|
HC SNARE
|
Facility
|
OP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.19 |
| Max. Negotiated Rate |
$1,160.32 |
| Rate for Payer: Aetna Commercial |
$1,095.85
|
| Rate for Payer: Aetna Medicare |
$335.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$402.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$402.89
|
| Rate for Payer: BCBS Complete |
$515.70
|
| Rate for Payer: BCBS MAPPO |
$322.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.88
|
| Rate for Payer: BCN Commercial |
$1,002.38
|
| Rate for Payer: BCN Medicare Advantage |
$322.31
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,108.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.31
|
| Rate for Payer: Healthscope Commercial |
$1,160.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,057.18
|
| Rate for Payer: PACE Senior Care Partners |
$306.19
|
| Rate for Payer: PACE SWMI |
$322.31
|
| Rate for Payer: PHP Commercial |
$1,095.85
|
| Rate for Payer: PHP Medicare Advantage |
$322.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.64
|
| Rate for Payer: Priority Health Medicare |
$325.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.79
|
| Rate for Payer: Railroad Medicare Medicare |
$322.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.53
|
| Rate for Payer: UHC Core |
$1,076.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.31
|
| Rate for Payer: UHC Exchange |
$322.31
|
| Rate for Payer: UHC Medicare Advantage |
$322.31
|
| Rate for Payer: VA VA |
$322.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.93
|
|
|
HC SNARE
|
Facility
|
IP
|
$1,289.24
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.01 |
| Max. Negotiated Rate |
$1,160.32 |
| Rate for Payer: Aetna Commercial |
$1,095.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.41
|
| Rate for Payer: BCN Commercial |
$996.32
|
| Rate for Payer: Cash Price |
$1,031.39
|
| Rate for Payer: Cofinity Commercial |
$1,108.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,031.39
|
| Rate for Payer: Healthscope Commercial |
$1,160.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$966.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.85
|
| Rate for Payer: Nomi Health Commercial |
$1,057.18
|
| Rate for Payer: PHP Commercial |
$1,095.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.01
|
| Rate for Payer: Priority Health HMO/PPO |
$1,121.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,134.53
|
| Rate for Payer: UHC Core |
$1,076.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$966.93
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$17.49
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO |
$18.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.85
|
| Rate for Payer: UHC Core |
$17.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HC SODIUM BICARBONATE 4.2% SOL
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
63600214
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$19.28 |
| Rate for Payer: Aetna Commercial |
$18.21
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.69
|
| Rate for Payer: BCBS Complete |
$8.57
|
| Rate for Payer: BCBS MAPPO |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Medicare Advantage |
$5.36
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: PACE Senior Care Partners |
$5.09
|
| Rate for Payer: PACE SWMI |
$5.36
|
| Rate for Payer: PHP Commercial |
$18.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO |
$18.64
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.35
|
| Rate for Payer: Railroad Medicare Medicare |
$5.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.85
|
| Rate for Payer: UHC Core |
$17.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.36
|
| Rate for Payer: UHC Exchange |
$5.36
|
| Rate for Payer: UHC Medicare Advantage |
$5.36
|
| Rate for Payer: VA VA |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HC SODIUM LEVEL
|
Facility
|
IP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.08
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC SODIUM LEVEL
|
Facility
|
OP
|
$20.81
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
30100423
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$18.73 |
| Rate for Payer: Aetna Commercial |
$17.69
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.65
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.61
|
| Rate for Payer: Mclaren Medicaid |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.69
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health HMO/PPO |
$18.10
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.31
|
| Rate for Payer: UHC Core |
$17.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.20
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.48
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.61
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
IP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.07 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.66
|
| Rate for Payer: BCN Commercial |
$16.72
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO |
$18.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.04
|
| Rate for Payer: UHC Core |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.23
|
|
|
HC SODIUM OTHER SOURCE
|
Facility
|
OP
|
$21.64
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
30100555
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$5.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.76
|
| Rate for Payer: BCBS Complete |
$3.69
|
| Rate for Payer: BCBS MAPPO |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.79
|
| Rate for Payer: BCN Commercial |
$16.83
|
| Rate for Payer: BCN Medicare Advantage |
$5.41
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.41
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.23
|
| Rate for Payer: Mclaren Medicaid |
$3.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.68
|
| Rate for Payer: Meridian Medicaid |
$3.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Nomi Health Commercial |
