Health Medicare |
$41.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.68
|
| Rate for Payer: Railroad Medicare Medicare |
$41.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.00
|
| Rate for Payer: UHC Core |
$137.58
|
| Rate for Payer: UHC Exchange |
$41.19
|
| Rate for Payer: UHC Medicaid |
$29.05
|
| Rate for Payer: UHC Medicare Advantage |
$41.19
|
| Rate for Payer: UHCCP Medicaid |
$29.05
|
| Rate for Payer: VA VA |
$41.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.58
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$169.81 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$207.38
|
| Rate for Payer: BCBS Trust/PPO |
$201.50
|
| Rate for Payer: BCN Commercial |
$201.50
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Commercial |
$209.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Nomi Health Commercial |
$200.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: PHP Commercial |
$207.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.70
|
| Rate for Payer: UHC Core |
$203.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.99
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$243.98
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$207.38
|
| Rate for Payer: Aetna Medicare |
$63.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.24
|
| Rate for Payer: BCBS Complete |
$45.16
|
| Rate for Payer: BCBS MAPPO |
$60.99
|
| Rate for Payer: BCBS Trust/PPO |
$200.58
|
| Rate for Payer: BCN Commercial |
$200.58
|
| Rate for Payer: BCN Medicare Advantage |
$60.99
|
| Rate for Payer: Cash Price |
$195.18
|
| Rate for Payer: Cofinity Commercial |
$209.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.99
|
| Rate for Payer: Healthscope Commercial |
$219.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.99
|
| Rate for Payer: Mclaren Medicaid |
$43.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.04
|
| Rate for Payer: Meridian Medicaid |
$45.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.38
|
| Rate for Payer: Nomi Health Commercial |
$200.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.99
|
| Rate for Payer: PACE Senior Care Partners |
$57.95
|
| Rate for Payer: PACE SWMI |
$60.99
|
| Rate for Payer: PHP Commercial |
$207.38
|
| Rate for Payer: PHP Medicare Advantage |
$60.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.26
|
| Rate for Payer: Priority Health Medicare |
$61.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.81
|
| Rate for Payer: Railroad Medicare Medicare |
$60.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.70
|
| Rate for Payer: UHC Core |
$203.72
|
| Rate for Payer: UHC Exchange |
$60.99
|
| Rate for Payer: UHC Medicaid |
$43.01
|
| Rate for Payer: UHC Medicare Advantage |
$60.99
|
| Rate for Payer: UHCCP Medicaid |
$43.01
|
| Rate for Payer: VA VA |
$60.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.99
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$55.65
|
| Rate for Payer: BCBS Trust/PPO |
$54.07
|
| Rate for Payer: BCN Commercial |
$54.07
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$56.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Healthscope Commercial |
$58.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Nomi Health Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: PHP Commercial |
$55.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.61
|
| Rate for Payer: UHC Core |
$54.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.10
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$65.47
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$58.92 |
| Rate for Payer: Aetna Commercial |
$55.65
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.46
|
| Rate for Payer: BCBS Complete |
$12.12
|
| Rate for Payer: BCBS MAPPO |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCN Commercial |
$53.82
|
| Rate for Payer: BCN Medicare Advantage |
$16.37
|
| Rate for Payer: Cash Price |
$52.38
|
| Rate for Payer: Cofinity Commercial |
$56.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.37
|
| Rate for Payer: Healthscope Commercial |
$58.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.10
|
| Rate for Payer: Mclaren Medicaid |
$11.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.19
|
| Rate for Payer: Meridian Medicaid |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.65
|
| Rate for Payer: Nomi Health Commercial |
$53.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.10
|
| Rate for Payer: PACE Senior Care Partners |
$15.55
|
| Rate for Payer: PACE SWMI |
$16.37
|
| Rate for Payer: PHP Commercial |
$55.65
|
| Rate for Payer: PHP Medicare Advantage |
$16.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$56.96
|
| Rate for Payer: Priority Health Medicare |
$16.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.57
|
| Rate for Payer: Railroad Medicare Medicare |
$16.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.61
|
| Rate for Payer: UHC Core |
$54.67
|
| Rate for Payer: UHC Exchange |
$16.37
|
| Rate for Payer: UHC Medicaid |
$11.54
|
| Rate for Payer: UHC Medicare Advantage |
$16.37
|
| Rate for Payer: UHCCP Medicaid |
$11.54
|
| Rate for Payer: VA VA |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.10
|
|
|
HC SOMATOMEDIN