$17.74
|
| Rate for Payer: PACE Senior Care Partners |
$5.14
|
| Rate for Payer: PACE SWMI |
$5.41
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Medicare Advantage |
$5.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO |
$18.83
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.04
|
| Rate for Payer: UHC Core |
$18.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.41
|
| Rate for Payer: UHC Exchange |
$5.41
|
| Rate for Payer: UHC Medicare Advantage |
$5.41
|
| Rate for Payer: UHCCP Medicaid |
$3.51
|
| Rate for Payer: VA VA |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.23
|
|
|
HC SODIUM URINE
|
Facility
|
IP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.87 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: BCBS Trust/PPO |
$28.73
|
| Rate for Payer: BCN Commercial |
$27.19
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Nomi Health Commercial |
$28.86
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health HMO/PPO |
$30.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$29.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.39
|
|
|
HC SODIUM URINE
|
Facility
|
OP
|
$35.19
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
30100424
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$31.67 |
| Rate for Payer: Aetna Commercial |
$29.91
|
| Rate for Payer: Aetna Medicare |
$9.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.00
|
| Rate for Payer: BCBS Complete |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.93
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: BCN Medicare Advantage |
$8.80
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cash Price |
$28.15
|
| Rate for Payer: Cofinity Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.39
|
| Rate for Payer: Mclaren Medicaid |
$3.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.24
|
| Rate for Payer: Meridian Medicaid |
$3.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.91
|
| Rate for Payer: Nomi Health Commercial |
$28.86
|
| Rate for Payer: PACE Senior Care Partners |
$8.36
|
| Rate for Payer: PACE SWMI |
$8.80
|
| Rate for Payer: PHP Commercial |
$29.91
|
| Rate for Payer: PHP Medicare Advantage |
$8.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.87
|
| Rate for Payer: Priority Health HMO/PPO |
$30.62
|
| Rate for Payer: Priority Health Medicare |
$8.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.97
|
| Rate for Payer: UHC Core |
$29.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.80
|
| Rate for Payer: UHC Exchange |
$8.80
|
| Rate for Payer: UHC Medicare Advantage |
$8.80
|
| Rate for Payer: UHCCP Medicaid |
$3.66
|
| Rate for Payer: VA VA |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.39
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
OP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$46.36 |
| Max. Negotiated Rate |
$175.67 |
| Rate for Payer: Aetna Commercial |
$165.91
|
| Rate for Payer: Aetna Medicare |
$50.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.00
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS MAPPO |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.47
|
| Rate for Payer: BCN Commercial |
$151.76
|
| Rate for Payer: BCN Medicare Advantage |
$48.80
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$167.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.80
|
| Rate for Payer: Healthscope Commercial |
$175.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: PACE Senior Care Partners |
$46.36
|
| Rate for Payer: PACE SWMI |
$48.80
|
| Rate for Payer: PHP Commercial |
$165.91
|
| Rate for Payer: PHP Medicare Advantage |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: Priority Health HMO/PPO |
$169.82
|
| Rate for Payer: Priority Health Medicare |
$49.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.78
|
| Rate for Payer: Railroad Medicare Medicare |
$48.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.77
|
| Rate for Payer: UHC Core |
$162.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.80
|
| Rate for Payer: UHC Exchange |
$48.80
|
| Rate for Payer: UHC Medicare Advantage |
$48.80
|
| Rate for Payer: VA VA |
$48.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.39
|
|
|
HC SOFTGOOD FOOT DROP PREVENT
|
Facility
|
IP
|
$195.19
|
|
| Hospital Charge Code |
27000148
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$175.67 |
| Rate for Payer: Aetna Commercial |
$165.91
|
| Rate for Payer: BCBS Trust/PPO |
$159.33
|
| Rate for Payer: BCN Commercial |
$150.84
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cofinity Commercial |
$167.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.15
|
| Rate for Payer: Healthscope Commercial |
$175.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.91
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: PHP Commercial |
$165.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.87
|
| Rate for Payer: Priority Health HMO/PPO |
$169.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.77
|
| Rate for Payer: UHC Core |
$162.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.39
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
OP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$145.39 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.48
|
| Rate for Payer: BCBS Complete |
$64.62
|
| Rate for Payer: BCBS MAPPO |
$40.38
|
| Rate for Payer: BCBS Trust/PPO |
$132.80
|
| Rate for Payer: BCN Commercial |
$125.60
|
| Rate for Payer: BCN Medicare Advantage |
$40.38
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$145.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: Nomi Health Commercial |
$132.46
|
| Rate for Payer: PACE Senior Care Partners |
$38.37
|
| Rate for Payer: PACE SWMI |
$40.38
|
| Rate for Payer: PHP Commercial |
$137.31
|
| Rate for Payer: PHP Medicare Advantage |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO |
$140.54
|
| Rate for Payer: Priority Health Medicare |
$40.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.23
|
| Rate for Payer: Railroad Medicare Medicare |
$40.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.16
|
| Rate for Payer: UHC Core |
$134.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.38
|
| Rate for Payer: UHC Exchange |
$40.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.38
|
| Rate for Payer: VA VA |
$40.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.16
|
|
|
HC SOFTGOOD HIP PILLOW ABD
|
Facility
|
IP
|
$161.54
|
|
| Hospital Charge Code |
27000149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$145.39 |
| Rate for Payer: Aetna Commercial |
$137.31
|
| Rate for Payer: BCBS Trust/PPO |
$131.87
|
| Rate for Payer: BCN Commercial |
$124.84
|
| Rate for Payer: Cash Price |
$129.23
|
| Rate for Payer: Cofinity Commercial |
$138.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.23
|
| Rate for Payer: Healthscope Commercial |
$145.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.31
|
| Rate for Payer: Nomi Health Commercial |
$132.46
|
| Rate for Payer: PHP Commercial |
$137.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO |
$140.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.16
|
| Rate for Payer: UHC Core |
$134.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.16
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
OP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$56.81 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$203.32
|
| Rate for Payer: Aetna Medicare |
$62.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.75
|
| Rate for Payer: BCBS Complete |
$95.68
|
| Rate for Payer: BCBS MAPPO |
$59.80
|
| Rate for Payer: BCBS Trust/PPO |
$196.65
|
| Rate for Payer: BCN Commercial |
$185.98
|
| Rate for Payer: BCN Medicare Advantage |
$59.80
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$205.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.80
|
| Rate for Payer: Healthscope Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: Nomi Health Commercial |
$196.14
|
| Rate for Payer: PACE Senior Care Partners |
$56.81
|
| Rate for Payer: PACE SWMI |
$59.80
|
| Rate for Payer: PHP Commercial |
$203.32
|
| Rate for Payer: PHP Medicare Advantage |
$59.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: Priority Health HMO/PPO |
$208.10
|
| Rate for Payer: Priority Health Medicare |
$60.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.26
|
| Rate for Payer: Railroad Medicare Medicare |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.50
|
| Rate for Payer: UHC Core |
$199.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.80
|
| Rate for Payer: UHC Exchange |
$59.80
|
| Rate for Payer: UHC Medicare Advantage |
$59.80
|
| Rate for Payer: VA VA |
$59.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.40
|
|
|
HC SOFTGOOD SHOULDER PILLOW ABD
|
Facility
|
IP
|
$239.20
|
|
| Hospital Charge Code |
27000150
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$155.48 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$203.32
|
| Rate for Payer: BCBS Trust/PPO |
$195.26
|
| Rate for Payer: BCN Commercial |
$184.85
|
| Rate for Payer: Cash Price |
$191.36
|
| Rate for Payer: Cofinity Commercial |
$205.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.36
|
| Rate for Payer: Healthscope Commercial |
$215.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.32
|
| Rate for Payer: Nomi Health Commercial |
$196.14
|
| Rate for Payer: PHP Commercial |
$203.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.48
|
| Rate for Payer: Priority Health HMO/PPO |
$208.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.50
|
| Rate for Payer: UHC Core |
$199.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.40
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
IP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: BCBS Trust/PPO |
$48.83
|
| Rate for Payer: BCN Commercial |
$46.23
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health HMO/PPO |
$52.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$49.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
|
|
HC SOLUBLE TRANSFERRIN RECEPTOR
|
Facility
|
OP
|
$59.82
|
|
|
Service Code
|
CPT 84238
|
| Hospital Charge Code |
30100631
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.85
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.69
|
| Rate for Payer: BCBS Complete |
$27.76
|
| Rate for Payer: BCBS MAPPO |
$14.96
|
| Rate for Payer: BCBS Trust/PPO |
$49.18
|
| Rate for Payer: BCN Commercial |
$46.51
|
| Rate for Payer: BCN Medicare Advantage |
$14.96
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cash Price |
$47.86
|
| Rate for Payer: Cofinity Commercial |
$51.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$53.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.86
|
| Rate for Payer: Mclaren Medicaid |
$26.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.70
|
| Rate for Payer: Meridian Medicaid |
$27.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.85
|
| Rate for Payer: Nomi Health Commercial |
$49.05
|
| Rate for Payer: PACE Senior Care Partners |
$14.21
|
| Rate for Payer: PACE SWMI |
$14.96
|
| Rate for Payer: PHP Commercial |
$50.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.88
|
| Rate for Payer: Priority Health HMO/PPO |
$52.04
|
| Rate for Payer: Priority Health Medicare |
$15.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.08
|
| Rate for Payer: Railroad Medicare Medicare |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.64
|
| Rate for Payer: UHC Core |
$49.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.96
|
| Rate for Payer: UHC Exchange |
$14.96
|
| Rate for Payer: UHC Medicare Advantage |
$14.96
|
| Rate for Payer: UHCCP Medicaid |
$26.44
|
| Rate for Payer: VA VA |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.86
|
|
|
HC SOMATOMEDIN
|
Facility
|
OP
|
$55.14
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.10 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.23
|
| Rate for Payer: BCBS Complete |