|
Facility
|
IP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: BCBS Trust/PPO |
$46.45
|
| Rate for Payer: BCN Commercial |
$46.45
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$46.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.49
|
| Rate for Payer: UHC Core |
$46.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.18
|
|
|
HC SOMATOMEDIN
|
Facility
|
OP
|
$56.24
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$50.62 |
| Rate for Payer: Aetna Commercial |
$47.80
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.57
|
| Rate for Payer: BCBS Complete |
$10.41
|
| Rate for Payer: BCBS MAPPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$46.23
|
| Rate for Payer: BCN Commercial |
$46.23
|
| Rate for Payer: BCN Medicare Advantage |
$14.06
|
| Rate for Payer: Cash Price |
$44.99
|
| Rate for Payer: Cofinity Commercial |
$48.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.06
|
| Rate for Payer: Healthscope Commercial |
$50.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.18
|
| Rate for Payer: Mclaren Medicaid |
$9.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.76
|
| Rate for Payer: Meridian Medicaid |
$10.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.80
|
| Rate for Payer: Nomi Health Commercial |
$46.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.18
|
| Rate for Payer: PACE Senior Care Partners |
$13.36
|
| Rate for Payer: PACE SWMI |
$14.06
|
| Rate for Payer: PHP Commercial |
$47.80
|
| Rate for Payer: PHP Medicare Advantage |
$14.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$48.93
|
| Rate for Payer: Priority Health Medicare |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.49
|
| Rate for Payer: UHC Core |
$46.96
|
| Rate for Payer: UHC Exchange |
$14.06
|
| Rate for Payer: UHC Medicaid |
$9.92
|
| Rate for Payer: UHC Medicare Advantage |
$14.06
|
| Rate for Payer: UHCCP Medicaid |
$9.92
|
| Rate for Payer: VA VA |
$14.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.18
|
|
|
HC SOYBEAN IGE
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.79
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$21.29
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Medicaid |
$4.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PACE Senior Care Partners |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.79
|
| Rate for Payer: UHC Core |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.70 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: Aetna Medicare |
$1,604.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,927.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,927.99
|
| Rate for Payer: BCBS Complete |
$1,141.99
|
| Rate for Payer: BCBS MAPPO |
$1,542.39
|
| Rate for Payer: BCBS Trust/PPO |
$5,072.00
|
| Rate for Payer: BCN Commercial |
$5,072.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,542.39
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,542.39
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,627.18
|
| Rate for Payer: Mclaren Medicaid |
$1,087.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,619.51
|
| Rate for Payer: Meridian Medicaid |
$1,141.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,773.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,696.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: PACE Senior Care Partners |
$1,465.27
|
| Rate for Payer: PACE SWMI |
$1,542.39
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,542.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,087.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,367.53
|
| Rate for Payer: Priority Health Medicare |
$1,557.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,294.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,542.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,429.22
|
| Rate for Payer: UHC Core |
$5,151.59
|
| Rate for Payer: UHC Exchange |
$1,542.39
|
| Rate for Payer: UHC Medicaid |
$1,087.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,542.39
|
| Rate for Payer: UHCCP Medicaid |
$1,087.70
|
| Rate for Payer: VA VA |
$1,542.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,627.18
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,169.57
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,294.02 |
| Max. Negotiated Rate |
$5,552.61 |
| Rate for Payer: Aetna Commercial |
$5,244.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,095.45
|
| Rate for Payer: BCN Commercial |
$5,095.45
|
| Rate for Payer: Cash Price |
$4,935.66
|
| Rate for Payer: Cofinity Commercial |
$5,305.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,935.66
|
| Rate for Payer: Healthscope Commercial |
$5,552.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,627.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,244.13
|
| Rate for Payer: Nomi Health Commercial |
$5,059.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,627.18
|
| Rate for Payer: PHP Commercial |
$5,244.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,367.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,294.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,429.22
|
| Rate for Payer: UHC Core |
$5,151.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,627.18
|
|