$16.14
|
| Rate for Payer: BCBS MAPPO |
$13.78
|
| Rate for Payer: BCBS Trust/PPO |
$45.33
|
| Rate for Payer: BCN Commercial |
$42.87
|
| Rate for Payer: BCN Medicare Advantage |
$13.78
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.78
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Mclaren Medicaid |
$15.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: Meridian Medicaid |
$16.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PACE Senior Care Partners |
$13.10
|
| Rate for Payer: PACE SWMI |
$13.78
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Medicare |
$13.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.78
|
| Rate for Payer: UHC Exchange |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$13.78
|
| Rate for Payer: UHCCP Medicaid |
$15.37
|
| Rate for Payer: VA VA |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC SOMATOMEDIN
|
Facility
|
IP
|
$55.14
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
30100425
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$49.63 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: BCBS Trust/PPO |
$45.01
|
| Rate for Payer: BCN Commercial |
$42.61
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Cofinity Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.11
|
| Rate for Payer: Healthscope Commercial |
$49.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.87
|
| Rate for Payer: Nomi Health Commercial |
$45.21
|
| Rate for Payer: PHP Commercial |
$46.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health HMO/PPO |
$47.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Core |
$46.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.36
|
|
|
HC SOYBEAN IGE
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC SOYBEAN IGE
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200062
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$3.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.77
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
IP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,931.59 |
| Max. Negotiated Rate |
$5,443.74 |
| Rate for Payer: Aetna Commercial |
$5,141.31
|
| Rate for Payer: BCBS Trust/PPO |
$4,937.47
|
| Rate for Payer: BCN Commercial |
$4,674.36
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Healthscope Commercial |
$5,443.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,536.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: PHP Commercial |
$5,141.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: Priority Health HMO/PPO |
$5,262.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,052.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,322.77
|
| Rate for Payer: UHC Core |
$5,050.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,536.45
|
|
|
HC SPACEOAR HYDROGEL
|
Facility
|
OP
|
$6,048.60
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
27800131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.54 |
| Max. Negotiated Rate |
$5,443.74 |
| Rate for Payer: Aetna Commercial |
$5,141.31
|
| Rate for Payer: Aetna Medicare |
$1,572.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,890.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,890.19
|
| Rate for Payer: BCBS Complete |
$2,419.44
|
| Rate for Payer: BCBS MAPPO |
$1,512.15
|
| Rate for Payer: BCBS Trust/PPO |
$4,972.55
|
| Rate for Payer: BCN Commercial |
$4,702.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,512.15
|
| Rate for Payer: Cash Price |
$4,838.88
|
| Rate for Payer: Cofinity Commercial |
$5,201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,838.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,512.15
|
| Rate for Payer: Healthscope Commercial |
$5,443.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,536.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,587.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,738.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,141.31
|
| Rate for Payer: Nomi Health Commercial |
$4,959.85
|
| Rate for Payer: PACE Senior Care Partners |
$1,436.54
|
| Rate for Payer: PACE SWMI |
$1,512.15
|
| Rate for Payer: PHP Commercial |
$5,141.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,512.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,931.59
|
| Rate for Payer: Priority Health HMO/PPO |
$5,262.28
|
| Rate for Payer: Priority Health Medicare |
$1,527.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,052.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,512.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,322.77
|
| Rate for Payer: UHC Core |
$5,050.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,512.15
|
| Rate for Payer: UHC Exchange |
$1,512.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,512.15
|
| Rate for Payer: VA VA |
$1,512.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,536.45
|
|
|
HC SP ANGIOGRAPHY RENAL BIL
|
Facility
|
IP
|
$3,849.48
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
36100348
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,502.16 |
| Max. Negotiated Rate |
$3,464.53 |
| Rate for Payer: Aetna Commercial |
$3,272.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,142.33
|
| Rate for Payer: BCN Commercial |
$2,974.88
|
| Rate for Payer: Cash Price |
$3,079.58
|
| Rate for Payer: Cofinity Commercial |
$3,310.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,079.58
|
| Rate for Payer: Healthscope Commercial |
$3,464.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,887.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,272.06
|
| Rate for Payer: Nomi Health Commercial |
$3,156.57
|
| Rate for Payer: PHP Commercial |
$3,272.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,502.16
|
| Rate for Payer: Priority Health HMO/PPO |
$3,349.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,579.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,387.54
|
| Rate for Payer: UHC Core |
$3,214.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,887.11
|
|
